Feasibility and early experience of a novel multidisciplinary alcohol-associated liver disease clinic

• Published in: Journal of substance abuse treatment 2021-11, Vol.130, p.108396-108396, Article 108396
• Main Authors: Mellinger, Jessica L., Winder, Gerald Scott, Fernandez, Anne C., Klevering, Kristin, Johnson, Amanda, Asefah, Haila, Figueroa, Mary, Buchanan, Jack, Blow, Fred, Lok, Anna S.F.
• Format: Article
• Language: English
• Subjects: Addiction; Alcohol Drinking; Alcohol related disorders; Alcohol related mortality; Alcohol use; Alcohol use disorder; Alcoholic cirrhosis; Alcoholism; Ambulatory Care Facilities; Comorbidity; Emergency services; Feasibility; Feasibility Studies; Female; Hepatitis; Hospitalization; Humans; Inpatient care; Insurance; Liver cirrhosis; Liver Cirrhosis, Alcoholic; Liver diseases; Liver Diseases, Alcoholic; Medical treatment; Patient admissions; Psychiatry; Psychosocial factors; Psychosocial therapy; Quality; Relapse; Sobriety; Substance abuse; Substance abuse treatment; Treatment preferences; Women
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2021.108396

Alcohol cessation improves mortality in alcohol-associated liver disease (ALD), but access to treatment is limited. To address this gap, implementation and early feasibility and outcomes of a multidisciplinary ALD clinic are described. The clinic comprised a hepatologist, psychiatrist, psychologist, nurse, and social worker. Patients included those with alcohol-associated cirrhosis or acute alcoholic hepatitis who were not in the transplant evaluation process, who had less than 6 months’ sobriety and willingness to engage in alcohol use treatment. Psychosocial metrics in addition to routine hepatic function labs were collected. Treatment plans were tailored based on patient preferences and needs after multidisciplinary discussion. 89 patients were referred from both inpatient and outpatient settings, with 51 seen during the initial year. 38 remained active in clinic (4 died, 6 discharged, 3 moved to transplant clinic). 55% were women, 88% were white, 61% had private insurance. 49% had alcoholic hepatitis. 71% were decompensated. 80% had severe alcohol use disorder (AUD) and 84% had at least 1 comorbid psychiatric or substance use disorder. 63% chose one-on-one AUD treatment, 57% were prescribed relapse prevention medications. Mean MELD-Na score improved from baseline of 14 (SD 6.6) to 11.3 at 6 months (p=0.01). Hospital utilization significantly declined when comparing 6 months before to 6 months after initial visit (emergency department visits: 0.51 to 0.20 per person-month; inpatient admission: 0.34 to 0.14 per person-month; (β= -0.89, 95% CI -1.18 to -0.60). A multidisciplinary ALD clinic was feasible with encouraging early outcomes. Further research should explore ways to expand this model and increase clinic capacity. •Alcohol-related liver disease has become a public health emergency, especially for young people and women.•Integrated, multidisciplinary management of alcohol-related liver disease is recommended.•Integrated mental health and hepatology care is feasible and produced encouraging early outcomes.