Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, MS B-158, Aurora, CO, 80045, USA,
Dig Dis Sci. 2013 Oct;58(10):2809-16. doi: 10.1007/s10620-013-2740-8. Epub 2013 Jul 11.
Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. Primary care providers (PCPs), in contrast to gastroenterology/hepatology (GI/Hep) providers, are the first medical contact for the majority of patients with, or at risk for, NAFLD. PCP awareness of and facility with NAFLD is critical for management of these patients.
The purpose of this study was to assess understanding and practice patterns of PCPs and non-GI/Hep subspecialty providers with respect to the diagnosis and management of NAFLD.
We administered an online, 61-question survey to 479 providers in internal medicine, family medicine, endocrinology, cardiology, and obstetrics and gynecology (ObGyn) across three health systems: academic medical center, safety-net health system and managed care health system.
There were 246 respondents (51 %), with the majority (87 %) being PCPs (internal medicine, family medicine, ObGyn). Only 31 % of providers identified NAFLD as a clinically important diagnosis in their practice. Although 65 % of providers reported some degree of facility in diagnosing NAFLD, less than half (47 %) were comfortable managing NAFLD. Only 33 % refer patients with suspected NAFLD to GI/Hep. Subspecialists in endocrinology and cardiology reported greater clinical concern over NAFLD and were more likely (67 %) to refer patients with suspected NAFLD to GI/Hep.
The majority of providers do not identify NAFLD as a clinically important diagnosis and do not refer to GI/Hep. However, 83 % expressed a need for education on NAFLD. Our data reveal practice gaps within NAFLD care and identify opportunities for targeted education to guide PCPs in the evaluation and management of NAFLD.
非酒精性脂肪性肝病（NAFLD）是慢性肝病的主要原因。与胃肠病学/肝脏病学（GI/Hep）医生相比，初级保健医生（PCP）是大多数患有或有患 NAFLD 风险的患者的首要医疗联系人。PCP 对 NAFLD 的认识和处理能力对于这些患者的管理至关重要。
本研究旨在评估 PCP 和非 GI/Hep 亚专科医生在诊断和管理 NAFLD 方面的理解和实践模式。
我们向三个医疗系统（学术医疗中心、保障医疗系统和管理式医疗系统）的内科、家庭医学、内分泌学、心脏病学和妇产科（ObGyn）的 479 名医生进行了一项在线、61 个问题的调查。
共有 246 名医生（51%）回复，其中大多数（87%）是 PCP（内科、家庭医学、ObGyn）。只有 31%的医生认为 NAFLD 是他们实践中的一个重要临床诊断。尽管 65%的医生表示在诊断 NAFLD 方面有一定程度的熟练程度，但只有不到一半（47%）的医生对管理 NAFLD 感到舒适。只有 33%的医生会将疑似 NAFLD 患者转介给 GI/Hep。内分泌学和心脏病学的专家表示对 NAFLD 的临床关注更多，并且更有可能（67%）将疑似 NAFLD 患者转介给 GI/Hep。
大多数医生并不认为 NAFLD 是一个重要的临床诊断，也不会转介给 GI/Hep。然而，83%的医生表示需要关于 NAFLD 的教育。我们的数据揭示了 NAFLD 治疗中的实践差距，并确定了有针对性的教育机会，以指导 PCP 评估和管理 NAFLD。
