Dr. Nancy Rowe on how to educate providers about hepatology guidelines

When discussing survey results showing that providers have varying awareness and understanding about chronic liver disease guidelines, Nancy Rowe, chief of hepatology at Rush University Medical Center, talks about how their understanding could improve.


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, “Are you aware of guidelines for this?” If the answer is no, well, it stops there. But if the answer is yes, it might prompt you to say, “Well, what guidelines do you know?” I think it’s a really different thing to be asked in a questionnaire 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,” and then UpToDate says, “30% of the time you should To do so because the guidelines indicate that this is an evidence-based drug.”

It is troubling that a practitioner who is comfortable caring for a patient with liver disease is unable to name a guide or even the academic body that produces the guide. But this is not the only administrative tool doctors have at their disposal. The survey didn’t ask, “If you don’t know the guidelines, what go-to resource would you consider?” If the phone is a friend around, that could be a problem. If it’s to go to UpToDate or look at Medscape or something like that, they’ll probably get more reliable information.

What should be done to educate providers about these guidelines?

Doctor education or provider education is really complicated. We know that if we email something to someone or we email something to someone, it takes effort to read it and then keep it. If we don’t highlight aspects, if we don’t feel they are applicable to the population we care for, and we don’t receive test questions showing that we got our medical knowledge from the thing we’re reading, it may not be helpful.

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 inclined to pay attention and apply it to the patient who comes next. Part of that is just awareness of the disease. Ensure that the person practicing the medical profession, regardless of specialty, knows that up to 30% to 40% of the patients they care for can develop comorbid liver disease, even if they are diabetic or have diabetes. Re-coming for sore throat. This patient may have other co-morbidities, one of which is a hepatic complaint, that they should recognize.

If they understood the scale of individuals with liver disease, they’d be more likely, when that little mail message or little highlight comes in that says, “Would you like to read this? This is an educational piece about a liver problem.” They might be like, “Oh, yeah, I need to read this because this is important for the patients I care for.”

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