Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA.
Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USA.
Inquiry. 2024 Jan-Dec;61:469580241241272. doi: 10.1177/00469580241241272.
Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients' insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.
初级保健医生（PCP）非常适合管理非酒精性脂肪性肝病（NAFLD）患者，但有限的现有研究表明，他们对 NAFLD 的自然史、诊断方法和管理知识不足。这项定性研究的目的是进一步了解 PCP 对 NAFLD 的诊断和管理的知识和实践。我们对休斯顿大都市区的 PCP 进行了深入访谈，探讨了目前用于诊断和管理 NAFLD 的临床实践，以及 PCP 对 NAFLD 给患者带来的负担的看法。我们记录了访谈，对其进行了转录，对抄本进行了编码，并确定了模式和主题。接受采访的 PCP（n=16）来自内科或家庭医学，经验范围（1.5-30 年）。我们发现，不同的实践和保险状况会导致 NAFLD 的诊断和管理存在差异。有异常肝脏影像学的患者如果有保险或在安全网医疗保健系统内，会被 PCP 转介给专家。没有保险且持续肝酶升高的患者会接受 PCP 的生活方式建议，而无需进行确认性影像学检查或转介给专家。PCP 在 NAFLD 管理中的作用各不相同，有些帮助患者设定饮食和身体活动目标，而有些则只提供一般建议和/或转介患者给营养师。NAFLD 的诊断和管理在 PCP 之间存在很大差异，可能会受到患者的保险状况和诊所特定实践的影响。美国医疗系统中 NAFLD 的负担不断增加，这凸显了更多 PCP 参与管理 NAFLD 的必要性。
