P4622 - Knowledge, Skills, and Confidence Gaps in Diagnosis of Primary Biliary Cholangitis Among Gastroenterologists and Advance Practice Providers Practicing in Gastroenterology or Hepatology

Sophie Peloquiin, MSc¹, Mitchell L Shiffman, MD², Kris V.. Kowdley, MD, FACG³, Edward Mena, MD⁴, Andrea A Gossard, APRN, CNP⁵, Lu Fan, PhD¹, Lyota Bonyeme, MA, MSc¹, Patrice Lazure, MSc^1
1AXDEV Group Inc., Montreal, PQ, Canada; ²Liver Institute of Virginia, Bon Secours Health System, Richmond, VA; ³Liver Institute Northwest, Seattle, WA; ⁴Pasadena Liver Center, Pasadena, CA; ⁵The Cholestatic Liver Diseases Laboratory, Mayo Clinic, Rochester, MN

Introduction: Primary biliary cholangitis (PBC) is a chronic progressive inflammatory disease that can result in end-stage liver disease. Optimal care for PBC patients requires a multidisciplinary team approach to slow down disease progression and improve patients’ quality of life. This mixed-method study aimed at identifying knowledge, skill and confidence gaps of HCPs in ensuring an adequate PBC diagnosis.

Methods: Semi-structured qualitative 45-minute interviews and a 15-minute quantitative survey were conducted within four sub-specialties: hepatologists, general gastroenterologists (GIs), primary care providers (PCPs) and advanced practice practitioners in GI/hepatology (APPs). The participants needed to be active in clinical practice in U.S., with a minimum of 2 years of experience. To ensure the focus on non-expert HCPs, a maximum PBC patient caseload was set for recruitment (20 patients/year for GIs, hepatologists and APPs; 10 patients over past 5 years for PCPs). Qualitative data underwent thematic analysis, quantitative data were analyzed using sub-group analysis with chi-square tests, and all data were triangulated in final analysis. This abstract will mainly focus on the gaps of GIs and APPs.

Results: A total of 24 HCPs (6/sub-specialty) participated in interviews and 160 (40/sub-specialty) participated in survey. Mixed-method findings included difficulties with timely diagnosis and differentiating PBC from other liver diseases. Specifically, suboptimal skills (GIs 32%; APPs 100%) and suboptimal confidence (GIs 32%; APPs 100%) in recognizing liver enzyme patterns that suggest PBC were identified (Table 1). For APPs, the study also identified suboptimal skills (72%) and confidence (92%) in distinguishing between cholestatic and hepatocellular patterns in liver function tests, and in interpreting the significance of elevated alkaline phosphatase levels (suboptimal skills 92%; confidence 97%). APPs also had suboptimal skills (47%) and confidence (75%) in utilizing anti-mitochondrial antibody (AMA) testing effectively for diagnosis. GIs (30%) reported suboptimal confidence in employing advanced diagnostic tools like liver biopsy in PBC.

Discussion: Knowledge, skills and confidence gaps were identified among GIs and APPs, pointing to an opportunity for educational interventions for GI providers. Focused educational interventions in recognizing PBC symptom patterns and appropriate use of diagnostic tools will improve care for patients living with PBC.


Disclosures:


Sophie Peloquiin, MSc¹, Mitchell L Shiffman, MD², Kris V.. Kowdley, MD, FACG³, Edward Mena, MD⁴, Andrea A Gossard, APRN, CNP⁵, Lu Fan, PhD¹, Lyota Bonyeme, MA, MSc¹, Patrice Lazure, MSc¹. P4622 - Knowledge, Skills, and Confidence Gaps in Diagnosis of Primary Biliary Cholangitis Among Gastroenterologists and Advance Practice Providers Practicing in Gastroenterology or Hepatology, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.