Provider Knowledge on Liver Disease Guidelines Varies, Dr Nancy Reau Says

Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, elaborates on survey results published in the Salix Liver Health Annual Trends Report, showing providers have varying awareness and understanding on guidelines for chronic liver disease (CLD).

According to a survey of more than 400 health care providers, 38% said were not aware of and/or could not name national guidelines for the management of CLD, and using the American Association for the Study of Liver Diseases (AASLD) guidelines was more of a priority for gastroenterologists (82%) compared with all other providers.

Transcript

Why did you include nurse practitioners and physician assistants in the survey?

Adding nurse practitioners and physician assistants to the survey was really important. We know that primary care is often managed quite a bit by our APPs [advanced practice providers] and, even within subspecialty care and inpatient management, they are a very critical, important practice. So some of our patients really do find that the bulk of their care is provided by APPs, and so if we don't survey them, we don't really understand this critical component in our patients' management.

Why was there such a high number of respondents who were unaware of or could not name national guidelines for chronic liver disease management?

National guidelines come from lots of different places. When you're a liver specialist, it's easy for us to look at the American Liver Association or the European Liver Association and know that they've got reliable guidelines, and we tend to, as members, get alerts when these guidelines are updated or when a new guideline is released. If you're a gastroenterologist or if you're a primary care physician, your resource for your guidelines is going to be a little bit different.

Now, as a GI [gastroenterologist], American College of Gastroenterology as well as AGA [American Gastroenterology Association] do release liver-associated or liver-centric guidelines, and they should be aware of some of that. But when you start to move into the community, especially if you're not doing fellow education or you're looking at that very busy day that you've gone through and you're getting your big journal and you're looking at the titles, you might not remember—especially if it didn't seem relevant to you at that day when you were doing screening colonoscopy and taking care of reflux disease—that there was a new guideline released on hemochromatosis. So I think a lot of our community physicians do find that they might not be aware of things just because it's not as well highlighted as it would be in an academic institution where we're consistently being challenged by our fellows or we're responsible for fellow education and we tend to be a little bit more aware of when these new releases occur.

Plus, we tend to find that our metrics are a little more aligned with guideline-supported management. What I mean by that is that, if you're teaching fellows or if you have residents that you're you're educating, you tend to try to at least know what the guidelines are so that if you're going against them, you can at least say, "our guidelines would suggest we might be doing this, but this is the reason that we're not following the guidelines right now." I would imagine that occurs a lot less in the community practices.