TY - JOUR
T1 - Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease
T2 - A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group
AU - Im, Gene Y.
AU - Mellinger, Jessica L.
AU - Winters, Adam
AU - Aby, Elizabeth S.
AU - Lominadze, Zurabi
AU - Rice, John
AU - Lucey, Michael R.
AU - Arab, Juan P.
AU - Goel, Aparna
AU - Jophlin, Loretta L.
AU - Sherman, Courtney B.
AU - Parker, Richard
AU - Chen, Po Hung
AU - Devuni, Deepika
AU - Sidhu, Sandeep
AU - Dunn, Winston
AU - Szabo, Gyongyi
AU - Singal, Ashwani K.
AU - Shah, Vijay H.
N1 - Publisher Copyright:
© 2021 AGA Institute
PY - 2021/11
Y1 - 2021/11
N2 - 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. Methods: 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. Results: 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. Conclusions: 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.
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Addiction Medicine
KW - Alcohol Pharmacotherapy
KW - Alcohol Survey
KW - Alcohol Use Disorder
KW - Alcohol-Associated Liver Disease
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U2 - 10.1016/j.cgh.2020.10.026
DO - 10.1016/j.cgh.2020.10.026
M3 - Article
C2 - 33069880
AN - SCOPUS:85101876611
SN - 1542-3565
VL - 19
SP - 2407-2416.e8
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 11
ER -