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Digestive Diseases and Sciences

, Volume 60, Issue 9, pp 2628–2635 | Cite as

Primary Care Providers Report Challenges to Cirrhosis Management and Specialty Care Coordination

  • Lauren A. Beste
  • Bonnie K. Harp
  • Rebecca K. Blais
  • Ginger A. Evans
  • Susan L. Zickmund
Original Article

Abstract

Background

Two-thirds of patients with cirrhosis do not receive guideline-concordant liver care. Cirrhosis patients are less likely to receive recommended care when followed exclusively by primary care providers (PCPs), as opposed to specialty co-management. Little is known about how to optimize cirrhosis care delivered by PCPs.

Aims

We conducted a qualitative analysis to explore PCPs’ attitudes and self-reported roles in caring for patients with cirrhosis.

Methods

We recruited PCPs from seven Veterans Affairs facilities in the Pacific Northwest via in-service trainings and direct email from March to October 2012 (n = 24). Trained staff administered structured telephone interviews covering: (1) general attitudes; (2) roles and practices; and (3) barriers and facilitators to cirrhosis management. Two trained, independent coders reviewed each interview transcript and thematically coded responses.

Results

Three overarching themes emerged in PCPs’ perceptions of cirrhosis patients: the often overwhelming complexity of comorbid medical, psychiatric, and substance issues; the importance of patient self-management; and challenges surrounding specialty care involvement and co-management of cirrhosis. While PCPs felt they brought important skills to bear, such as empathy and care coordination, they strongly preferred to defer major cirrhosis management decisions to specialists. The most commonly reported barriers to care included patient behaviors, access issues, and conflicts with specialists.

Conclusions

PCPs perceive Veterans with cirrhosis as having significant medical and psychosocial challenges. PCPs tend not to see their role as directing cirrhosis-related management decisions. Educational efforts directed at PCPs must foster PCP empowerment and improve comfort with managing cirrhosis.

Keywords

Primary care health Specialty care Chronic liver disease Attitudes 

Notes

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Portions of this work were presented at The Liver Meeting (November 5, 2013), the annual meeting of the American Association for the Study of Liver Disease. This material is the result of work supported by resources from the VA Puget Sound Health Care System (Seattle, Washington). Funding was provided by the VA National Hepatitis C Resource Centers program, through the Office of HIV, Hepatitis C, and Public Health Pathogens.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York (Outside the USA) 2015

Authors and Affiliations

  • Lauren A. Beste
    • 1
    • 2
    • 3
  • Bonnie K. Harp
    • 2
  • Rebecca K. Blais
    • 4
    • 5
  • Ginger A. Evans
    • 1
    • 3
  • Susan L. Zickmund
    • 6
    • 7
  1. 1.Primary Care ServiceVA Puget Sound Health Care SystemSeattleUSA
  2. 2.Health Services Research and DevelopmentVA Puget Sound Health Care SystemSeattleUSA
  3. 3.Division of General Internal MedicineUniversity of WashingtonSeattleUSA
  4. 4.Mental Health ServiceVA Puget Sound Health Care SystemSeattleUSA
  5. 5.Department of PsychologyUtah State UniversityLoganUSA
  6. 6.Center for Health Equity Research and PromotionVA Pittsburgh Health Care SystemPittsburghUSA
  7. 7.Departments of Medicine and Clinical and Translational ScienceUniversity of PittsburghPittsburghUSA

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