Training of hepatology providers improves the screening and resultant interventions for alcohol use disorder

Abstract

Alcohol use disorder (AUD) screening is important but focused training with using AUDIT‐10 with counselling/mental health (MH) referral may be needed. We aimed to compare the effect of training on AUD screening/intervention in hepatology clinics in pre vs post‐training phases of a quality‐improvement initiative. Pre‐training encounters were evaluated for inquiry into AUD, AUDIT‐10 and MH referrals. Dedicated AUD‐related training was provided to hepatology providers and analyses repeated post‐training. Pre‐training (n = 378) and post‐training patients(n = 318) had similar demographics and disease characteristics. Post‐training there was higher inquiry about alcohol(92% vs 80%, P < .0001), counselling (82% vs 68%, P < .0001). This led to higher diagnosis of drinkers (49% vs 31%, P < .0001) of whom higher proportion had AUDIT‐10 administered(91% vs 34%, P < .0001) and referred to MH(29% vs 8%, P < .0001). On regression presumed alcohol‐related aetiology, younger age and post‐training period were associated with AUDIT‐10 administration. AUD‐focused training significantly improves rates of screening and MH referral for problem drinking in a hepatology clinic population.

Screening for alcohol use disorder and monitoring for alcohol use in the liver clinic

“…Inclusion of focused addiction medicine training within the hepatology fellowship curriculum is needed to improve awareness and comfort of hepatologists in screening and addressing AUD among patients with liver disease seen in both outpatient and inpatient settings. [12,14] CONFLICTS OF INTEREST Ashwani K.…”

Substance‐use simulation impairs driving capability in patients with cirrhosis regardless of hepatic encephalopathy

“…[19] This is further worsened from the provider standpoint with the need to improve questioning and documentation of alcohol-use disorder in clinics. [20] Alcohol use and its link to fatal crashes have been well established with another recent, large, paired-matched study highlighting this association. [21] Our study noted that simulating alcohol intake with BAC >0.17% and driving under simulation induces greater CCs but lower REEs in patients with cirrhosis, especially in those with prior HE.…”

“…[ 19 ] This is further worsened from the provider standpoint with the need to improve questioning and documentation of alcohol‐use disorder in clinics. [ 20 ] Alcohol use and its link to fatal crashes have been well established with another recent, large, paired‐matched study highlighting this association. [ 21 ]…”

Bridging the Gap: Dual Fellowship Training in Addiction Medicine and Digestive Diseases

“…Analogous efforts are emerging within hepatology, particularly in the care of patients with ALD and HCV [ 40 ]. Measures to implement standardized screening for unhealthy alcohol use with validated instruments such as the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) within hepatology clinics can increase identification of alcohol use disorder and referrals to addiction treatment [ 41 ]. Incorporation of addiction specialists and dedicated addiction treatment units within liver transplantation programs are associated with decreased rates of alcohol use among patients with ALD before and after transplantation [ 42 ].…”