AUTHOR=Papadakis Sophia , Anastasaki Marilena , Gergianaki Irini , Koek Ger , Mendive Juan , Anastasiou Foteini , Heyens Leen , Garcia-Retortillo Montserrat , Muris Jean , Lionis Christos 

TITLE=Development and implementation of a continuing medical education program on non-alcoholic fatty liver disease for primary care practitioners in Europe

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1034626

DOI=10.3389/fmed.2023.1034626

ISSN=2296-858X

ABSTRACT=Background: Primary care has a crucial role to play in the prevention, early detection, referral and risk factor management for Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steato-Hepatitis (NAFLD/NASH). In 2021, a team of European collaborators developed a continuing medical education (CME) program on NAFLD/NASH which consolidates evidence and clinical best practices tailored to the primary care setting. This paper reports on the methodology used to design and develop the CME and the results of a feasibility study. 
Methods: An expert advisory group representing both European specialists and general practitioners supported the design of the CME to be implemented in three European settings (Greece, Spain and the Netherlands). The CME features four training modules and problem-based learning using clinical case studies. The CME was tested regarding feasibility and acceptability among a sample of primary care providers (PCPs) in Crete, Greece (n=28) with measurement occurring before, immediately after and one month following the training. Outcome measures included satisfaction with the CME, changes in PCPs knowledge, attitudes, confidence and self-reported clinical practices related to NAFLD/NASH. 
Results: The CME is available as an open-access e-learning course on the European Society for Primary Care Gastroenterology education platform (www.espcg.eu) in English, Greek, Spanish and Dutch. The feasibility study documented high satisfaction levels, with 96.3% of PCPs reporting they were extremely or very satisfied with the overall training. Statistically significant increases in PCPs confidence in NAFLD/NASH-related clinical practices were documented between the pre-and post-assessments. At the follow-up, 62.4% of PCPs reported the CME had changed their clinical practices related to NAFLD/NASH to a great extent. A statistically significant trend was observed between pre and follow-up assessments for the reported proportion of patients with obesity and/or diabetes mellitus screened for NAFLD (p-value=0.035).
Conclusion: This CME intervention developed by experts and tailored to PCPs in European settings may serve as an asset for increasing knowledge, confidence and practice behaviours related to NAFLD/NASH.