title: Identifying practice gaps to optimize medical care for patients with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. Primary care providers (PCPs), in contrast to gastroenterology/hepatology (GI/Hep) providers, are the first medical contact for the majority of patients with, or at risk for, NAFLD. PCP awareness of and facility with NAFLD is critical for management of these patients.
  
  
  OBJECTIVE
  The purpose of this study was to assess understanding and practice patterns of PCPs and non-GI/Hep subspecialty providers with respect to the diagnosis and management of NAFLD.
  
  
  METHODS
  We administered an online, 61-question survey to 479 providers in internal medicine, family medicine, endocrinology, cardiology, and obstetrics and gynecology (ObGyn) across three health systems: academic medical center, safety-net health system and managed care health system.
  
  
  RESULTS
  There were 246 respondents (51 %), with the majority (87 %) being PCPs (internal medicine, family medicine, ObGyn). Only 31 % of providers identified NAFLD as a clinically important diagnosis in their practice. Although 65 % of providers reported some degree of facility in diagnosing NAFLD, less than half (47 %) were comfortable managing NAFLD. Only 33 % refer patients with suspected NAFLD to GI/Hep. Subspecialists in endocrinology and cardiology reported greater clinical concern over NAFLD and were more likely (67 %) to refer patients with suspected NAFLD to GI/Hep.
  
  
  CONCLUSIONS
  The majority of providers do not identify NAFLD as a clinically important diagnosis and do not refer to GI/Hep. However, 83 % expressed a need for education on NAFLD. Our data reveal practice gaps within NAFLD care and identify opportunities for targeted education to guide PCPs in the evaluation and management of NAFLD.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, MS B-158, Aurora, CO, 80045, USA, amanda.wieland@ucdenver.edu.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Wieland
authors.forename: Matthew
authors.initials: M
authors.lastname: Quallick
authors.forename: Aimee
authors.initials: A
authors.lastname: Truesdale
authors.forename: Pamela
authors.initials: P
authors.lastname: Mettler
authors.forename: Kiran M
authors.initials: KM
authors.lastname: Bambha
mesh_terms: D000328:Adult; D003625:Data Collection; D019468:Disease Management; D004502:Education, Medical, Continuing; D005234:Fatty Liver / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012307:Risk Factors; D013038:Specialization; D011795:Surveys and Questionnaires; D014481:United States