非酒精性脂肪性肝炎护理中的临床实践差距和挑战：一项国际医师需求评估。
Clinical practice gaps and challenges in non-alcoholic steatohepatitis care: An international physician needs assessment.
机构信息
AXDEV Group Inc., Québec, Canada.
Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM) and NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Headington, UK.
出版信息
Liver Int. 2022 Aug;42(8):1772-1782. doi: 10.1111/liv.15324. Epub 2022 Jun 9.
BACKGROUND AND AIMS
Even as several pharmacological treatments for non-alcoholic steatohepatitis (NASH) are in development, the incidence of NASH is increasing on an international scale. We aim to assess clinical practice gaps and challenges of hepatologists and endocrinologists when managing patients with NASH in four countries (Germany/Italy/United Kingdom/United States) to inform educational interventions.
METHODS
A sequential mixed-method design was used: qualitative semi-structured interviews followed by quantitative online surveys. Participants were hepatologists and endocrinologists practising in one of the targeted countries. Interview data underwent thematic analysis and survey data were analysed with chi-square and Kruskal-Wallis tests.
RESULTS
Most interviewees (n = 24) and surveyed participants (89% of n = 224) agreed that primary care must be involved in screening for NASH, yet many faced challenges involving and collaborating with them. Endocrinologists reported low knowledge of which blood markers to use when suspecting NASH (56%), when to order an MRI (65%) or ultrasound/FibroScan® (46%), and reported sub-optimal skills interpreting alanine aminotransferase (ALT, 37%) and aspartate aminotransferase (AST, 38%) blood marker test results, causing difficulty during diagnosis. Participants believed that more evidence is needed for upcoming therapeutic agents; yet, they reported sub-optimal knowledge of eligibility criteria for clinical trials. Knowledge and skill gaps when managing comorbidities, as well as skill gaps facilitating patient lifestyle changes were reported.
CONCLUSIONS
Educational interventions are needed to address the knowledge and skill gaps identified and to develop strategies to optimize patient care, which include implementing relevant care pathways, encouraging referrals and testing, and multidisciplinary collaboration, as suggested by the recent Global Consensus statement on NAFLD.
背景和目的
尽管有几种治疗非酒精性脂肪性肝炎（NASH）的药物正在研发中，但 NASH 的国际发病率仍在上升。我们旨在评估四个国家（德国/意大利/英国/美国）的肝病专家和内分泌专家在管理 NASH 患者时的临床实践差距和挑战，以为教育干预提供信息。
方法
采用顺序混合方法设计：定性半结构式访谈后进行定量在线调查。参与者为在目标国家之一执业的肝病专家和内分泌专家。对访谈数据进行主题分析，对调查数据进行卡方检验和克鲁斯卡尔-沃利斯检验。
结果
大多数访谈者（n=24）和调查参与者（89%的 n=224）都认为初级保健必须参与 NASH 的筛查，但许多人面临着与他们合作的挑战。内分泌专家报告说，在怀疑 NASH 时，他们对使用哪些血液标志物（56%）、何时进行 MRI（65%）或超声/FibroScan®（46%）知之甚少，并且报告说，在解读丙氨酸氨基转移酶（ALT，37%）和天冬氨酸氨基转移酶（AST，38%）血液标志物测试结果方面技能欠佳，导致诊断困难。参与者认为，即将到来的治疗药物需要更多的证据；然而，他们报告说对临床试验的入选标准了解不足。在管理合并症时，知识和技能差距以及促进患者生活方式改变的技能差距都得到了报道。
结论
需要进行教育干预，以解决确定的知识和技能差距，并制定优化患者护理的策略，这包括实施相关的护理路径、鼓励转诊和检测，以及多学科合作，正如最近的非酒精性脂肪性肝病全球共识声明所建议的那样。
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