| Autor: |
William Blad, Maryam Noeman, Rajan N. Patel, Indrajit Ghosh, Sehar Farooq, Deepak Suri, Lourdes Cumlat |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Oral. |
| DOI: |
10.1136/gutjnl-2020-bsgcampus.72 |
| Popis: |
Introduction The current landscape of service provision for patients with liver disease does not match that of disease burden. A North London-based drug and alcohol dependency unit (‘Better Lives’) provides blood borne virus (BBV) screening and opioid substitution therapy (OST) as well as Hepatitis C Virus (HCV) treatment. These patients are often complex with marginalised social needs, have chaotic lifestyles and don’t engage with conventional care models. We aimed to describe the demographics of a cohort of patients seen in a novel community outreach clinic (OC). Methods Approximately 1000 patients per year receive OST from ‘Better Lives’ via a multidisciplinary clinic with doctors, nurses and recovery workers. 117 (11.7%) screened positive for chronic HCV. 22 (18.8% of chronic HCV patients, 2.2% of those receiving OST) with advanced liver fibrosis or cirrhosis (F3/F4) were referred to OC between November 2018 and September 2019. We used electronic hospital records to assess ‘Did Not Attend’ (DNA) rates to outpatient appointments (OPA) and emergency department (ED) attendances prior to review in OC and completion of key investigations afterward. Results 22 patients referred to OC in the study period (median age 52 (IQR 46.3 – 57), 81.8% male, 40.9% white). 14 patients (63.6%) attended. Chronic HCV primary aetiology in 12 (54.5%), 11 (50%) self-reported ongoing alcohol intake and 4 (18%) were people who inject drugs (PWID). Median liver stiffness 19 kPa (IQR 12.95 – 36.1). 12 (54.5%) did not have registered GPs. 15 (68.2%) DNA hospital appointments prior to OC clinic. Conclusion This is the first UK-based nurse-delivered community liver cirrhosis outreach clinic aimed to improve treatment and supportive medical care and offer a link to hospital cirrhosis services. We re-engaged two-thirds of complex marginalised patients with advanced fibrosis via OC that would otherwise have been lost to follow up. Patients attending OC had an average of 2 prior DNA to hospital OPA and 6 ED attendances. 35% and almost 50% of patients had their surveillance US abdomen and gastroscopies, respectively, following attendance to OC compared with only 12% who did not attend. Further work to investigate if a community based liver outreach clinic can improve the trajectory of marginalised patients is required. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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