Introduction The National Liver Disease Strategy for England aims to provide high-quality care for all patients with all liver disease. There have been moves towards subspecialist management of patients with chronic viral hepatitis. It is unclear if this is also the case for Autoimmune Hepatitis (AIH). We are conducting a (BSG and HQIP funded) Management and Outcome Audit of AIH in 28 UK centres of varying size.
Method To report on current infrastructure in hospitals participating in the Multi-centre Audit. Hospitals used a web-based data collection tool to answer questions about their staff, facilities and service provision.
Results We received information from 27 hospitals: 13 classified themselves as District General Hospitals (DGHs) (9 with >500 beds) and 14 as University Hospitals (all with >500 beds). Fifteen hospitals accepted Hepatology referrals from other hospitals.
Total number of Consultant Gastroenterologists per hospital was (median (range)) 9(3–21). Of these, 2 (0–10) were Hepatologists (>70% of workload liver disease) and a further 0 (0–4) had an interest in liver disease (40–70% of workload). Eight hospitals (35%), all of them DGHs, did not have a Hepatologist and 3 (12%) had no Consultant with an interest in liver disease.
Number of Consultant Gastroenterologists managing AIH per hospital was 3.5(1–10) and number of Hepatologists managing AIH was 2(0–10). The percentage of all the Consultants who managed AIH was 43(20–100)%. This was higher in DGHs than in University Hospitals: 100(20–100%) vs 37(20–100%). In 8 hospitals (7 DGHs), all of the 6(3–10) Gastroenterologists managed AIH. In University Hospitals, all Hepatologists managed AIH and in 5 hospitals (with Hepatologists), so did other Gastroenterologists.
Eighteen hospitals (67%) had 1(0–6) specialist nurses mainly managing liver disease and 18 (67% provided telephone advice for patients with liver disease. However, in only three hospitals (12%) did these nurses manage outpatients with AIH. 16 hospitals (59%) had at >1 Histopathologist with an interest in liver disease and 70% had a joint clinical-pathological meeting. Eleven hospitals (42%) provided hospital information sheets for patients with AIH. Only three (12%) had departmental hospital guidelines for the management of AIH. Nine (33%) had database of patients with AIH.
Conclusion In contrast to chronic viral hepatitis, there has been little development of subspecialisation amongst Gastroenterology and Hepatology physicians and nurses in regard to management of AIH. There is variability in service provision but it is unclear if this influences outcome. All centres in the Audit now have a database to monitor their patients with AIH: this should help improve resource provision and aid management.
Disclosure of interest None Declared.
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