Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study
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 furth...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-03-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | https://doi.org/10.1177/00469580241241272 |
| _version_ | 1797242673592008704 |
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| author | Natalia I. Heredia PhD, MPH Jemima C. John PhD, MPH Sonia Singh MPH Jessica P. Hwang MD, MPH Larkin L. Strong PhD, MPH Maya Balakrishnan MD, MPH Lorna H. McNeill PhD, MPH |
| author_facet | Natalia I. Heredia PhD, MPH Jemima C. John PhD, MPH Sonia Singh MPH Jessica P. Hwang MD, MPH Larkin L. Strong PhD, MPH Maya Balakrishnan MD, MPH Lorna H. McNeill PhD, MPH |
| author_sort | Natalia I. Heredia PhD, MPH |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T18:42:58Z |
| format | Article |
| id | doaj.art-2353bdc90c8743999c35df84d142ae27 |
| institution | Directory Open Access Journal |
| issn | 0046-9580 1945-7243 |
| language | English |
| last_indexed | 2024-04-24T18:42:58Z |
| publishDate | 2024-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| spelling | doaj.art-2353bdc90c8743999c35df84d142ae272024-03-27T09:03:34ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432024-03-016110.1177/00469580241241272Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative StudyNatalia I. Heredia PhD, MPH0Jemima C. John PhD, MPH1Sonia Singh MPH2Jessica P. Hwang MD, MPH3Larkin L. Strong PhD, MPH4Maya Balakrishnan MD, MPH5Lorna H. McNeill PhD, MPH6Center for Health Equity, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USADepartment of Epidemiology, The University of Texas Health Science Center at Houston School of Public Health, Houston TX, USAThe University of Texas Health Science Center at Houston, Houston TX, USADepartment of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USAHealth Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USASection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USAHealth Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USAPrimary 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.https://doi.org/10.1177/00469580241241272 |
| spellingShingle | Natalia I. Heredia PhD, MPH Jemima C. John PhD, MPH Sonia Singh MPH Jessica P. Hwang MD, MPH Larkin L. Strong PhD, MPH Maya Balakrishnan MD, MPH Lorna H. McNeill PhD, MPH Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| title | Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study |
| title_full | Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study |
| title_fullStr | Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study |
| title_full_unstemmed | Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study |
| title_short | Understanding Primary Care Physician Perspectives on the Diagnosis and Management of Non-Alcoholic Fatty Liver Disease: A Qualitative Study |
| title_sort | understanding primary care physician perspectives on the diagnosis and management of non alcoholic fatty liver disease a qualitative study |
| url | https://doi.org/10.1177/00469580241241272 |
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