Pharmacist-led screening for advanced fibrosis using the FIB-4 index in patients 65 years or older with a clinical suspicion for MASLD at a family medicine clinic

Purpose Metabolic dysfunction–associated steatotic liver disease (MASLD) describes cardiometabolic-associated liver disease ranging from steatosis to cirrhosis. Less than 5% of patients with MASLD have disease awareness, and untreated MASLD may lead to complications including death. Guideline recommendations to screen for advanced fibrosis utilizing the fibrosis-4 (FIB-4) index are new, and adoption of these recommendations will take time. This study represents the first investigation into the implementation of primary care–based MASLD screening using the FIB-4 index. Methods A single-center, retrospective screening analysis assessed a pharmacist’s impact on MASLD-related fibrosis screening and management in primary care. Data collection was performed for adults 65 years of age or older seen by the pharmacist for an annual wellness visit from April 2022 to October 2023. Patients with a clinical suspicion for MASLD underwent screening for advanced fibrosis using the FIB-4 index. The primary outcomes were the number of patients in each risk category and subsequent intervention. Results Of the 577 patients reviewed, 265 showed a clinical suspicion for MASLD and underwent further screening for advanced fibrosis. Of these, 224 (84.5%) patients were identified as low risk, 26 (9.8%) patients were identified as moderate risk and qualified for secondary assessment, and 15 (5.7%) patients were identified as high risk and received a referral for a hepatologist. Across all risk categories, 134 (51.0%) patients qualified for additional pharmacotherapy. Conclusion Pharmacist-led FIB-4 screening allowed the pharmacist to identify and subsequently provide appropriate pharmacotherapy recommendations for older adults with elevated risk for advanced fibrosis. Pharmacists providing annual wellness visits or chronic disease management are well positioned to provide screening, education, and treatment recommendations for MASLD.