The Role of Advanced Practice Providers in the Care of Nonalcoholic Fatty Liver Disease

Gajos, Andrea; Tapper, Elliot B.

doi:10.1016/j.clinthera.2020.12.009

Cited by 3 publications

(1 citation statement)

References 29 publications

(24 reference statements)

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“…Advanced Practice Providers (APPs) have been shown to successfully deliver behavioral change interventions, including for patients with heart failure [35] opioid use disorder [36], and diabetes [37,38]. Given the roots of the APP professions in health promotion, they may be best positioned to promote behavior change for MASLD patients [39]. To this end, we studied the feasibility and acceptability of an APP-led longitudinal SMA telehealth program focused on educating and empowering patients with MASLD in an academic hepatology practice setting.…”

Section: Introductionmentioning

confidence: 99%

BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management

Dalal,

Catalli,

Miller

et al. 2024

BMC Public Health

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Background Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. Methods A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. Results We included 57 participants (median age 57, interquartile range (IQR) 50 – 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 – 36), with a median weight loss of 2 pounds (IQR -2 – 6) after BRIDGE. Conclusion The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.

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