Improving nonalcoholic fatty liver disease management by general practitioners: A critical evaluation and impact of an educational training program

Ignazio Grattagliano, Gaetano D'Ambrosio, Vincenzo O. Palmieri, Antonio Moschetta, Giuseppe Palasciano, Piero Portincasa, Nicola Acquafredda, Emilia Aprile, Francesco Avitto, Giuseppe Baldassarre, Giacoma Barletta, Vincenzo Bini, Vito Borraccia, Antonio Brizzi, Gaetano Bufano, Oronzo Campanelli, Pietro Capitanio, Stanislao Caputo, Armando Caroselli, Vincenza CentroneEufemia Chiuri, Angela Ciaccia, Cinzia D'Agostino, Vito De Gennaro, Cosimo De Mola, Mario Domenico Dell'Orco, Francesco Di Munno, Tommaso Di Renzo, Gianfranco Di Lecce, Anna Doronzo, Costantino Frisario, Vittoria Formica, Gaetano Fusco, Maria Antonia Gargano, Franco Germano, Rosa La Selva, Orazio Lippolis, Francesco Lo Re, Donato Lopinto, Paolo Mangione, Raffaella Marra, Mario Filippo Massa, Giovanni Matarrese, Stefano Montanaro, Claudio Paci, Domenico Pasculli, Angelo Ramunni, Adele Riccio, Maria Giovanna Sabatelli, Leonardo Savino, Luca Savino, Pietro Scalera, Maria Lucia Scardino, Francesco Scatigna, Giacomo Schiraldi, Raffaele Taveri, Maria Fiorenza Tota, Fabrizio Trotta, Antonia Visaggio, Maria Zamparella

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background/Aims. The epidemic diffusion of nonalcoholic fatty liver disease (NAFLD) represents an emerging problem in family medicine. General Practitioners (GPs) should pay attention to patients with fatty liver, look at associated conditions, identify causal factors and patients at risk of evolution. This study aimed to assess GPs' knowledge and practice and a training project impact about NAFLD. Methods. 56 GPs filled a questionnaire before and after attending a tailored workshop on NAFLD, and performed a clinical survey in patients with persistent hypertransaminasemia including screening and liver biopsy when indicated. Four months after a training workshop, GPs were questioned again about their practice changes with NAFLD. Results. At baseline, less than 30% of GPs considered NAFLD as a cause of persistent hypertransaminasemia; over two-thirds thought that NAFLD had a prevalence of 5-10% in the general population; about 50% considered hypertransaminasemia as the main indication for liver biopsy in NAFLD; their main approach included a low lipid-content diet. Comparison of pre/post workshop questionnaires showed significant improvements, despite knowledge on diet composition and steatogenic drugs remained poor. Among screened patients with hypertransaminasemia, NAFLD had a prevalence of 36% and was associated with the metabolic syndrome in more than 50%. Liver biopsy was obtained in 8% of NAFLD. Chronic viral hepatitis was better diagnosed than NAFLD (biopsy performed in 86% of cases). The training workshop resulted in practice changes concerning screening of risk patients, search for NASH and managing NAFLD in chronic viral hepatitis. Conclusions. GPs' knowledge about NAFLD appears barely adequate, thus targeted training is essential to improve their knowledge and practice.

Original languageEnglish (US)
Pages (from-to)389-394
Number of pages6
JournalJournal of Gastrointestinal and Liver Diseases
Volume17
Issue number4
StatePublished - 2008

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Disease Management
General Practitioners
Education
Biopsy
Chronic Hepatitis
Non-alcoholic Fatty Liver Disease
Liver
Diet
Fatty Liver
General Practice
Medicine
Lipids

Keywords

  • Audit
  • Educational meeting
  • Liver steatosis
  • Management appropriateness

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Grattagliano, I., D'Ambrosio, G., Palmieri, V. O., Moschetta, A., Palasciano, G., Portincasa, P., ... Zamparella, M. (2008). Improving nonalcoholic fatty liver disease management by general practitioners: A critical evaluation and impact of an educational training program. Journal of Gastrointestinal and Liver Diseases, 17(4), 389-394.

Improving nonalcoholic fatty liver disease management by general practitioners : A critical evaluation and impact of an educational training program. / Grattagliano, Ignazio; D'Ambrosio, Gaetano; Palmieri, Vincenzo O.; Moschetta, Antonio; Palasciano, Giuseppe; Portincasa, Piero; Acquafredda, Nicola; Aprile, Emilia; Avitto, Francesco; Baldassarre, Giuseppe; Barletta, Giacoma; Bini, Vincenzo; Borraccia, Vito; Brizzi, Antonio; Bufano, Gaetano; Campanelli, Oronzo; Capitanio, Pietro; Caputo, Stanislao; Caroselli, Armando; Centrone, Vincenza; Chiuri, Eufemia; Ciaccia, Angela; D'Agostino, Cinzia; De Gennaro, Vito; De Mola, Cosimo; Dell'Orco, Mario Domenico; Di Munno, Francesco; Di Renzo, Tommaso; Di Lecce, Gianfranco; Doronzo, Anna; Frisario, Costantino; Formica, Vittoria; Fusco, Gaetano; Gargano, Maria Antonia; Germano, Franco; La Selva, Rosa; Lippolis, Orazio; Re, Francesco Lo; Lopinto, Donato; Mangione, Paolo; Marra, Raffaella; Massa, Mario Filippo; Matarrese, Giovanni; Montanaro, Stefano; Paci, Claudio; Pasculli, Domenico; Ramunni, Angelo; Riccio, Adele; Sabatelli, Maria Giovanna; Savino, Leonardo; Savino, Luca; Scalera, Pietro; Scardino, Maria Lucia; Scatigna, Francesco; Schiraldi, Giacomo; Taveri, Raffaele; Tota, Maria Fiorenza; Trotta, Fabrizio; Visaggio, Antonia; Zamparella, Maria.

In: Journal of Gastrointestinal and Liver Diseases, Vol. 17, No. 4, 2008, p. 389-394.

Research output: Contribution to journalArticle

Grattagliano, I, D'Ambrosio, G, Palmieri, VO, Moschetta, A, Palasciano, G, Portincasa, P, Acquafredda, N, Aprile, E, Avitto, F, Baldassarre, G, Barletta, G, Bini, V, Borraccia, V, Brizzi, A, Bufano, G, Campanelli, O, Capitanio, P, Caputo, S, Caroselli, A, Centrone, V, Chiuri, E, Ciaccia, A, D'Agostino, C, De Gennaro, V, De Mola, C, Dell'Orco, MD, Di Munno, F, Di Renzo, T, Di Lecce, G, Doronzo, A, Frisario, C, Formica, V, Fusco, G, Gargano, MA, Germano, F, La Selva, R, Lippolis, O, Re, FL, Lopinto, D, Mangione, P, Marra, R, Massa, MF, Matarrese, G, Montanaro, S, Paci, C, Pasculli, D, Ramunni, A, Riccio, A, Sabatelli, MG, Savino, L, Savino, L, Scalera, P, Scardino, ML, Scatigna, F, Schiraldi, G, Taveri, R, Tota, MF, Trotta, F, Visaggio, A & Zamparella, M 2008, 'Improving nonalcoholic fatty liver disease management by general practitioners: A critical evaluation and impact of an educational training program', Journal of Gastrointestinal and Liver Diseases, vol. 17, no. 4, pp. 389-394.
Grattagliano, Ignazio ; D'Ambrosio, Gaetano ; Palmieri, Vincenzo O. ; Moschetta, Antonio ; Palasciano, Giuseppe ; Portincasa, Piero ; Acquafredda, Nicola ; Aprile, Emilia ; Avitto, Francesco ; Baldassarre, Giuseppe ; Barletta, Giacoma ; Bini, Vincenzo ; Borraccia, Vito ; Brizzi, Antonio ; Bufano, Gaetano ; Campanelli, Oronzo ; Capitanio, Pietro ; Caputo, Stanislao ; Caroselli, Armando ; Centrone, Vincenza ; Chiuri, Eufemia ; Ciaccia, Angela ; D'Agostino, Cinzia ; De Gennaro, Vito ; De Mola, Cosimo ; Dell'Orco, Mario Domenico ; Di Munno, Francesco ; Di Renzo, Tommaso ; Di Lecce, Gianfranco ; Doronzo, Anna ; Frisario, Costantino ; Formica, Vittoria ; Fusco, Gaetano ; Gargano, Maria Antonia ; Germano, Franco ; La Selva, Rosa ; Lippolis, Orazio ; Re, Francesco Lo ; Lopinto, Donato ; Mangione, Paolo ; Marra, Raffaella ; Massa, Mario Filippo ; Matarrese, Giovanni ; Montanaro, Stefano ; Paci, Claudio ; Pasculli, Domenico ; Ramunni, Angelo ; Riccio, Adele ; Sabatelli, Maria Giovanna ; Savino, Leonardo ; Savino, Luca ; Scalera, Pietro ; Scardino, Maria Lucia ; Scatigna, Francesco ; Schiraldi, Giacomo ; Taveri, Raffaele ; Tota, Maria Fiorenza ; Trotta, Fabrizio ; Visaggio, Antonia ; Zamparella, Maria. / Improving nonalcoholic fatty liver disease management by general practitioners : A critical evaluation and impact of an educational training program. In: Journal of Gastrointestinal and Liver Diseases. 2008 ; Vol. 17, No. 4. pp. 389-394.
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abstract = "Background/Aims. The epidemic diffusion of nonalcoholic fatty liver disease (NAFLD) represents an emerging problem in family medicine. General Practitioners (GPs) should pay attention to patients with fatty liver, look at associated conditions, identify causal factors and patients at risk of evolution. This study aimed to assess GPs' knowledge and practice and a training project impact about NAFLD. Methods. 56 GPs filled a questionnaire before and after attending a tailored workshop on NAFLD, and performed a clinical survey in patients with persistent hypertransaminasemia including screening and liver biopsy when indicated. Four months after a training workshop, GPs were questioned again about their practice changes with NAFLD. Results. At baseline, less than 30{\%} of GPs considered NAFLD as a cause of persistent hypertransaminasemia; over two-thirds thought that NAFLD had a prevalence of 5-10{\%} in the general population; about 50{\%} considered hypertransaminasemia as the main indication for liver biopsy in NAFLD; their main approach included a low lipid-content diet. Comparison of pre/post workshop questionnaires showed significant improvements, despite knowledge on diet composition and steatogenic drugs remained poor. Among screened patients with hypertransaminasemia, NAFLD had a prevalence of 36{\%} and was associated with the metabolic syndrome in more than 50{\%}. Liver biopsy was obtained in 8{\%} of NAFLD. Chronic viral hepatitis was better diagnosed than NAFLD (biopsy performed in 86{\%} of cases). The training workshop resulted in practice changes concerning screening of risk patients, search for NASH and managing NAFLD in chronic viral hepatitis. Conclusions. GPs' knowledge about NAFLD appears barely adequate, thus targeted training is essential to improve their knowledge and practice.",
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T1 - Improving nonalcoholic fatty liver disease management by general practitioners

T2 - A critical evaluation and impact of an educational training program

AU - Grattagliano, Ignazio

AU - D'Ambrosio, Gaetano

AU - Palmieri, Vincenzo O.

AU - Moschetta, Antonio

AU - Palasciano, Giuseppe

AU - Portincasa, Piero

AU - Acquafredda, Nicola

AU - Aprile, Emilia

AU - Avitto, Francesco

AU - Baldassarre, Giuseppe

AU - Barletta, Giacoma

AU - Bini, Vincenzo

AU - Borraccia, Vito

AU - Brizzi, Antonio

AU - Bufano, Gaetano

AU - Campanelli, Oronzo

AU - Capitanio, Pietro

AU - Caputo, Stanislao

AU - Caroselli, Armando

AU - Centrone, Vincenza

AU - Chiuri, Eufemia

AU - Ciaccia, Angela

AU - D'Agostino, Cinzia

AU - De Gennaro, Vito

AU - De Mola, Cosimo

AU - Dell'Orco, Mario Domenico

AU - Di Munno, Francesco

AU - Di Renzo, Tommaso

AU - Di Lecce, Gianfranco

AU - Doronzo, Anna

AU - Frisario, Costantino

AU - Formica, Vittoria

AU - Fusco, Gaetano

AU - Gargano, Maria Antonia

AU - Germano, Franco

AU - La Selva, Rosa

AU - Lippolis, Orazio

AU - Re, Francesco Lo

AU - Lopinto, Donato

AU - Mangione, Paolo

AU - Marra, Raffaella

AU - Massa, Mario Filippo

AU - Matarrese, Giovanni

AU - Montanaro, Stefano

AU - Paci, Claudio

AU - Pasculli, Domenico

AU - Ramunni, Angelo

AU - Riccio, Adele

AU - Sabatelli, Maria Giovanna

AU - Savino, Leonardo

AU - Savino, Luca

AU - Scalera, Pietro

AU - Scardino, Maria Lucia

AU - Scatigna, Francesco

AU - Schiraldi, Giacomo

AU - Taveri, Raffaele

AU - Tota, Maria Fiorenza

AU - Trotta, Fabrizio

AU - Visaggio, Antonia

AU - Zamparella, Maria

PY - 2008

Y1 - 2008

N2 - Background/Aims. The epidemic diffusion of nonalcoholic fatty liver disease (NAFLD) represents an emerging problem in family medicine. General Practitioners (GPs) should pay attention to patients with fatty liver, look at associated conditions, identify causal factors and patients at risk of evolution. This study aimed to assess GPs' knowledge and practice and a training project impact about NAFLD. Methods. 56 GPs filled a questionnaire before and after attending a tailored workshop on NAFLD, and performed a clinical survey in patients with persistent hypertransaminasemia including screening and liver biopsy when indicated. Four months after a training workshop, GPs were questioned again about their practice changes with NAFLD. Results. At baseline, less than 30% of GPs considered NAFLD as a cause of persistent hypertransaminasemia; over two-thirds thought that NAFLD had a prevalence of 5-10% in the general population; about 50% considered hypertransaminasemia as the main indication for liver biopsy in NAFLD; their main approach included a low lipid-content diet. Comparison of pre/post workshop questionnaires showed significant improvements, despite knowledge on diet composition and steatogenic drugs remained poor. Among screened patients with hypertransaminasemia, NAFLD had a prevalence of 36% and was associated with the metabolic syndrome in more than 50%. Liver biopsy was obtained in 8% of NAFLD. Chronic viral hepatitis was better diagnosed than NAFLD (biopsy performed in 86% of cases). The training workshop resulted in practice changes concerning screening of risk patients, search for NASH and managing NAFLD in chronic viral hepatitis. Conclusions. GPs' knowledge about NAFLD appears barely adequate, thus targeted training is essential to improve their knowledge and practice.

AB - Background/Aims. The epidemic diffusion of nonalcoholic fatty liver disease (NAFLD) represents an emerging problem in family medicine. General Practitioners (GPs) should pay attention to patients with fatty liver, look at associated conditions, identify causal factors and patients at risk of evolution. This study aimed to assess GPs' knowledge and practice and a training project impact about NAFLD. Methods. 56 GPs filled a questionnaire before and after attending a tailored workshop on NAFLD, and performed a clinical survey in patients with persistent hypertransaminasemia including screening and liver biopsy when indicated. Four months after a training workshop, GPs were questioned again about their practice changes with NAFLD. Results. At baseline, less than 30% of GPs considered NAFLD as a cause of persistent hypertransaminasemia; over two-thirds thought that NAFLD had a prevalence of 5-10% in the general population; about 50% considered hypertransaminasemia as the main indication for liver biopsy in NAFLD; their main approach included a low lipid-content diet. Comparison of pre/post workshop questionnaires showed significant improvements, despite knowledge on diet composition and steatogenic drugs remained poor. Among screened patients with hypertransaminasemia, NAFLD had a prevalence of 36% and was associated with the metabolic syndrome in more than 50%. Liver biopsy was obtained in 8% of NAFLD. Chronic viral hepatitis was better diagnosed than NAFLD (biopsy performed in 86% of cases). The training workshop resulted in practice changes concerning screening of risk patients, search for NASH and managing NAFLD in chronic viral hepatitis. Conclusions. GPs' knowledge about NAFLD appears barely adequate, thus targeted training is essential to improve their knowledge and practice.

KW - Audit

KW - Educational meeting

KW - Liver steatosis

KW - Management appropriateness

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