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Michael K Porayko,1 Amy Articolo,2 Wendy Cerenzia,3 Brandon Coleman,3 Daxa Patel,2 Sylvie Stacy3 1Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA; 2Novo Nordisk, Inc, Plainsboro, NJ, USA; 3CE Outcomes, LLC, Birmingham, AL, USACorrespondence: Wendy Cerenzia, CE Outcomes, LLC, 2101 Highland Ave S, #300A, Birmingham, AL, 35205, USA, Tel +1 205 259 1519, Fax +1 205 259 1501, Email wendy.cerenzia@ceoutcomes.comPurpose: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are a part of a complex metabolic disease process requiring a multi-faceted and multidisciplinary management approach. This study was conducted to identify areas where medical education across a multidisciplinary team could be optimized in providing optimal care of patients with NAFLD/NASH.Methods: A survey instrument including a patient case vignette was developed to understand approaches of US clinicians to diagnosis and management of patients with NAFLD/NASH. The survey was fielded via email in December 2020–January 2021. Analysis was conducted using embedded Qualtrics analytic software.Results: There were 629 survey respondents: 318 PCPs, including physicians, NPs, and PAs, 57 hepatologists, 156 gastroenterologists, and 98 endocrinologists. Survey results demonstrated variation in likelihood to screen patients for NAFLD/NASH among specialists and PCPs as well as in the types of clinicians that respondents would involve in the initial management of a patient diagnosed with NASH. Notably, between 15% and 33% across respondent clinician types would not include any other clinicians or medical specialists in initial management. For a patient with newly diagnosed NASH, the most likely initial management recommendations included drug therapy to improve control of diabetes and therapy to lower lipids and were less likely to recommend drug therapy for weight loss, drug therapy for NASH, or bariatric surgery. Respondents rated “poor patient adherence to lifestyle modifications” and “lack of approved therapies for NASH” as the most significant barriers to optimal management of patients with NASH.Conclusion: Variation in the evaluation and management of patients with NAFLD/NASH across PCPs and medical subspecialists was identified in this study. Education aimed at multidisciplinary roles in optimally managing patients with NAFLD/NASH, can be beneficial, particularly if focused on increasing screening, implementing guideline updates as they emerge, and incorporating new therapies as they gain approval for clinical practice.Keywords: continuing medical education, patient care, specialty care, primary care, educational needs

Most people with type 2 diabetes (T2D) also have obesity and the prevalence of both continues to increase. This study sought to understand approaches of endocrinologists (ENDOs) and primary care physicians (PCPs) in managing patients with both T2D and obesity to identify areas where physicians may benefit from continued education. A patient case-based survey assessing approaches to managing patients with T2D and obesity was fielded in October 2021, with responses from US-practicing ENDOs (n=181) and PCPs (n=350) . Survey questions included free response, multiple choice, and rating scales. Descriptive analysis was performed. When presented with a patient with poorly controlled T2D, obesity, and other clinical concerns (eg, elevated blood pressure (BP) , hyperlipidemia, and cigarette use) , improving HbA1c was among the top three goals in 93% of physicians, while BP control was a top goal for just over half and weight loss was a top goal for only 45%. In another patient presenting with T2D and unchanged BMI of 37 kg/m2, despite 6 months of lifestyle intervention, 9% of ENDOs and 15% of PCPs would continue current weight management without change. If the patient’s BMI been higher at 47 kg/m2, both ENDOs and PCPs were more likely to begin a weight loss medication and PCPs were more likely to defer management to a specialist. Most physicians (63%) agreed that effectively managing T2D leads to weight loss and 83% agreed that GLP-1 receptor agonists are effective for obesity. However, only half of ENDOs and 29% of PCPs have a certain percentage of body weight loss goal when managing obesity in patients with T2D. Further, 19% of ENDOs and 30% of PCPs reported that they trial diet, exercise, and behavioral modifications for 6 months or longer. Results show physicians may benefit from continuing education focused on the importance of addressing weight in combination with glycemic control for patients with T2D and obesity, and the benefits of pharmacotherapy as a component of weight management. Disclosure W.Cerenzia: None. S.Stacy: None. S.Wiley: None.

Patients with beta thalassemia are benefitting from longer life expectancies, highlighting the importance of appropriate transition from pediatric to adult care. Data are limited regarding continuity of care and adult hematologists’ management of patients with beta thalassemia. We conducted a survey of practicing US hematologists to identify practice gaps, attitudes, and barriers to optimal patient management among US-practicing hematologists. A total of 42 responses were collected, with 19 (45%) practicing at a beta thalassemia center of excellence (CoE). Nearly 90% of CoE physicians said they had a transition protocol or plan in place versus 30% of non-CoE physicians. Most physicians said parents should remain actively involved in medical visits. Adherence was rated as the most important patient education topic during transition. The most significant barrier cited was patient reluctance to transition away from pediatric care. Physicians in CoEs as compared with non-CoE physicians reported greater knowledge of beta thalassemia and familiarity with butyrates, gene therapy, and luspatercept. Highly rated topics for beta thalassemia-focused CME activities included management of complications and clinical trial updates. These findings suggest practice gaps and barriers to optimal care in the transition from pediatric to adult care, the ongoing management of adult patients, knowledge of the disease state, and familiarity with emerging treatments. Differences CoE vs non-CoE physician responses suggest variations in knowledge, practice, and attitudes that may be helpful in tailoring CME activities to different learner audiences. The small sample size used in some sub-analyses may not be representative of all hematologists treating beta thalassemia patients.

Rationale Food allergy is documented to result in considerable morbidity, negative impact on quality of life, and substantial medical care costs. Although anecdotal data suggest widely varying practices in the diagnosis and management of food allergies, the diversity and relative frequency of these practices have not been documented. Methods A questionnaire was developed evaluating allergists’ management approaches of individuals with peanut allergy (PA) in Germany (DE), France (FR), and the United Kingdom (UK). Results Here, we report the survey results from a total of 109 allergists from DE, FR and the UK. They reported to confirm PA at initial diagnosis using skin prick test (≥60%), while allergists from DE and FR reported using allergen-specific IgE testing more (>86%) compared to the UK (75%). Half of the responders reported assessing the patient’s quality of life. 63% allergists reported retesting for PA resolution at a later date, with 45% allergists indicated to recommend ingestion of a normal serving of peanut regularly upon resolution. Lack of effective PA treatment was reported to be a ‘very significant’ barrier for optimal PA treatment, with allergists being less than ‘moderately familiar’ with data from clinical trials testing new treatments options for PA. Lastly, allergists stated that the severity of patient’s PA ranked as the most important factor in their decision to recommend oral immunotherapy for PA treatment. Conclusions This survey provides essential insights into the practice of allergists and highlights some areas that would inform strategies for education and improving PA healthcare.

One challenge in medical education is the inability to compare and aggregate outcomes data across continuing educational activities due to variations in evaluation tools, data collection approaches and reporting. To address this challenge, Gilead collaborated with CE Outcomes to develop, pilot, and implement a standardized outcomes evaluation across Gilead directed medical education activities around the world. Development of the standardized tool occurred during late 2018, with Gilead stakeholders invited to provide input on the questions and structure of the evaluation form. Once input was captured, a draft evaluation tool was developed and circulated for feedback. Questions were created to collect 1) participant demographic characteristics 2)data on planned changes to practice, key learnings and anticipated barriers, and 3) learner satisfaction with content and perceived achievement of learning objectives. The evaluation tool was piloted in H1 2019 across 7 medical education activities. Revisions based on pilot feedback were incorporated. The evaluation tool was broadly released during H2 2019 and data were collected from over 30 educational activities. By the end of 2019, it was possible to compare outcomes results from individual activities and aggregate data to demonstrate overall educational reach and impact. Continuing education activities provide valuable up-to-date information to clinicians with the goal of improving patient care. While often challenging to highlight the impact of education due to variations in outcomes, this standardized approach establishes a method to collect meaningful outcomes data that demonstrates the collective impact of continuing education and allows for comparison across individual activities.

This study sought to understand the evolving continuing medical education (CME) needs of physicians managing patients with tardive dyskinesia (TD). A case-based survey was developed, and later updated, to assess current practice, knowledge, and attitudes of neurologists and psychiatrists in the management of patients with TD. The original and updated survey were fielded in May 2018 and March 2020, respectively, to US-practicing psychiatrists and neurologists. Results were obtained from 213 psychiatrists and 187 neurologists in 2018 and from 125 psychiatrists and 128 neurologists in 2020. Less than half of physicians in both 2018 and 2020 were able to correctly identify the prevalence of TD in patients on maintenance antipsychotics, with many underestimating reported prevalence. Respondents reported moderate familiarity with VMAT2 inhibitor therapies for TD, with self-reported familiarity increasing more among neurologists than psychiatrists since the 2018 study. Psychiatrists are more likely than neurologists to take responsibility for medical management of TD symptoms and antipsychotic medication adjustment. Despite recommendations from APA guidelines and AAN reviews, 15% of physicians would use an anticholinergic to manage TD symptoms and only about half would opt for a VMAT2 inhibitor. There was a larger increase in VMAT inhibitor use between 2018 and 2020 among neurologists as compared to psychiatrists. The findings support the need for CME on TD focused toward specific provider groups. While both types of specialists would benefit from CME on the topic of TD epidemiology, there is an increased need for CME that includes treatment updates among psychiatrists.Funding. Neurocrine Biosciences, Inc.

The objective is to identify practice patterns and attitudes of and barriers faced by US physicians assessing thromboembolism/stroke risk and managing anticoagulation in atrial fibrillation (AF) to determine educational needs. Case-based surveys were used to assess practice patterns, guideline use, barriers, and attitudes; 51 cardiologists and 50 primary care physicians (PCPs) were surveyed. Most cardiologists use validated risk scoring systems to assess thromboembolism/stroke risk, and more than half of PCPs use clinical experience. Assessment of bleeding risk varied; more than half of respondents rely on clinical judgment or patient bleeding history. The most commonly used prophylactic agents are warfarin/another vitamin K antagonist (PCPs) or antiplatelet agents (cardiologists). Newer anticoagulants are used less frequently. Bleeding risk, need for frequent monitoring (vitamin K antagonists), and medication costs were the most significant barriers. Cardiologists and PCPs could benefit from education on validated scoring systems to assess risk of thromboembolism/stroke and bleeding in AF, on newly released AF guidelines, and on newer anticoagulants.

The purpose of this study was to describe practice patterns of US psychiatrists with regard to the diagnosis and management of depression in adults with bipolar I disorder and to identify relevant gaps in clinical knowledge and competence.Two focus groups were conducted using nominal group technique via a web interface and teleconference to elicit barriers that psychiatrists face in managing depression in patients with bipolar I disorder. These results framed a case-based survey that was administered to 200 US-based psychiatrists to explore and quantitatively assess their knowledge and practice patterns with respect to the diagnosis and management of depression in patients with bipolar I disorder. We completed all statistical analyses with PASW Statistics 18 and used descriptive statistics to summarize survey responses.To identify previously undiagnosed mania, 67% of clinician respondents said that they asked depressed patients if they had previously experienced all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision mania-defining symptoms. To treat a patient with symptoms of depression and no other risk factors for bipolar I disorder, 85% of the respondents said that they would use an antidepressant; 55% of respondents were not concerned that their choice of treatment would lead to a manic episode; 5% thought that there was no greater risk of treatment-emergent mood disorder when treating depression in patients with bipolar I disorder compared with major depressive disorder. If the patient had depression and risk factors for bipolar I disorder, 54% of the respondents said that they would still prescribe an antidepressant as monotherapy.The clinician responses were not adherent to evidence-based practice based on clinical trial results or current guideline recommendations. There is an unmet need for education to enable psychiatrists to differentiate between unipolar and bipolar depression, to identify the risk of treatment-emergent mood disorders with the use of antidepressants, and to effectively manage patients at risk for bipolar I disorder.

e16233Background: Most patients with pancreatic ductal adenocarcinoma (PDAC) are diagnosed with advanced disease and are ineligible for potentially curative surgical resection. Oncologists are face...

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