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Identifying Practice Gaps to Optimize Medical Care for Patients with Nonalcoholic Fatty Liver Disease

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Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. Primary care providers (PCPs), in contrast to gastroenterology/hepatology (GI/Hep) providers, are the first medical contact for the majority of patients with, or at risk for, NAFLD. PCP awareness of and facility with NAFLD is critical for management of these patients.

Aim

The purpose of this study was to assess understanding and practice patterns of PCPs and non-GI/Hep subspecialty providers with respect to the diagnosis and management of NAFLD.

Methods

We administered an online, 61-question survey to 479 providers in internal medicine, family medicine, endocrinology, cardiology, and obstetrics and gynecology (ObGyn) across three health systems: academic medical center, safety-net health system and managed care health system.

Results

There were 246 respondents (51 %), with the majority (87 %) being PCPs (internal medicine, family medicine, ObGyn). Only 31 % of providers identified NAFLD as a clinically important diagnosis in their practice. Although 65 % of providers reported some degree of facility in diagnosing NAFLD, less than half (47 %) were comfortable managing NAFLD. Only 33 % refer patients with suspected NAFLD to GI/Hep. Subspecialists in endocrinology and cardiology reported greater clinical concern over NAFLD and were more likely (67 %) to refer patients with suspected NAFLD to GI/Hep.

Conclusions

The majority of providers do not identify NAFLD as a clinically important diagnosis and do not refer to GI/Hep. However, 83 % expressed a need for education on NAFLD. Our data reveal practice gaps within NAFLD care and identify opportunities for targeted education to guide PCPs in the evaluation and management of NAFLD.

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Acknowledgments

We would like to thank Dr. Al Marcus, Dr. Lori Crane and Dr. Lisa Cicutto for their help with study design and survey formulation. This work was supported by NIH/NCATS Colorado CTSI Grant Number TL1 TR000155 and by NIH T32 DK07038 Gastrointestinal Diseases Training Grant. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views.

Conflict of interest

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, MS B-158, Aurora, CO, 80045, USA

    Amanda C. Wieland & Kiran M. Bambha

  2. Division of Gastroenterology, Kaiser Permanente Colorado, 280 Exempla Circle, Lafayette, CO, 80026, USA

    Matthew Quallick

  3. Division of Gastroenterology and Hepatology, Denver Health Medical Center, 660 Bannock St. MC 4000, Denver, CO, 80204, USA

    Aimee Truesdale

  4. Department of Biostatistics and Informatics, Colorado Biostatistics Consortium, Colorado School of Public Health, 12477 E. 19th Ave., Aurora, CO, 80045, USA

    Pamela Mettler

Authors
  1. Amanda C. Wieland
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  2. Matthew Quallick
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  3. Aimee Truesdale
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  4. Pamela Mettler
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  5. Kiran M. Bambha
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Corresponding author

Correspondence to Kiran M. Bambha.

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Wieland, A.C., Quallick, M., Truesdale, A. et al. Identifying Practice Gaps to Optimize Medical Care for Patients with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 58, 2809–2816 (2013). https://doi.org/10.1007/s10620-013-2740-8

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  • DOI: https://doi.org/10.1007/s10620-013-2740-8

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