Gips Julia R, Yanek Lisa, Wu Jiajun, Hamilton James P, Woreta Tinsay A, Clark Jeanne M
PGY-3 Osler Medical Residency, Johns Hopkins School of Medicine, Baltimore, USA.
Assistant Professor of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA.
J Family Med Prim Care. 2024 Aug;13(8):2958-2963. doi: 10.4103/jfmpc.jfmpc_1769_23. Epub 2024 Jul 26.
Nonalcoholic fatty liver disease (NAFLD) is increasingly common, and primary care physicians (PCPs) are often the first to diagnose NAFLD. While guidelines on NAFLD management in primary care exist, there are limited data on clinical practice patterns.
We gathered data from over 370,000 patients with at least one PCP visit between July 2016 and September 2023. Using ICD-10 codes to identify patients with a diagnosis of NAFLD or Nonalcoholic Steatohepatitis (NASH), we extracted demographics, comorbidities, laboratory results, prescriptions, imaging orders, and referrals to describe their care.
We identified 10,334 patients with a diagnosis code of NAFLD (93.1%) and/or NASH (16.7%) during a PCP visit. Just over half (54.8%) were female, mean age was 52.8 years, and mean BMI was 33.2 kg/m with 90% having overweight or obese. More than 50% had hypertension and hyperlipidemia, and 38% had diabetes. At the diagnosis visit, 2.7% had ultrasound elastography ordered, 2.7% liver biopsy, and less than 1% magnetic resonance elastography. During follow-up ranging from 0 to 7 years, patients had a mean of 15 encounters, during which 4% were diagnosed with fibrosis or cirrhosis. Only 24.2% of patients were referred to a nutritionist and 18% had an appointment, and only 0.7% were referred to hepatology and 3.8% saw a hepatologist.
PCPs have not widely implemented clinical practice guidelines for NAFLD, resulting in suboptimal care including for the substantial minority with fibrosis or cirrhosis. Patients might benefit from targeted NAFLD education for PCPs and improved decision and management support.
非酒精性脂肪性肝病（NAFLD）日益常见，基层医疗医生（PCP）往往是最先诊断出NAFLD的人。虽然存在基层医疗中NAFLD管理的指南，但关于临床实践模式的数据有限。
我们收集了2016年7月至2023年9月期间至少有一次基层医疗就诊的37万多名患者的数据。使用国际疾病分类第十版（ICD - 10）编码来识别诊断为NAFLD或非酒精性脂肪性肝炎（NASH）的患者，我们提取了人口统计学信息、合并症、实验室检查结果、处方、影像学检查医嘱和转诊信息来描述他们的治疗情况。
我们在基层医疗就诊期间识别出10334例诊断编码为NAFLD（93.1%）和/或NASH（16.7%）的患者。略超过一半（54.8%）为女性，平均年龄为52.8岁，平均体重指数为33.2kg/m²，90%超重或肥胖。超过50%患有高血压和高脂血症，38%患有糖尿病。在诊断就诊时，2.7%接受了超声弹性成像检查，2.7%接受了肝活检，不到1%接受了磁共振弹性成像检查。在0至7年的随访期间，患者平均就诊15次，在此期间4%被诊断为纤维化或肝硬化。只有24.2%的患者被转诊至营养师处，其中18%预约就诊，只有0.7%被转诊至肝病科，3.8%看过肝病专家。
基层医疗医生尚未广泛实施NAFLD的临床实践指南，导致治疗效果欠佳，包括对相当一部分患有纤维化或肝硬化的患者。患者可能会从针对基层医疗医生的针对性NAFLD教育以及改善决策和管理支持中受益。
