Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
Clin Gastroenterol Hepatol. 2021 Nov;19(11):2407-2416.e8. doi: 10.1016/j.cgh.2020.10.026. Epub 2020 Oct 16.
BACKGROUND & AIMS: While abstinence-promoting behavioral and pharmacotherapies are part of the therapeutic foundation for alcohol use disorder (AUD) and alcohol-associated liver disease (ALD), these therapies, along with alcohol screening and education, are often underutilized. Our aim was to examine provider attitudes and practices for alcohol screening, treatment and education in patients with liver disease.
We conducted a survey of primarily (89%) hepatology and gastroenterology providers within (80%) and outside the United States (20%). Surveys were sent to 921 providers with 408 complete responses (44%), of whom 343 (80%) work in a tertiary liver transplant center.
While alcohol screening rates in liver disease patients was nearly universal, less than half of providers reported practicing with integrated addiction providers, using alcohol biomarkers and screening tools. Safe alcohol use by liver disease patients was felt to exist by 40% of providers. While 60% of providers reported referring AUD patients for behavioral therapy, 71% never prescribed AUD pharmacotherapy due to low comfort (84%). Most providers (77%) reported low addiction education and 90% desired more during GI/hepatology fellowship training. Amongst prescribers, baclofen was preferred, but with gaps in pharmacotherapy knowledge. Overall, there was low adherence to the 2019 AASLD practice guidance for ALD, although higher in hepatologists and experienced providers.
While our survey of hepatology and gastroenterology providers demonstrated higher rates of alcohol screening and referrals for behavioral therapy, we found low rates of prescribing AUD pharmacotherapy due to knowledge gaps from insufficient education. Further studies are needed to assess interventions to improve provider alignment with best practices for treating patients with AUD and ALD.
尽管促进戒酒的行为和药物疗法是酒精使用障碍（AUD）和酒精相关肝病（ALD）治疗基础的一部分，但这些疗法以及酒精筛查和教育往往未得到充分利用。我们的目的是研究肝病患者中酒精筛查、治疗和教育方面提供者的态度和实践。
我们对美国（80%）和美国以外地区（20%）的主要（89%）肝脏病学和胃肠病学提供者进行了一项调查。向 921 名提供者发送了调查，其中 408 名完成了调查（44%），其中 343 名（80%）在三级肝移植中心工作。
尽管肝病患者的酒精筛查率几乎是普遍的，但不到一半的提供者报告与综合成瘾提供者合作，使用酒精生物标志物和筛查工具。40%的提供者认为肝病患者可以安全饮酒。尽管 60%的提供者报告将 AUD 患者转介进行行为治疗，但由于舒适度低（84%），71%的提供者从未开处 AUD 药物治疗。大多数提供者（77%）报告说接受的成瘾教育较少，90%的人希望在胃肠病学/肝脏病学住院医师培训中接受更多的教育。在开处方者中，巴氯芬是首选，但在药物治疗知识方面存在差距。总体而言，尽管在肝脏病学家和经验丰富的提供者中，对 2019 年 AASLD 关于 ALD 的实践指南的遵循率较低，但仍较低。
尽管我们对肝脏病学和胃肠病学提供者的调查显示，酒精筛查和转介行为治疗的比率较高，但由于教育不足导致知识差距，开处 AUD 药物治疗的比率较低。需要进一步研究以评估干预措施，以提高提供者与治疗 AUD 和 ALD 患者的最佳实践的一致性。
