Dr. Nancy Reau on how to educate providers on liver disease guidelines

When discussing survey results showing that providers have varying knowledge and understanding of chronic liver disease guidelines, Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, discusses how to improve their understanding.


How were providers asked if they were aware of liver disease guidelines?

I haven’t specifically answered the question myself, but the build is usually something along the lines of, “Do you know there are guidelines for this?” If the answer was no, well, that’s it. But if the answer was yes, then that might prompt you to say, “Well, what guidelines do you know?” I think it’s really different to be asked that question in a quiz than when you have a difficult patient in front of you and you’re like, “Oh wow, I’m going to go to UpToDate and I’m going to read about this because I don’t know the answer here,” then UpToDate says, “30% of the time you should because the guidelines suggest it’s evidence-based medicine.

It is concerning that a practitioner who feels comfortable caring for a patient with liver disease is unable to label a guideline or even the academic body that produces the guideline . But it’s not the only management tool available to clinicians. The survey did not ask, “If you don’t know a guideline, what would be your go-to resource?” If it’s phoning a friend next door, that could be problematic. If it’s going to UpToDate or looking at Medscape or something, maybe they’d get more reliable information.

What needs to be done to educate providers on these guidelines?

Training doctors or training providers is really complicated. We know that if we just send something to someone or if you send something to someone, it takes the effort to read it and keep it. If we didn’t underline the aspects, and if it didn’t seem applicable to the population we’re dealing with, and we weren’t given quiz questions demonstrating that we got our medical knowledge from what we read, it may not be so useful.

I think this part of provider education is a bit like patient education. If your patient or provider thinks what you are teaching them is important, they will be more likely to pay attention and apply it to the next patient. Part of that is simply disease awareness. Ensure that anyone working in a doctor’s office, regardless of specialty, knows that up to 30% to 40% of the patients they care for may have concurrent liver disease, even if they present for diabetes or if they’re coming back for strep throat. This patient might have other comorbid conditions, one of which is liver disease, which he should recognize.

If they understand the number of people with liver disease, they’ll be more susceptible, when that little direct mail comes in or that little highlight that says, “Would you like to read this?” This is an educational article about a liver problem.” They might be like, “Oh, yeah, I have to read this because it’s important to the patients I care for.”

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