Combined Hepatology/Addictions Advanced Fibrosis Clinic Leads To High Attendance Rates Amongst Cohort With History Of Failure To Engage With Service.

Author: Biggart L, Barclay S, Sills L , Motaleb E, Ritchie C, Ready S, McGlinn S, Kane K

Theme: Epidemiology & Public Health Research Year: 2017

New direct acting antivirals (DAAs) make treatment in community settings easier. In our institution patients with F0-2 disease eligible for DAA treatment may be treated by nurses following MDT discussion, however those with F3/4 disease or eligible only for an interferon containing regimen (F0-2 GT3 patients) require Hepatology consultant review. Hospital attendance rates are historically poor. We initiated a pilot community advanced fibrosis clinic to attempt to engage such patients in care.

Patients with F3/4 fibrosis from previous investigation/partial assessment, or requiring assessment for interferon, were offered transfer of their Opiate Replacement Therapy (ORT) to a dedicated combined clinic. Assessment including education, bloods, fibroscan was performed by a Hepatology Nurse Specialist followed by a Hepatology Consultant review in a monthly outreach clinic. Prescription management aligned appointments to see the nurse and consultant with addictions review and ORT treatment.

From November 2016 to April 2017 26 patients were appointed for consultant review (8 (30.8%) Genotype 3 F0/2, 18 (69.2%) either F3 (4, 15.4%) or F4 (14, 53.8%)). 3 of the F3/4 patients were decompensated (2 Childs Pugh B, 1 Childs Pugh C). Median time from diagnosis was 7 (±6) years. 7 (26.9%) were drinking to excess, 7 (26.9%) reported current injecting drug use. Prior to referral to the consultant outreach clinic, patients had failed to attend 139 HCV related appointments (66 consultant, 73 nurse). Excluding 5 patients initially referred in 2016, the median number of missed appointments was 6 (±4). 23/26 (88.5%) of patients attended their consultant appointment for assessment. To date 9/26 (35%) have started treatment, treatment outcomes will be presented.

A dedicated combined addictions/hepatology advanced fibrosis outreach clinic demonstrated high attendance rates. This approach allowed hepatology review and management of a cohort with a high burden of advanced/decompensated liver disease, who had previously failed to attend multiple hospital appointments.

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