The following is a summary of “Underrecognition and Suboptimal Quality of Care for Nonalcoholic Fatty Liver Disease Cirrhosis in Primary Care Patients with Diabetes Mellitus,” published in the October 2023 issue of Primary Care by Chu et al. 

Nonalcoholic fatty liver disease (NAFLD) stands as a major contributor to cirrhosis, yet its recognition in primary care remains inadequate. Managing cirrhosis involves intricate monitoring, and the quality of care (QoC) for patients with NAFLD-related cirrhosis in primary care may be lacking. In this retrospective-prospective cohort study involving primary care patients with diabetes mellitus, identification of NAFLD cirrhosis was based on evidence of cirrhosis from abdominal imaging (identified through natural language processing) or an ICD code for cirrhosis. 

Confirmation of both cirrhosis and NAFLD was then conducted through manual chart review. Subsequently, the study assessed the adequacy of cirrhosis care measures, including hepatitis A and B vaccination, components of the Model for End-Stage Liver Disease (MELD) score, esophagogastroduodenoscopy (EGD), and hepatocellular carcinoma screening. A composite score was created to quantify overall QoC (on a scale of 0-8), with a high QoC defined as ≥6 points. Among 3,028 primary care patients with diabetes mellitus, 51 (1.7%) were identified with NAFLD cirrhosis. Despite 78% having ≥3 average primary care visits per year, only 24% underwent hepatocellular carcinoma screening annually in at least 75% of the years since diagnosis. 

The average QoC composite score was 4.9 (SD 2.4), and fewer than one-third achieved high QoC. The study concludes that NAFLD cirrhosis is prevalent but underdiagnosed in primary care, and the receipt of comprehensive QoC needs to be revised. Given the increasing incidence of NAFLD cirrhosis, there is a need for heightened awareness among primary care providers and improved mechanisms to ensure high QoC for this population.

Source: sciencedirect.com/science/article/pii/S0002934323006526