Lee-Kim Victoria, Morkem Rachael, Barber David, Flemming Jennifer A, Kehar Mohit
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Paediatr Child Health. 2021 Aug 27;27(2):93-98. doi: 10.1093/pch/pxab057. eCollection 2022 May.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. Primary-care physicians (PCPs) play a key role in identifying patients requiring specialist referral. In this study, we aim to determine PCPs' practice patterns for paediatric NAFLD, as knowledge gaps have been reported for adult NAFLD.
A survey was sent to 60 PCPs in the Eastern Ontario Network from July 2019 to January 2020.
Thirty-seven (62%) PCPs responded to the survey. Twenty-one incorrectly considered the prevalence of paediatric NAFLD to be ≤10%. The majority (35/36) cared for less than five paediatric NAFLD patients. Thirty-four (92%) were only 'slightly familiar' or 'not familiar at all' with paediatric NAFLD. Only one PCP routinely screens for NAFLD. Only one PCP was aware of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) clinical guidelines for paediatric NAFLD. Twenty-five (68%) correctly selected lifestyle modifications as a treatment option. Lack of confidence in the knowledge of NAFLD was the most common barrier for managing paediatric cases.
The majority of PCPs are not screening for paediatric NAFLD and are not familiar with its clinical spectrum, citing a lack of knowledge regarding NAFLD as the greatest barrier. This may cause delays in diagnosis and a presentation with advanced fibrosis at the time of specialist referral. Dissemination and implementation of clinical guidelines have the potential to improve knowledge and screening rates for NAFLD in children at the primary-care level.
非酒精性脂肪性肝病（NAFLD）是儿童慢性肝病最常见的病因。基层医疗医生（PCP）在识别需要专科转诊的患者方面起着关键作用。在本研究中，我们旨在确定基层医疗医生对儿童NAFLD的诊疗模式，因为已有报道称成人NAFLD存在知识差距。
2019年7月至2020年1月，向东安大略网络的60名基层医疗医生发送了一份调查问卷。
37名（62%）基层医疗医生回复了调查问卷。21名医生错误地认为儿童NAFLD的患病率≤10%。大多数（35/36）医生诊治的儿童NAFLD患者少于5名。34名（92%）医生对儿童NAFLD只是“略有了解”或“完全不熟悉”。只有一名基层医疗医生常规筛查NAFLD。只有一名基层医疗医生知晓北美小儿胃肠病、肝病和营养学会（NASPGHAN）关于儿童NAFLD的临床指南。25名（68%）医生正确选择生活方式改变作为一种治疗选择。对NAFLD知识缺乏信心是管理儿童病例最常见的障碍。
大多数基层医疗医生没有对儿童NAFLD进行筛查，也不熟悉其临床范围，称对NAFLD缺乏了解是最大障碍。这可能导致诊断延迟以及在专科转诊时出现晚期纤维化。临床指南的传播和实施有可能提高基层医疗水平对儿童NAFLD的认识和筛查率。
