Challenges to the care of chronic liver disease (CLD) include the burden of costs, managed and multidisciplinary care issues, and the lack of awareness for clinical guidelines.
Not enough primary care providers (PCPs) know about new guidelines for chronic liver disease (CLD), according to the second edition of a liver report.
The “Liver Health Annual Trends Report” identifies these and other shortfalls affecting the management of CLD, including reimbursement barriers. The report, produced by Salix Pharmaceuticals, includes data collected from an online survey, phone interviews, and secondary research from peer-reviewed publications.
Researchers anticipate rising mortality from CLD, tripling by 2030.
An independent third-party recruiting firm invited over 400 health care providers to participant in this study in May, 2022. Participants were required to have treated more than 4 patients with CLD annually and were comprised of the following sub-groups: gastroenterologists, institution-based specialists, PCPs, and nurse practitioners/physician assistants (NPs/PAs).
“This trends report strives to be representative of all physician segments’ lived experience and the diversity that exists within the United States with respect to patient management and the economic and social factors that impact the management of CLD patients,” said Salix.
The report notes that liver disease has a higher mortality rate than diabetes or stroke, increasing 3% per 100,000 patients in a study from 2018 to 2019. Cirrhosis of the liver and other select liver diseases were reported the 3rd highest principal diagnosis, with the highest rate of 30-day all-cause hospital readmission (30.8%).
Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) were found to be the largest causes of CLD among community-based gastroenterologists, PCPs, NPs/PAs (40% and 43%) reported by CLD providers.
Only 35% of patients with NASH/NAFLD and 41% of patients with cirrhosis are receiving multidisciplinary care, largely due to provider shortages. However, 61% of CLD providers reported PCPs to be the best equipped to manage comorbidities associated with CLD.
Some hematologists have begun partnering with endocrinology and bariatrics/obesity medicine to build multidisciplinary clinics that offer care that a PCP may not have the resources to provide.
Furthermore, the highest mortality rates were found in non-Hispanic American Indian or Alaska Natives (5.97%), Hispanics (3.24%), non-Hispanic Whites (1.46%), and non-Hispanic Blacks (0.09%).
Primary market research identified key challenges patients and providers face when treating CLD, including the burden of socio-economic costs that may impact a patient’s outcome, managed and multidisciplinary care issues, and the lack of awareness for American Association for the Study of Liver Diseases (AASLD) guidelines.
CLD providers report the top socio-economic factors impacting patient’s health are substance/health behaviors, access to health services, insurance status and the ability to pay out-of-pocket costs, and social support network/inclusion.
Most (63%) specialists reported insurance status as being a barrier to patients in receiving multidisciplinary care. Additionally, 50% of providers reported that a patient’s ability to pay out-of-pocket costs for CLD care is “extremely important to CLD patient outcomes.”
In 2022, 38% of respondents said they did not believe national guidelines for the management of liver disease existed and/or could not name any national guidelines. Using the AASLD guidelines was more of a priority for gastroenterologists (82%) compared with all other providers.
Of providers who are aware or interested in guidelines, 18% of PCPs and 20% of NPs/PAs said they do not know how to incorporate them into daily practice.
Findings in this report suggest a need for better management when it comes to PCP’s being able to offer patient’s with CLD multidisciplinary care to help not only identify early signs of liver disease, but also being able to properly treat patients accordingly to early CLD symptoms. Cost barriers and ethnic barriers also present themselves as areas where better management practices may be implemented.
“This trends report is part of that dedication—to understand what barriers exist to quality care for CLD and cirrhosis patients, including those with cirrhotic complications such as hepatic encephalopathy; to measure the trends impacting the adoption of guidelines and improved care over time; and to spread awareness of the challenges,” Nicola Kayel, vice president of GI Marketing at Salix Pharmaceuticals said.