Abstract PO-061: Primary care physicians' perspectives on non-alcoholic fatty liver disease
Authors: Heredia Natalia I. , Hwang Jessica P. , John Jemima , Strong Larkin L. , Balakrishnan Maya , McNeill Lorna H. 
Published: December 2020

Abstract
Introduction. Non-alcoholic fatty liver disease (NAFLD) is a growing cause for hepatocellular cancer in the U.S., disproportionately affecting Hispanics. Primary care physicians (PCPs) are typically the first point of contact and are often the only available resource for low-income or uninsured patients. Early studies suggest inadequate knowledge among PCPs about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to understand PCP knowledge and practices about NAFLD diagnosis and management, especially PCPs who serve predominately Hispanic patient populations. Methods. We conducted in-depth interviews with PCPs in the greater Houston area who were recruited through email and word-of-mouth from clinics with a predominately Hispanic population. PCPs completed written informed consent and a brief demographic questionnaire prior to the interview. Interviews were 30-45 minutes in length, recorded and later transcribed. Interviews addressed current clinic practice for diagnosing and managing NAFLD, perceptions of the burden of NAFLD on patients, among other topics. NVivo was used to identify patterns and themes, with two team members separately coding and resolving discrepancies through consensus. Results. PCPs (n=14) were from internal or family medicine, with a wide range of experience (1.5 to 30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. There was variation in how NAFLD initially came to PCPs attention- in some clinics, NAFLD was detected from liver enzymes that were part of annual routine blood panels, though in other practices NAFLD was discovered incidentally when doing purposeful workup for other conditions. The typical diagnosis process involved assessment of liver enzymes and if elevated, proceeding to liver imaging (ultrasound, CT scan, or MRI). For patients with abnormal liver imaging, if they had insurance or were within a safety- net health system, PCPs sometimes referred to hepatologists or gastroenterologists. For uninsured patients outside of the safety-net health system, PCPs sometimes proceeded with lifestyle modification recommendations in patients with persistently elevated liver enzymes, given concerns about ability to access imaging services or see a specialist. There was wide variation in the role PCPs play in the management of NAFLD. Some physicians used motivational interviewing and helped patients set dietary and physical activity goals, while others simply gave verbal recommendations and/or referred on to a dietician. Several PCPs expressed frustration with the lack of guidance for screening and management of NAFLD. Conclusions. The process of diagnosing and managing NAFLD appears to vary widely among PCPs, and may be influenced by a patient’s insurance status and clinic-specific practices. Given the growing burden of NAFLD on the U.S. medical system, data driven guidance on diagnosis and management of NAFLD patients is needed to support PCPs.
Citation Format: Natalia I. Heredia, Jessica P. Hwang, Jemima John, Larkin L. Strong, Maya Balakrishnan, Lorna H. McNeill. Primary care physicians' perspectives on non-alcoholic fatty liver disease [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-061.