Dr Nancy Reau on How to Educate Providers on Liver Disease Guidelines


Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, elaborates on how to improve provider knowledge on liver disease guidelines.

When discussing survey results showing providers have varying awareness and understanding on guidelines for chronic liver disease, Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, talks about how to improve their understanding.


How were providers asked whether they were aware of liver disease guidelines?

I didn't answer the question specifically myself, but the build is usually something along the line of, "Are you aware that guidelines exist for this?" If the answer was no, well, it kind of stops there. But if the answer was yes, it might prompt you then to say, "Well, what guidelines are you aware of?" I think it's really different to be asked that on a questionnaire as opposed to when you have a difficult patient in front of you and you're like, "Oh wow, I'm gonna go to UpToDate and I'm going to read about this because I don't know the answer right here," and then UpToDate says, "30% of the time you should do this because the guidelines suggest that this is evidence-based medicine."

It's worrisome that a practitioner who feels comfortable taking care of a patient with liver disease is unable to label a guideline or even the the academic body that produces the guideline. But that's not the only management tool that clinicians have. The survey didn't ask, "If you don't know a guideline, what would you consider your go-to resource?" If it's phone a friend next door, that might be problematic. If it's to go to UpToDate or look at Medscape or something, maybe they would be getting more reliable information.

What should be done to educate providers about these guidelines?

Physician education or provider education is really complicated. We know that if we just mail something to someone or you email something to someone, it does take the effort of reading it and then retaining it. If we didn't highlight aspects, and if it didn't feel applicable to the population we're taking care of, and we weren't given quiz questions that demonstrated that we got our medical knowledge out of the thing we read, it may not be that useful.

I think that part of provider education is a little bit like patient education. If your patient or your provider believes that what you're teaching them is important, they're going to be more inclined to pay attention and apply it to the patient that next comes in. Part of that is just disease awareness. Making sure that someone who is in a medical practice, irrespective of specialty, knows that up to 30% to 40% of the patients they're caring for can have concomitant liver disease, even if they're coming in for diabetes or they're coming in for strep throat. That patient might have other comorbid conditions, one of which is a liver complaint, that they should be recognizing.

If they understand the volume of individuals with liver disease, they're going to be more likely, when that little mailer comes through or that little highlight that says, "Would you like to read this? This is an educational piece on a liver problem." They might be like, "Oh, yeah, I need to read this because this is important to the patients that I'm taking care of."

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