{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:39:12Z","timestamp":1782319152371,"version":"3.54.5"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Primary care has a crucial role to play in the prevention, early detection, referral, and risk factor management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NAFLD\/NASH). In 2021, a team of European collaborators developed a continuing medical education (CME) program on NAFLD\/NASH that consolidates evidence and clinical best practices tailored to the primary care setting. This article reports on the methodology used to design and develop the CME and the results of a feasibility study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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 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 Greece (<jats:italic>n<\/jats:italic>\u2009=\u200928) with measurements occurring before, immediately after, and 1\u2009month following the training. Outcome measures included satisfaction with the CME, changes in PCPs\u2019 knowledge, attitudes, confidence, and self-reported clinical practices related to NAFLD\/NASH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The CME is available as an open-access e-learning course on the European Society for Primary Care Gastroenterology education platform<jats:xref><jats:sup>1<\/jats:sup><\/jats:xref> in English, Greek, Spanish, and Dutch. The feasibility study documented high levels of satisfaction, with 96% of PCPs reporting they were extremely or very satisfied with the overall training. Statistically significant increases in PCPs\u2019 confidence in NAFLD\/NASH-related clinical practices were documented between the pre- and post-assessments. At the follow-up, 62% of GPs reported that the CME had changed their clinical practices related to NAFLD\/NASH to a great extent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This CME intervention developed by experts and tailored to PCPs in European settings may serve as an asset for increasing knowledge, confidence, and practice behaviors related to NAFLD\/NASH.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1034626","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T11:43:13Z","timestamp":1679571793000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Development and implementation of a continuing medical education program on non-alcoholic fatty liver disease for primary care practitioners in Europe"],"prefix":"10.3389","volume":"10","author":[{"given":"Sophia","family":"Papadakis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilena","family":"Anastasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irini","family":"Gergianaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ger","family":"Koek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Mendive","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foteini","family":"Anastasiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"Heyens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Garcia-Retortillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Muris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Lionis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0140-6736(21)01701-3","article-title":"The EASL-lancet liver commission: protecting the next generation of Europeans against liver disease complications and premature mortality","volume":"399","author":"Karlsen","year":"2022","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1159\/000443344","article-title":"European Association for the Study of diabetes (EASD); European Association for the Study of obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease","volume":"9","year":"2016","journal-title":"J Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"288","DOI":"10.20524\/aog.2018.0240","article-title":"Non-alcoholic fatty liver disease: controlling an emerging epidemic, challenges, and future directions","volume":"31","author":"Ofosu","year":"2018","journal-title":"Ann Gastroenterol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12916-014-0145-y","article-title":"Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis","volume":"12","author":"Mokdad","year":"2014","journal-title":"BMC Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/liv.13682","article-title":"Liver diseases: a major, neglected global public health problem requiring urgent actions and large-scale screening","volume":"38","author":"Marcellin","year":"2018","journal-title":"Liver Int"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"533","DOI":"10.2147\/DMSO.S146339","article-title":"Obesity and nonalcoholic fatty liver disease: current perspectives","volume":"11","author":"Sarwar","year":"2018","journal-title":"Diabetes Metab Syndr Obes"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"404","DOI":"10.20524\/aog.2021.0604","article-title":"Epidemiology of nonalcoholic fatty liver disease in Europe: a systematic review and meta-analysis","volume":"34","author":"Cholongitas","year":"2021","journal-title":"Ann Gastroenterol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"S104","DOI":"10.1016\/j.jhep.2008.01.009","article-title":"Non-alcoholic fatty liver disease: the mist gradually clears","volume":"48","author":"de Alwis","year":"2008","journal-title":"J Hepatol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1002\/hep.26717","article-title":"Extrahepatic complications of nonalcoholic fatty liver disease","volume":"59","author":"Armstrong","year":"2014","journal-title":"Hepatology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease:practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"154770","DOI":"10.1016\/j.metabol.2021.154770","article-title":"Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk","volume":"119","author":"Muzurovi\u0107","year":"2021","journal-title":"Metabolism"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1097\/MOL.0000000000000652","article-title":"Fatty liver, cardiometabolic disease and mortality","volume":"31","author":"Bedogni","year":"2020","journal-title":"Curr Opin Lipidol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s11892-021-01383-7","article-title":"The relationship between type 2 diabetes, NAFLD, and cardiovascular risk","volume":"21","author":"Caussy","year":"2021","journal-title":"Curr Diab Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/S0973-6883(12)60102-9","article-title":"Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults","volume":"34","author":"Vernon","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1016\/S0140-6736(17)32866-0","article-title":"Disease burden and costs from excess alcohol consumption, obesity, and viral hepatitis: fourth report of the lancet Standing commission on liver disease in the UK","volume":"391","author":"Williams","year":"2018","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/S2468-1253(18)30077-3","article-title":"Non-alcoholic fatty liver disease and the interface between primary and secondary care","volume":"3","author":"Tsochatzis","year":"2018","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e743","DOI":"10.3399\/bjgp18X699377","article-title":"Barbara Hanratty","volume":"68","author":"Standing","year":"2018","journal-title":"Br J Gen Pract"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/S1665-2681(19)31317-1","article-title":"Primary care practitioners survey of non-alcoholic fatty liver disease","volume":"12","author":"Said","year":"2013","journal-title":"Ann Hepatol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/j.1365-2036.2009.03961.x","article-title":"Screening for hepatitis B, C and nonalcoholic fatty liver disease: a survey of community-based physicians","volume":"29","author":"Kallman","year":"2009","journal-title":"Aliment Pharmacol Ther"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s13104-016-1946-1","article-title":"Awareness of nonalcoholic steatohepatitis and associated practice patterns of primary care physicians and specialists","volume":"9","author":"Polanco-Briceno","year":"2016","journal-title":"BMC Res Notes"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3138\/canlivj-2020-0033","article-title":"A Canadian survey on knowledge of non-alcoholic fatty liver disease among physicians","volume":"4","author":"Sebastiani","year":"2021","journal-title":"Can Liver J"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1186\/s13104-018-3673-2","article-title":"Survey on knowledge of non-alcoholic fatty liver disease (NAFLD) among doctors in Sri Lanka: a multicenter study","volume":"11","author":"Matthias","year":"2018","journal-title":"BMC Res Notes"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e743","DOI":"10.3399\/bjgp18X699377","article-title":"GPs\u2019 experiences and perceptions of early detection of liver disease: a qualitative study in primary care","volume":"68","author":"Standing","year":"2018","journal-title":"Br J Gen Pract"},{"key":"ref24","first-page":"389","article-title":"Improving nonalcoholic fatty liver disease management by general practitioners: a critical evaluation and impact of an educational training program","volume":"17","author":"Grattagliano","year":"2008","journal-title":"JGLD"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1080\/08870446.2011.613995","article-title":"The theory of planned behaviour: reactions and reflections","volume":"26","author":"Ajzen","year":"2011","journal-title":"Psychol Health"},{"key":"ref26","article-title":"Theory of reasoned actin, theory of planned behaviour, and the integrative model","volume-title":"Health behaviour and health education 4th edition","author":"Montano","year":"2008"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"100322","DOI":"10.1016\/j.jhepr.2021.100322","article-title":"Non-alcoholic fatty liver disease: a patient guideline","volume":"3","author":"Francque","year":"2021","journal-title":"JHEP Rep"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1034626\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T11:43:17Z","timestamp":1679571797000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1034626\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,23]]},"references-count":27,"alternative-id":["10.3389\/fmed.2023.1034626"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1034626","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,23]]},"article-number":"1034626"}}