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Overview

A survey of 751 U.S. based gastroenterologists/hepatologists, endocrinologists, and primary care physicians conducted in May 2020, revealed significant disparities between published practice guidance and the clinical realities of diagnosing and managing NAFLD and NASH.  These disparities were seen both among specialists with extensive experience in liver disease and among other practitioners likely to see relatively large numbers of NAFLD and NASH patients. The findings suggest a considerable need for broad-based education to increase awareness about guideline-based diagnosis and management of NAFLD and NASH.

Purpose and Objectives

Research Purpose: Assess educational needs that will eliminate barriers and gaps experienced by HCPs in the diagnosis and management of NASH, and share the results with the entire medical community in order to enhance future medical education programs.

Study Objectives: Compare current diagnostic and treatment patterns of the management of NASH among gastroenterologists/hepatologists, endocrinologists, and primary care physicians in the US with the most recent practice guidance on NASH*

*“The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Diseases” [Chalasani et al. 2018]

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Sample

Quota
Gastroenterologists
Hepatologists
Endocrinologists
175
175
401
751
Total Sample
PCPs/GPs
Specialty
  • Average time to complete survey with 24 questions: 11 minutes
  • Participants from 46 states
  • Average years in practice 19.5; between 2 years and 35 years in practice
  • To qualify to participate in the survey, respondents had to be at least “somewhat familiar with NASH”.
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Gap: Screening

Question: Roughly what proportion of the following patient groups are likely to have NAFLD?

Result:

Survey chart about PCP NASH Knowledge

Note: Patients with severe obesity, T2DM, and/or dyslipidemia may not be screened for NAFLD and NASH

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Gap: Diagnosis

Question: Ways to approach non-invasive diagnosis of steatohepatitis and advanced fibrosis in NAFLD.

Result:

Ways to approach non-invasive diagnosis of steatohepatitis and advanced fibrosis in NAFLD.

Note: Many respondents incorrectly consider abdominal ultrasound to be a clinically useful tool for diagnosing NASH and advanced fibrosis.

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Gap: NASH treatment

Question: Ways to approach non-invasive diagnosis of steatohepatitis and advanced fibrosis in NAFLD

Result:

Ways to approach non-invasive diagnosis of steatohepatitis and advanced fibrosis in NAFLD

*P value of <.05 indicate relationship between knowledge of the guidelines and specialty sub-group

Note: Clinicians may be overlooking low-cost treatments for NASH, most notably vitamin E and pioglitazone.

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Need for Education

Bar chart showing most respondents would like more education on screening, diagnosing and treating NASH.
Strongly Agree
Agree
Disagree
Strongly Disagree

Note: Most respondents would like more education on screening, diagnosing and treating NASH.