Multidisciplinary Clinic Models: A Paradigm of Care for Management of NAFLD

Abstract

ultidisciplinary clinics (MDCs) are an emerging model of health care delivery, offering patients coordinated care services to diagnose problems early and develop cohesive treatment plans. MDCs are commonly used in oncology, (1) type 2 diabetes mellitus (T2DM), (2) and women's health, (3) where they improve patient satisfaction and clinical and financial outcomes. In this review, we examine current MDC models and share a framework for patients with NAFLD to guide development of future multidisciplinary NAFLD programs. Multidisciplinary Care Models in MedicineWhile traditional health care delivery models consist of physicians assessing patients independently, MDCs promote coordinated care by integrating consultations and centralizing into a single clinic space. MDCs are often seen in oncology practices where multiple consultations are coordinated by a navigator into a single visit. (4) Many also have weekly conferences involving multiple providers who discuss and coordinate management plans and follow-up. (4,5) These models promote evidence-based, patient-centered plans and have been shown to improve clinical outcomes. (5) For example, a single-day MDC for patients with liver cancer that features a central clinical coordinator and frequent team meetings reported improvement in diagnosis, treatment, patient-provider communication, and satisfaction. (6) Despite variations in structure, MDCs are also well received by patients. In traditional sequential referral models of care, patients perceive poorer physician communication, inefficient use of time, misdiagnosis, mistreatment, and decreased satisfaction, which can lead to seeking a second opinion. (7) Conversely, patients in MDCs enjoy improved patient-physician communication and increased efficiency of travel time, appointments, and testing. (4,8) MDCs also improve patient experience and quality of life in cancer care, while reducing health care costs. (9) Multidisciplinary Care in NAFLDThe complexity of NAFLD and its associations with metabolic disease, cardiac and diabetic complications, and lifestyle factors make it ideal for multidisciplinary care. Patients with metabolic syndrome are at high risk for developing NAFLD complications, such as cirrhosis and HCC. (10) Data also suggest

The Shift from nonalcoholic fatty liver disease to metabolic dysfunction–associated fatty liver disease

“…American Association for the Study of Liver Diseases is convening a global nomenclature task force later this year to reach a consensus. Given the heterogeneity of disease and a movement toward multidisciplinary care models that can comprehensively treat patients with fatty liver and metabolic syndrome, MAFLD may be a more appropriate terminology to ensure all metabolic components are addressed 10 . It can also help improve identification and treatment for those at higher risk for fibrosis and liver stiffness 7 …”

“…Given the heterogeneity of disease and a movement toward multidisciplinary care models that can comprehensively treat patients with fatty liver and metabolic syndrome, MAFLD may be a more appropriate terminology to ensure all metabolic components are addressed. 10 It can also help improve identification and treatment for those at higher risk for fibrosis and liver stiffness. 7 With further comparison studies, debate, and time, we may eventually adopt a more comprehensive diagnostic nomenclature that can improve future research and patient care in fatty liver disease.…”

Multi-disciplinary clinic models for the management of non-alcoholic fatty liver disease

“…Considering the prognostic impact of non-liver-related comorbidities in NAFLD/NASH, an integrated multidisciplinary approach is therefore a crucial model of care for these patients. Such a model was recently highlighted by Kumar and colleagues who described the ICHANGE model, which is tailored to individual patients with NAFLD ( 3 ). Although the overall clinical care is coordinated by a hepatologist, many other specialists are involved to face the various comorbidities associated with NAFLD: an endocrinologist, a dietitian and a cardiologist.…”

“…The patient journey starts with the explanation of the follow-up program and visit planning by a nurse, followed by a first visit with a hepatologist and a registered dietitian. The aim is to identify all associated comorbidities, evaluate the stage of liver disease, review lifestyle practices, and formulate treatment plans, firstly and mainly based upon 10% total body weight loss, as recommended in clinical practice guidelines ( 3 , 4 ). There are tailored consultations with a cardiologist or endocrinologist based on risk factors and perceived cardiovascular risk.…”

“…Furthermore, tele-health and in-person appointments can be staggered to improve patient compliance and assessment; this could be helpful also in those cases in which several specialists are not available in the same health facility, avoiding the patient to frequently move between clinics ( 3 ).…”