BRIDGE to liver health: implementation of a group telehealth psychoeducational program through shared medical appointments for MASLD management.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significantly costly and increasingly prevalent disease, with treatment focused on lifestyle intervention. Integrating education and behavioral health into clinical care offers opportunities to engage and empower patients to prevent progression of liver disease. We describe the design and implementation of Behavioral Resources and Intervention through Digital Group Education (BRIDGE), a 6-session group telehealth program led by advanced practice providers (APPs) in 90-min shared medical appointments (SMAs) with small groups of MASLD patients in an academic outpatient hepatology clinic. The program contains multi-component group interventions, with didactic education and behavioral coaching, while leveraging peer-based learning and support. METHODS: A mixed-methods exploratory pilot study was conducted. Feasibility and acceptability of the clinical intervention were assessed by tracking recruitment, attendance, and retention of BRIDGE participants, patient interviews, and debriefing of clinician and staff views of the clinical program. Implementation metrics included program development time, workflow and scheduling logistics, and billing compliance for sustainability. Finally, patient parameters including changes in liver enzymes, FIB-4, weight, and BMI from pre- to post-BRIDGE were retrospectively analyzed. RESULTS: We included 57 participants (median age 57, interquartile range (IQR) 50 - 65 years), 38 (67%) female, 38 (67%) white, and 40% had public insurance. Thirty-three (58%) participants completed all six sessions, while 43 (75%) attended at least five sessions. Patients who completed all sessions were older (median age 61 vs 53.5; p = 0.01). Gender, race/ethnicity, and insurance type were not significantly associated with missed sessions, and patients had similar rates of completion regardless of weight, BMI, or stage of liver disease. Barriers to completion included personal illness, family reasons, work commitments, or insurance issues. Prior to BRIDGE, median BMI was 31.9 (SD 29 - 36), with a median weight loss of 2 pounds (IQR -2 - 6) after BRIDGE. CONCLUSION: The BRIDGE telehealth SMA program was feasible, well-attended, and positively reviewed. This pilot study informs future iterations of program development and evaluation of outcome measures.

Addressing body-focused repetitive behaviors in the dermatology practice.

Dermatologists are often the first to treat the medical consequences of body-focused repetitive behaviors (BFRBs) such as hair pulling, skin picking, and others. BFRBs are still under-recognized, and effectiveness of treatments is known only in limited circles. Patients exhibit varied presentations of BFRBs and repeatedly engage in these despite the physical and functional impairments. Dermatologists are uniquely placed to guide patients lacking knowledge about BFRBs and experiencing stigma, shame, and isolation. We provide an overview of the current understanding of the nature and management of BFRBs. Clinical suggestions for diagnosing and educating patients about their BFRBs and resources for patients to seek support are shared. Most importantly, with patients' readiness for change, dermatologists can guide patients toward specific resources for self-monitoring their ABC (antecedents, behaviors, consequences) cycles of BFRBs and recommend specialized treatment options.

Psychosocial concerns and interventions for patients and their identified support givers to help cope with acute manifestations of advanced coronary artery diseases.

Advanced coronary artery disease is a chronic condition and often has acute exacerbations requiring multiple hospitalizations. Such hospitalizations profoundly affect the patients and their families, caregivers, and friends. Therefore, this article focuses on the most common psychosocial concerns experienced during acute episodes and has implications for patients and their families along the continuum from the acute to the chronic phases. In each of the sections of this article, we will include (1) identification of these common psychosocial concerns, (2) assessment, and (3) psychosocial interventions used to address these concerns in patients during the acute phase and as patients and their families transition to the chronic phase of cardiovascular disease management.