Background and purpose: Nonalcoholic fatty liver disease (NAFLD) prevalence has reached epidemic proportions, and the severe form, nonalcoholic steatohepatitis, can result in cirrhosis and liver failure. The growing prevalence requires primary care (PC) providers to be adept at recognition and management; however, they experience significant knowledge gaps that can result in delayed access to interventions that could improve outcomes. This study's aim was to develop and evaluate a toolkit to improve knowledge gaps and support evidence-based practice (EBP) among PC nurse practitioners caring for patients with NAFLD in a midwestern state. Methods and intervention: The Adult NAFLD Toolkit was designed using the Knowledge to Action framework and guidelines from the Agency for Healthcare Research and Quality. The success of the toolkit was evaluated by administering the NAFLD survey for general practitioners in a pre–post evaluation design. Results: Pre–post survey scores (N = 11) were compared for statistically significant change using the Wilcoxon signed rank test for matched pairs and showed improvement in overall knowledge (p = .011), perceived preparedness to care for NAFLD (p = .007), intention to recommend weight loss for management (p = .008), and intention to use the NAFLD fibrosis score for patient monitoring (p = .008). Conclusions: The results of this pilot study demonstrate successful implementation and positive outcomes of an EBP toolkit and support its expanded use. Continued evaluation on a larger scale is needed. Health care providers can use the process described in this article to develop and implement toolkits to support EBP of other PC issues.
This report summarizes changes to the OPTN Policies and Bylaws approved by the OPTN/UNOS Executive Committee at meetings from July 2015 through November 2015. This policy notice provides the specific Policy and Bylaws language changes and the corresponding implementation dates. When reviewing the language changes, please note that underlined language is new and what will be in effect upon implementation and language that is struck will be deleted upon implementation. The policy language used to denote the approved changes reflects the most recent version of policy that has been approved, but not necessarily what is currently implemented.
The increasing prevalence of nonalcoholic fatty liver disease requires primary care providers to serve on the front lines of care for patients with nonalcoholic fatty liver disease. Knowledge gaps regarding nonalcoholic fatty liver disease exist among primary care physicians, but it is unknown whether primary care nurse practitioners demonstrate similar gaps because they are under-represented in the literature. The purpose of this study was to evaluate primary care nurse practitioners' clinical approaches regarding nonalcoholic fatty liver disease, their knowledge regarding diagnosis and management, and their preparedness level regarding care for patients with nonalcoholic fatty liver disease. Adequate knowledge was demonstrated in some, but not all, areas. The knowledge did not necessarily translate into clinical practice behaviors, however. In addition, only 35% of the participants agreed that they felt prepared to care for patients with nonalcoholic fatty liver disease. Implications are limited by the small sample size but provide some insight into primary care nurse practitioners' preparedness to care for this important epidemic.
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