for Alcohol-Associated Liver Disease
Liver cirrhosis is a symptom of a larger disease—alcohol use disorder.
Deaths from alcohol-associated liver disease have increased 58% in last decade.
Patients with alcohol use disorder are less likely to seek help. Liver failure presents unique opportunity for medical intervention when patient seeks medical care.
Proactive, coordinated patient care for treatment of alcohol-associated liver disease is less disruptive for patient in recovery and more cost effective than repeated hospitalizations.
Untreated addiction can cause liver disease to return; simply telling patient to “stop drinking” does not recognize patient’s addiction as a disease.
Poor diet compounds complications of a compromised liver. Telling patients to diet without coaching is less likely to work.
Lack of understanding of disease progression lulls patient into false sense of good health once cirrhosis symptoms disappear.
Undetected health concerns, such as thrush, may be discovered during transplant assessment, threatening patient’s condition and complicating approval for waitlist.
When liver disease returns, it can be at a more critical level and can result in an accelerated need for liver transplant.
While 6-month wait will end in August 2018 in Ontario, all other patients outside Ontario continue to face the 6-month wait. Holistic treatment could reduce pressure on liver transplant waitlists.
Liver Disease Treatment
Manages overall holistic treatment: responsible for case management and treatment flow; manages medical tests: bloodwork, endoscopy, digestive tract health (thrush); educates patient about disease management and goals of holistic treatment program; educates about short-term symptoms, expected long-term impact; provides materials that include links to comprehensive, reliable disease resources.
Responsible for patient’s diet and their understanding of impact of food on liver health. Works with patient to develop healthy, appropriate diet based on culture, family budget and personal food preferences.
Responsible for restoring liver health. Monitors patient’s progress. Ensures prompt referral for transplant assessment if liver health declines to MELD 12 and above.
Responsible for supporting patient recovery. Coordinates where necessary inpatient rehabilitation services. Prescribes appropriate anti-craving medication for patients who need enhanced treatment.
Models, Roles and Responsibilities
Urban LHINs: Liver Clinic
1 day | 4 appointments
Patients Referral by Family Doctor
Rural LHINs: Liver Care
Coordinated Treatment by
Nurse Practitioner Clinics
Nurse practitioner clinics as hub, using Ontario Telehealth Network models and technology for customized, comprehensive patient care with same team as urban centres.
eConsult: Specialists receive required patient data for review
eVisit: Patient meets with team through video connection
eCare: Patients are monitored or cared for in the comfort of their own home.