Shroff Hersh, Gallagher Heather
Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Substance Treatment and Recovery Program, University of North Carolina Hospital, Chapel Hill, North Carolina, USA.
Clin Ther. 2023 Dec;45(12):1177-1188. doi: 10.1016/j.clinthera.2023.09.016. Epub 2023 Oct 8.
Models of integrated, multidisciplinary care are optimal in the setting of complex, chronic diseases and in the overlap of medical and mental health disease, both of which apply to alcohol-related liver disease (ALD). Alcohol use disorder (AUD) drives nearly all cases of ALD, and coexisting mental health disease is common. ALD is a complex condition with severe clinical manifestations and high mortality that can occasionally lead to liver transplantation. As a result, integrated care for ALD is an attractive proposition. The aim of this narrative review was to: (1) review the overlapping and concerning trends in the epidemiology of AUD and ALD; (2) use a theoretical framework for integrated care known as the "five-component model" as a basis to highlight the need for integrated care and the overlapping clinical manifestations and management of the 2 conditions; and (3) review the existing applications of integrated care in this area.
We performed a narrative review of epidemiology, clinical manifestations, and management strategies in AUD and ALD, with a particular focus on areas of overlap that are pertinent to clinicians who manage each disease. Previously published models were reviewed for integrating care in AUD and ALD, both in the general ALD population and in the setting of liver transplantation.
The incidences of AUD and ALD are rising, with a pronounced acceleration driven by the Coronavirus Disease 2019 pandemic. Hepatologists are underprepared to diagnose and treat AUD despite its high prevalence in patients with liver disease. A patient who presents with overlapping clinical manifestations of both AUD and ALD may not fit neatly into typical treatment paradigms for each individual disease but rather will require new management strategies that are appropriately adapted. As a result, the dimensions of integrated care, including collective ownership of shared goals, interdependence among providers, flexibility of roles, and newly created professional activities, are highly pertinent to the holistic management of both diseases.
Integrated care models have proliferated as recognition grows of the dual pathology of AUD and ALD. Ongoing coordination across disciplines and research in the fields of hepatology and addiction medicine are needed to further elucidate optimal mechanisms for collaboration and improved quality of care.
综合多学科护理模式在复杂的慢性疾病以及医学与精神疾病重叠的情况下最为理想，这两种情况均适用于酒精性肝病（ALD）。酒精使用障碍（AUD）几乎导致所有ALD病例，且并存精神疾病很常见。ALD是一种具有严重临床表现和高死亡率的复杂病症，偶尔会导致肝移植。因此，对ALD进行综合护理是一个有吸引力的提议。本叙述性综述的目的是：（1）回顾AUD和ALD流行病学中重叠且相关的趋势；（2）使用一种称为“五要素模型”的综合护理理论框架，以此为基础强调综合护理的必要性以及这两种病症重叠的临床表现和管理方法；（3）回顾该领域综合护理的现有应用情况。
我们对AUD和ALD的流行病学、临床表现及管理策略进行了叙述性综述，特别关注与管理每种疾病的临床医生相关的重叠领域。我们回顾了先前发表的关于在AUD和ALD中进行综合护理的模型，包括在一般ALD人群以及肝移植背景下的模型。
AUD和ALD的发病率正在上升，2019年冠状病毒病大流行导致发病率显著加速上升。尽管肝病患者中AUD的患病率很高，但肝病专家在诊断和治疗AUD方面准备不足。同时出现AUD和ALD重叠临床表现的患者可能无法简单地纳入每种单一疾病的典型治疗模式，而是需要经过适当调整的新管理策略。因此，综合护理的各个方面，包括共同目标的集体所有权、提供者之间的相互依存、角色的灵活性以及新创建的专业活动，对于这两种疾病的整体管理非常相关。
随着对AUD和ALD双重病理认识的增加，综合护理模式不断涌现。肝病学和成瘾医学领域需要持续的跨学科协调和研究，以进一步阐明最佳协作机制并提高护理质量。
