More education needed to help PCPs ‘feel confident’ treating, managing MASLD
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Key takeaways:
- Less than 1% of all patients with MASLD were referred to hepatology.
- Follow-up imaging or biopsy was performed in less than 4% of high-risk patients.
BOSTON — Although primary care physicians play a vital role in managing metabolic dysfunction-associated steatotic liver disease, many are not following guidance on screening, risk stratification or referrals, according to research.
“Primary care physicians are likely not comfortable managing NAFLD/MASLD in their clinics at this time,” Julia R. Gips, MD, a second-year resident at Johns Hopkins Medicine, told Healio. “However, the reality is that much of the work following these patients will fall on their shoulders as the prevalence of metabolic disease continues to grow.”
Gips and colleagues conducted a retrospective cohort study, using electronic health record data from 370,000 patients who had at least one PCP visit at a Maryland health facility between July 1, 2016, and Sept. 17, 2023.
The study population included 10,334 adults (mean age, 52.8 years; 53.8% women) who were diagnosed with MASLD (93.1%) or metabolic dysfunction-associated steatohepatitis, formally NASH (16.7%). The researchers found that 67.8% of these patients had hypertension, 67.1% had hyperlipidemia and 38.3% were diabetic. The mean BMI of these patients was 33.2 kg/m2.
During a follow-up period that ranged from 0 to 7 years, researchers determined that patients had a mean of 15 visits for any reason, and that 4% of patients were diagnosed with fibrosis or cirrhosis during those visits.
According to research presented at The Liver Meeting, 24.2% of patients in the overall study population were referred to a nutritionist and 18.4% were seen by a nutritionist, while 0.7% were referred to a hepatologist and 3.8% were seen by a hepatologist.
In patients with advanced fibrosis or cirrhosis, 12.2% were referred to a hepatologist and 16.8% were seen by a hepatologist, while 35% of these patients were referred to a nutritionist and 15.6% were seen by a nutritionist.
In addition, lab data on aspartate aminotransferase was missing for 14% of patients, as was data on alanine aminotransferase for 13.8% and platelets for 54.6%.
According to the researchers, less than 4% of high-risk patients underwent follow-up imaging or biopsies, although repeat fibrosis screening is recommended every 1 to 3 years in this patient population.
“We need to provide more NAFLD education to primary care physicians so that they feel confident risk stratifying, managing and treating NAFLD in their clinics,” Gips told Healio. “Some of the efforts needed to improve NAFLD management in the primary care setting include publicly available learning modules and flowcharts, which highlight the essentials of NAFLD management.”
She continued, “Furthermore, we need to incorporate NAFLD management components into the EMR to offer best care practice alerts, akin to HgbA1c reminders for patients with diabetes, and increase access to ultrasound elastography and FibroScan modalities with primary care clinics.”
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Gips JR, et al. Management of nonalcoholic fatty liver disease in a primary care setting. Presented at: The Liver Meeting; Nov. 10-14, 2023; Boston (hybrid meeting).
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