title: Primary care practitioners survey of non-alcoholic fatty liver disease.
abstract: BACKGROUND
  The rising incidence of non alcoholic fatty liver disease (NAFLD) mirrors the epidemics of obesity and metabolic syndrome. Primary care practitioners (PCPs) are central to management of patients with NAFLD, but data on knowledge and attitudes of PCPs towards NAFLD are lacking.
  
  
  METHODS
  We conducted a statewide, stratified survey of 250 PCPs to examine knowledge, practices and attitudes regarding NAFLD and the barriers to providing care for this condition.
  
  
  RESULTS
  NAFLD was perceived as an important health problem by 83% of PCPs. Eighty five percent of PCPs underestimated the population prevalence of NAFLD. Although the association of NAFLD with metabolic syndrome was identified by 91% of PCPs, only 46% screened diabetic obese patients for NAFLD. Only 27% of PCPs referred NAFLD patients to a hepatologist for evaluation. PCPs who reported seeing more than 5 NAFLD patients annually, referred to hepatology less frequently (P = 0.01). The majority of PCPs (58%) recommended weight loss and a calorie restriction. Only 8% of PCPs would recommend Vitamin E. The major perceived barrier in managing NAFLD was lack of confidence in understanding of the disease (58% of PCPs).
  
  
  CONCLUSIONS
  An overwhelming majority of PCPs perceived NAFLD as an important health issue in their practice. However, screening rates for NAFLD among obese diabetics were low. A major barrier to managing these patients was self-reported lack of knowledge about NAFLD. Development of guidelines should emphasize strategies for screening vulnerable populations (obese, diabetics), evidence based management and barriers to providing care.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health. USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Said
authors.forename: Veronika
authors.initials: V
authors.lastname: Gagovic
authors.forename: Kristen
authors.initials: K
authors.lastname: Malecki
authors.forename: Marjory L
authors.initials: ML
authors.lastname: Givens
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
mesh_terms: D001291:Attitude of Health Personnel; D001364:Awareness; D031204:Caloric Restriction; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D010465:Perception; D058007:Physicians, Primary Care / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015431:Weight Loss; D014922:Wisconsin / Q000453:epidemiology