Introduction Currently patients at high risk of developing alcoholic liver disease are given advice by health professionals, often only reach hepatology services once advanced cirrhosis or complications are seen. This out-dated system needs improvement to avoid an unprecedented increase in advanced liver disease. We aim to show that our new service of proactive assessment of at risk patients will allow earlier recognition of liver disease in this patient group.
Method All eligible patients had no history of liver disease and had never seen gastroenterology/hepatology. Patients were referred from Alcohol Specialist Nurses (ASN), Alcohol Assertive Outreach Team (AAOT), Specialist Drug and Alcohol Services (SDAS) or GP after screening using Alcohol Use Disorders Identification Test (AUDIT), with a score ≥16 required. All patients were seen in community clinic by hepatology Advanced Nurse Practioner (ANP), undertaking full clinical assessment and Transient Elastrography (TE) using Fibroscan. Follow up: TE <8 kPa – repeat in 12 months, TE 8–12 kPa – repeat in 6 months, TE 12–20 kPa – repeat in 3 months, TE >20 kPa – refer to hepatology clinic. Any clinical concern regardless of TE score was also referred. All patients were seen between Nov 2013 and Feb 2015.
Results 527 eligible patients, 387 male and 140 female. Ages ranged from 20–82, mean age 46.1. AUDIT scores range was 16–52, with 79.1% of patients scoring 26–40. 189 patients, 141 male and 48 female, were seen with the remainder failing to attend. 64 (33.8%) reported alcohol abstinence since referral, with a further 7 (3.6%) drinking <21 U/week. 83 patients (43.9%) were high risk, still drinking >50 U/week. TE scores were: <8 kPa in 146 patients, 8–12 kPa in 19, 12–20 kPa in 10, >20 kPa in 7, no result in 7. Those with higher AUDIT scores (26–40) were more likely to have abnormal TE (18.8% >8 kPa) and 42.8% of TE >20 kPa AUDIT was 36–40. 17 patients (8.9%) were referred to hepatology, 7 with TE >20 kPa and 10 on clinical grounds. The remainder had follow up arranged appropriately.
Conclusion Our new service identified a number of patients who would benefit from specialist hepatology input. Those not requiring specialist input yet may benefit long term from assessment but prospective data on follow up is still in its infancy. As expected, those at higher risk were more likely to have evidence of liver disease. In addition, more than 1/3 of patients involved in this service significantly reduced their alcohol intake. Methods into improving attendance rates needs to be investigated. Overall our service for prospective assessment of those at high risk of alcohol related liver disease is a dynamic new approach that we hope will lead to a greater emphasis on primary prevention.
Disclosure of interest None Declared.
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