Vali Yasaman, Eijk Roel, Hicks Timothy, Jones William S, Suklan Jana, Holleboom Adriaan G, Ratziu Vlad, Langendam Miranda W, Anstee Quentin M, Bossuyt Patrick M M
Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Athena Institute, Faculty of Science, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands.
J Clin Med. 2022 May 11;11(10):2707. doi: 10.3390/jcm11102707.
(1) Background: Given the high prevalence of non-alcoholic fatty liver disease (NAFLD) and the limitations of liver biopsies, multiple non-invasive tests (NITs) have been developed to identify non-alcoholic fatty liver disease (NAFLD) patients at-risk of progression. The availability of these new NITs varies from country to country, and little is known about their implementation and adoption in routine clinical practice. This study aims to explore barriers and facilitators that influence the adoption of NAFLD NITs, from healthcare professionals' perspectives. (2) Methods: A cross-sectional study was performed using an exploratory mixed-methods approach. Twenty-seven clinicians from eight different countries with different specialties filled in our questionnaire. Of those, 16 participated in semi-structured interviews. Qualitative and quantitative data were collected and summarized using the recently published Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework for new medical technologies in healthcare organizations. (3) Results: Several factors were reported as influencing the uptake of NITs for NAFLD in clinical practice. Among those: insufficient awareness of tests; lack of practical guidelines and evidence for the performance of tests in appropriate patient populations and care settings; and absence of sufficient reimbursement systems were reported as the most important barriers. Other factors, most notably 'local champions', proper functional payment systems, and sufficient resources in academic hospitals, were indicated as important facilitating factors. (4) Conclusions: Clinicians see the adoption of NITs for NAFLD as a complex process that is modulated by several factors, such as robust evidence, practical guidelines, a proper payment system, and local champions. Future research could explore perspectives from other stakeholders on the adoption of NITs.
(1) 背景：鉴于非酒精性脂肪性肝病（NAFLD）的高患病率以及肝活检的局限性，已开发出多种非侵入性检测方法（NITs）来识别有疾病进展风险的非酒精性脂肪性肝病（NAFLD）患者。这些新型非侵入性检测方法在不同国家的可及性各不相同，对于它们在常规临床实践中的实施和应用了解甚少。本研究旨在从医疗保健专业人员的角度探讨影响非酒精性脂肪性肝病非侵入性检测方法应用的障碍和促进因素。(2) 方法：采用探索性混合方法进行横断面研究。来自八个不同国家、具有不同专业的27名临床医生填写了我们的问卷。其中，16人参与了半结构化访谈。使用最近发布的用于医疗保健组织中新型医疗技术的非采用、放弃、扩大规模、传播和可持续性（NASSS）框架收集和汇总定性和定量数据。(3) 结果：据报告，有几个因素影响非酒精性脂肪性肝病非侵入性检测方法在临床实践中的应用。其中，检测方法的认知不足；缺乏针对合适患者群体和护理环境中检测方法应用的实用指南和证据；以及缺乏足够的报销系统被报告为最重要的障碍。其他因素，最显著的是 “当地倡导者”、适当的功能性支付系统以及学术医院的充足资源，被指出是重要的促进因素。(4) 结论：临床医生认为采用非酒精性脂肪性肝病非侵入性检测方法是一个复杂的过程，受到多种因素的调节，如有力的证据、实用指南、适当的支付系统和当地倡导者。未来的研究可以探索其他利益相关者对采用非侵入性检测方法的看法。
