Designing and implementing an evidence-based integrated and multidisciplinary and patient-centered model of care for NAFLD/NASH in primary care in Europe

Irini Gergianaki, Marilena Anastasaki, Sophia Papadaki, Foteini Anastasiou, Filothei Voltyrakis, Barbara Sidiropoulou, Ger Koek, Leen Heyens, Juan Mendive, Jean Muris, Christos Lionis

Keywords: NAFLD; NASH

In spite of its high prevalence and impact on health, non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) have not received prompt attention by primary care (PC) providers. There is limited clinical research on the effectiveness of their involvement in the management of this disease. An ongoing international project aims to develop and evaluate an integrated, multidisciplinary, patient-centered model of care (MoC) for NAFLD/NASH screening, diagnosis/linkage to specialty care and translate learnings into harmonized PC practice guidelines.

Research questions:
To what extent a scaling-up clinical research could guide evidence-based formation of guidelines in PC.

A multi-stage implementation project is being conducted in PC settings in Greece, Spain and the Netherlands. First, a descriptive survey examining patient and provider barriers, beliefs and needs related to NAFLD/NASH was designed. Then, an international expert panel including ESPCG and EASL delegates, has been assembled to guide the translation of NAFLD/NASH practice guidance to PC with country-level tailoring. Lessons learned will be used to develop: 1) an e-learning module for PC professionals (evaluated before and after implementation), 2) an integrated NAFLD/NASH MoC (evaluated through a randomized controlled trial), 3) guidance to address practice gaps to PC.

The preliminary findings of this ongoing project show that patients recognized at a large proportion (76.3%) that obesity is a key determinant for NAFLD/NASH, and 74.2% out of 190 patients stated the ultrasound as the main diagnostic modality. Further NAFLD/NASH related awareness, illness perception and risk communication data are anticipated. The e-learning educational program has been developed with five modules, while an integrated MoC is under preparation.

Project results can be used to inform European and national policies concerning the role of PC on early NAFLD/NASH identification and management.

Points for discussion:
The project can work as an example of scaling-up clinical research in PC that can guide effective management of NAFLD/NASG high-risk patients.