Awareness, management, and practice patterns of pediatric NAFLD by primary care physicians
Victoria Lee-Kim1, Rachael Morkem2, David Barber2
1Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Insights
Most primary-care physicians lack knowledge and screening practices for pediatric nonalcoholic fatty liver disease (NAFLD). Improving guideline dissemination can enhance early detection and management of this common childhood liver condition.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Primary Care Medicine
Background:
- Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children.
- Primary-care physicians (PCPs) are crucial for identifying children needing specialist referral for NAFLD.
- Existing knowledge gaps in adult NAFLD suggest potential issues in pediatric practice patterns.
Purpose of the Study:
- To assess the current practice patterns of PCPs regarding pediatric nonalcoholic fatty liver disease.
- To identify knowledge gaps and barriers faced by PCPs in managing pediatric NAFLD.
- To evaluate PCP familiarity with clinical guidelines for pediatric NAFLD.
Main Methods:
- A survey was distributed to 60 PCPs within the Eastern Ontario Network.
- The survey was conducted between July 2019 and January 2020.
- Response rate was 62% (37 out of 60 PCPs).
Main Results:
- A significant majority of responding PCPs (92%) reported limited familiarity with pediatric NAFLD.
- Only one PCP routinely screened for pediatric NAFLD, and awareness of NASPGHAN guidelines was very low.
- Lack of confidence in NAFLD knowledge was the primary barrier identified by PCPs for managing pediatric cases.
Conclusions:
- Most PCPs demonstrate insufficient knowledge and screening practices for pediatric NAFLD.
- This gap may lead to delayed diagnoses and presentation of advanced liver disease.
- Disseminating clinical guidelines can improve PCP knowledge and screening rates for pediatric NAFLD.
Background:
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. Primary-care physicians (PCPs) play a key role in identifying patients requiring specialist referral. In this study, we aim to determine PCPs' practice patterns for paediatric NAFLD, as knowledge gaps have been reported for adult NAFLD.
Methods:
A survey was sent to 60 PCPs in the Eastern Ontario Network from July 2019 to January 2020.
Results:
Thirty-seven (62%) PCPs responded to the survey. Twenty-one incorrectly considered the prevalence of paediatric NAFLD to be ≤10%. The majority (35/36) cared for less than five paediatric NAFLD patients. Thirty-four (92%) were only 'slightly familiar' or 'not familiar at all' with paediatric NAFLD. Only one PCP routinely screens for NAFLD. Only one PCP was aware of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) clinical guidelines for paediatric NAFLD. Twenty-five (68%) correctly selected lifestyle modifications as a treatment option. Lack of confidence in the knowledge of NAFLD was the most common barrier for managing paediatric cases.
Conclusion:
The majority of PCPs are not screening for paediatric NAFLD and are not familiar with its clinical spectrum, citing a lack of knowledge regarding NAFLD as the greatest barrier. This may cause delays in diagnosis and a presentation with advanced fibrosis at the time of specialist referral. Dissemination and implementation of clinical guidelines have the potential to improve knowledge and screening rates for NAFLD in children at the primary-care level.
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