Nonalcoholic Fatty Liver Disease: Interface Between Primary Care and Hepatology Clinics.

Primary care physicians (PCPs) have the primary role in the diagnosis and management of nonalcoholic fatty liver disease (NAFLD), and in selecting patients for referral to a hepatologist for further evaluation. This study aimed to characterize PCP referrals for patients diagnosed with NAFLD at a major referral hospital, and to determine the severity of liver disease and patient pathway following evaluation in secondary care. New patients seen in the hepatology outpatient clinic (HOC) with a secondary care diagnosis of NAFLD were identified from the HOC scheduling database. PCP referrals for these patients were retrieved from the electronic medical records and reviewed by study clinicians, along with the hepatologists' clinic notes and letters. Over a 14-month period, 234 new PCP referrals received a diagnosis of NAFLD, accounting for 20.4% of the total number of new cases (n = 1,147) seen in the HOC. The 234 referrals were received from 170 individual PCPs at 135 practices. Most patients with NAFLD (88.5%) were referred for investigation of abnormal liver enzymes or other clinical concerns, including abnormal iron studies, hepatomegaly, and abdominal pain. Only 27 (11.5%) referrals included an assessment of liver disease severity. Following evaluation in the liver clinic, 175 patients (74.8%) were found to have a low risk of advanced fibrosis, and most (n = 159; 90.9%) were discharged back to their PCP for ongoing follow-up in primary care. Conclusion: In addition to better access to noninvasive fibrosis tests, educational strategies to enhance awareness and recognition of NAFLD as a cause for many of the initial concerns prompting patient referral might improve risk stratification and increase the appropriateness of PCP referrals.

Problem based learning in the clinical setting--a systematic review.

Problem based learning (PBL) is widely utilised as a curricula modality within the health professions and extensive literature exists to support its application. Recently nurse educators have embarked on the PBL journey as a method of contextualizing theory into practice in the classroom and clinical setting. The University of Queensland, in partnership with key health care providers, introduced an innovative undergraduate nursing curriculum in 2004. The curriculum incorporates problem based learning, clinical skills sessions, lectures and clinical practice as part of an intense weekly program from first year onwards. The program facilitates integration of evidence based theoretical and clinical knowledge driven by the PBL philosophy. However, in reality is PBL utilised by clinicians as a method of clinical teaching in undergraduate health professional programs? A systematic review of the literature was undertaken to answer this question revealing a paucity of evidence supporting or confirming the application of PBL in the clinical setting. The findings of this review highlight the current gaps in the PBL literature, supporting further research into the role of PBL as a teaching strategy for undergraduate nurses in the clinical practice setting.