Clinical practice gaps and challenges in non‐alcoholic steatohepatitis care: An international physician needs assessment
[1];
- 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
- Liver Institute Northwest and Washington State University Seattle WA USA
- Università degli Studi di Milano Milano Italy, IRCCS MultiMedica Milan Italy, International Atherosclerosis Society Milan Italy
- International Atherosclerosis Society Milan Italy, Heart Institute (InCor) University of São Paulo Medical School Hospital São Paulo Brazil, Hospital Israelita Albert Einstein São Paulo Brazil
- AXDEV Global Inc. Virginia Beach Virginia USA
Abstract 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.
- Sponsoring Organization:
- USDOE
- OSTI ID:
- 1871849
- Journal Information:
- Liver International, Journal Name: Liver International Journal Issue: 8 Vol. 42; ISSN 1478-3223
- Publisher:
- Wiley-BlackwellCopyright Statement
- Country of Publication:
- United Kingdom
- Language:
- English
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