Primary Care Providers Report Challenges to Cirrhosis Management and Specialty Care Coordination.
BACKGROUND
Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs.


OBJECTIVE
We conducted a qualitative analysis to explore PCPs' attitudes and self-reported roles in caring for patients with cirrhosis.


METHODS
We recruited PCPs from seven Veterans Affairs facilities in the Pacific Northwest via in-service trainings and direct email from March to October 2012 (n = 24). Trained staff administered structured telephone interviews covering: (1) general attitudes; (2) roles and practices; and (3) barriers and facilitators to cirrhosis management. Two trained, independent coders reviewed each interview transcript and thematically coded responses.


RESULTS
Three overarching themes emerged in PCPs' perceptions of cirrhosis patients: the often overwhelming complexity of comorbid medical, psychiatric, and substance issues; the importance of patient self-management; and challenges surrounding specialty care involvement and co-management of cirrhosis. While PCPs felt they brought important skills to bear, such as empathy and care coordination, they strongly preferred to defer major cirrhosis management decisions to specialists. The most commonly reported barriers to care included patient behaviors, access issues, and conflicts with specialists.


CONCLUSIONS
PCPs perceive Veterans with cirrhosis as having significant medical and psychosocial challenges. PCPs tend not to see their role as directing cirrhosis-related management decisions. Educational efforts directed at PCPs must foster PCP empowerment and improve comfort with managing cirrhosis.
Primary Care Service, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA, Lauren.Beste@va.gov.
Lauren A
LA
Beste
Bonnie K
BK
Harp
Rebecca K
RK
Blais
Ginger A
GA
Evans
Susan L
SL
Zickmund
D001291:Attitude of Health Personnel; D015897:Comorbidity; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D010819:Physician's Role; D011320:Primary Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000453:epidemiology; D014728:Veterans / Q000523:psychology