Introduction Alcohol misuse is the major cause of the increase in deaths from liver disease in the UK,1 particularly in Scotland2 and particularly in areas of social deprivation. Liver disease usually presents late, with advanced liver disease and cirrhosis often asymptomatic.3 Patients with alcohol misuse in areas of social deprivation are a “hard to reach” population. This study assessed the feasibility of using a portable Fibroscan® to measure transient elastography (TE), a non-invasive method of assessing hepatic fibrosis, as a screening tool within a community alcohol support service.
The study monitored the uptake of a Fibroscan® in individuals accessing one community alcohol support service in a deprived area; determined the apparent prevalence of undiagnosed fibrosis/cirrhosis in participants over a 6 month period; and monitored engagement following referral to specialist liver services of those individuals with TE > 7 kPa.
Methods Numbered research information packs were issued on request to individuals who self-identified as harmful drinkers. Consented individuals with a TE > 7 kPa were referred to a nurse-led service within the community service for further tests; results of which determined onward referral to a liver specialist. Participants were monitored for compliance with appointments and follow-up interventions.
Results 118 research packs issued with 79 participants: (67%) uptake. 3 unreliable Fibroscan® results (n = 76). 20 (26%) participants had a reading >7 kPa requiring referral to nurse led service. 12 (16%) with indications of significant liver disease requiring onward referral to liver specialist including 5 (7%) indicative of cirrhosis.19/20 (95%) participants requiring referral to nurse led service attended for further investigations.11/12 (92%) participants requiring onward referral to specialist services attended initial appointment.
Conclusion A 67% uptake suggests a nurse led Fibroscan® service in a community alcohol service is acceptable. Early indications show a high compliance with liver services offering potential for early intervention and improved health outcomes.
References 1 British Association for the Study of the Liver and British Society of Gastroenterology 2009. The National Plan for Liver Services. A time to act: improving liver health and outcomes in liver disease.
2 Scottish Public Health Observatory 2015. Public Health Information for Scotland.
3 Williams R, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384:1953–1997.
Disclosure of Interest None Declared