通向肝脏健康的桥梁：通过共享医疗预约为 MASLD 管理实施团体远程医疗心理教育计划。

BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management.

机构信息

Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA.

出版信息

BMC Public Health. 2024 Jun 7;24(1):1546. doi: 10.1186/s12889-024-18865-4.

DOI:10.1186/s12889-024-18865-4

PMID:38849779

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11161992/

Abstract

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support.

METHODS

A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed.

RESULTS

We included 57 participants (median age 57, interquartile range (IQR) 50 - 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 - 36), with a median weight loss of 2 pounds (IQR -2 - 6) after BRIDGE.

CONCLUSION

The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.

摘要

背景

代谢功能相关脂肪性肝病（MASLD）是一种代价高昂且日益普遍的疾病，其治疗重点是生活方式干预。将教育和行为健康纳入临床护理提供了机会，可以让患者参与并赋予他们预防肝病进展的能力。我们描述了一种 6 节小组远程医疗计划——行为资源和通过数字小组教育进行的干预（BRIDGE）的设计和实施，该计划由高级执业医师（APP）在学术门诊肝病诊所的小型 MASLD 患者中进行 90 分钟的共享医疗预约（SMA），以小组形式开展，每 6 节小组由行为教练领导。该计划包含多组件小组干预，包括讲座式教育和行为指导，同时利用基于同伴的学习和支持。

方法

进行了一项混合方法探索性试点研究。通过跟踪 BRIDGE 参与者的招募、出席和保留情况、患者访谈以及临床医生和工作人员对临床项目的看法进行汇报，评估临床干预的可行性和可接受性。实施指标包括项目开发时间、工作流程和日程安排后勤以及可持续性计费合规性。最后，回顾性分析了 BRIDGE 前后患者的肝脏酶、FIB-4、体重和 BMI 等参数的变化。

结果

我们纳入了 57 名参与者（中位数年龄 57 岁，四分位距（IQR）为 50-65 岁），其中 38 名（67%）为女性，38 名（67%）为白人，40%有公共保险。33 名（58%）参与者完成了所有 6 节课程，而 43 名（75%）至少参加了 5 节课程。完成所有课程的患者年龄较大（中位数年龄 61 岁比 53.5 岁；p=0.01）。性别、种族/民族和保险类型与错过的课程无显著相关性，并且无论体重、BMI 或肝病分期如何，患者的完成率相似。完成课程的障碍包括个人疾病、家庭原因、工作承诺或保险问题。在 BRIDGE 之前，BMI 的中位数为 31.9（SD 29-36），BRIDGE 后体重中位数减轻了 2 磅（IQR -2-6）。