Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Diabet Med. 2022 Jun;39(6):e14799. doi: 10.1111/dme.14799. Epub 2022 Feb 7.
We explored barriers and facilitators to the implementation of nonalcoholic fatty liver disease (NAFLD) pathway for people with diabetes to identify determinants of behaviour surrounding the diagnosis, assessment and management of NAFLD.
Health practitioners (n = 24) recruited from multidisciplinary diabetes clinics in primary care (n = 3) and hospital (n = 1) settings participated in four focus group discussions, and common themes were identified using thematic analysis.
Lack of knowledge and access to resources were key factors that underpinned an inconsistent approach by clinicians to NAFLD diagnosis and risk stratification and impacted their confidence to discuss the diagnosis with patients. Participants often prioritised other medical issues above NAFLD due to lack of concern about liver-related consequences, reluctance to overburden patients with information, lack of time and perceived absence of accessible fibrosis tests. All participants agreed that implementation of a NAFLD pathway would improve patient care and the general practitioners proposed that screening for NAFLD could be incorporated into routine review cycles for type 2 diabetes. A consistent message from participants was that educating patients about their liver disease needs to be implemented in an integrated care pathway.
From the perspectives of health practitioners, there is a gap in clinical practice for the implementation of clear, evidence-based guidelines for NAFLD in people with T2D. By focusing on comorbidity prevention and integrating NAFLD as a diabetes complication to be addressed during established cycles of care, many barriers to implementing a NAFLD pathway in primary care could be overcome.
我们探讨了实施非酒精性脂肪性肝病（NAFLD）途径的障碍和促进因素，以确定围绕 NAFLD 的诊断、评估和管理行为的决定因素。
从初级保健的多学科糖尿病诊所（n=3）和医院（n=1）招募的卫生保健从业者（n=24）参加了 4 次焦点小组讨论，使用主题分析确定了共同的主题。
缺乏知识和获取资源是临床医生对 NAFLD 诊断和风险分层方法不一致的关键因素，这影响了他们与患者讨论诊断的信心。由于对肝脏相关后果缺乏关注、不愿给患者带来过多信息负担、缺乏时间和认为无法获得可用的纤维化检测，参与者通常将其他医疗问题置于 NAFLD 之上。所有参与者都同意实施 NAFLD 途径将改善患者护理，全科医生建议可以将 NAFLD 的筛查纳入 2 型糖尿病的常规审查周期。参与者的一致意见是，需要在综合护理途径中实施关于患者肝脏疾病的教育。
从卫生保健从业者的角度来看，在 T2D 患者中实施明确、基于证据的 NAFLD 指南的临床实践存在差距。通过关注共病预防，并将 NAFLD 整合为在既定护理周期中需要解决的糖尿病并发症，可以克服在初级保健中实施 NAFLD 途径的许多障碍。
