1
|
Hjorth M, Svanberg A, LoMartire R, Kaminsky E, Rorsman F. Patient perceived quality of cirrhosis care- adjunctive nurse-based care versus standard medical care: a pragmatic multicentre randomised controlled study. BMC Nurs 2024; 23:251. [PMID: 38637755 PMCID: PMC11027520 DOI: 10.1186/s12912-024-01934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Cirrhosis treatment implies prevention and alleviation of serious disease events. Healthcare providers may, however, fail to meet patients' expectations of collaboration and specific needs of information and support. Individualised nursing care could meet patients' needs. The aim was thus to measure patient-perceived quality of care after adjunctive registered nurse-based intervention Quality Liver Nursing Care Model (QLiNCaM) compared with standard medical care. METHODS This pragmatic multicentre study consecutively randomised patients to either adjunctive registered nurse-based care, or standard medical care for 24 months (ClinicalTrials.gov NCT02957253). Patients were allocated to either group at an equal ratio, at six Swedish outpatient clinics during 2016-2022. Using the questionnaire 'Quality of care from the patient's perspective', patients rated their perceived lack of quality for the adjunctive registered nurse-based intervention compared with the control group at 12 and 24 months, respectively. RESULTS In total, 167 patients were recruited. Seven out of 22 items in the questionnaire supported the finding that 'lacking quality' decreased with adjunctive registered nurse-based care (p < 0.05) at 12 months follow-up; however, these differences could not be established at 24 months. CONCLUSION Additional structured registered nurse-based visits in the cirrhosis outpatient team provided support for improved patient-perceived quality of care during the first 12 months. Registered nurses increase patient involvement and present easy access to cirrhosis outpatient care. Patients express appreciation for personalised information. This study reinforces registered nurses' role in the outpatient cirrhosis team, optimising patient care in compensated and decompensated cirrhosis. TRIAL REGISTRATION Registered at Clinical Trials 18th of October 2016, [ https://www. CLINICALTRIALS gov ], registration number: NCT02957253.
Collapse
Affiliation(s)
- Maria Hjorth
- Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden.
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | | | - Riccardo LoMartire
- Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden
- School of Health and Wellfare, Dalarna University, Falun, Sweden
| | - Elenor Kaminsky
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Rorsman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
2
|
Parker R, Allison M, Anderson S, Aspinall R, Bardell S, Bains V, Buchanan R, Corless L, Davidson I, Dundas P, Fernandez J, Forrest E, Forster E, Freshwater D, Gailer R, Goldin R, Hebditch V, Hood S, Jones A, Lavers V, Lindsay D, Maurice J, McDonagh J, Morgan S, Nurun T, Oldroyd C, Oxley E, Pannifex S, Parsons G, Phillips T, Rainford N, Rajoriya N, Richardson P, Ryan J, Sayer J, Smith M, Srivastava A, Stennett E, Towey J, Vaziri R, Webzell I, Wellstead A, Dhanda A, Masson S. Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group. BMJ Open Gastroenterol 2023; 10:e001221. [PMID: 37797967 PMCID: PMC10551993 DOI: 10.1136/bmjgast-2023-001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care. DESIGN A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives. RESULTS The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided. CONCLUSION It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.
Collapse
Affiliation(s)
- Richard Parker
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, UK
| | | | - Seonaid Anderson
- Angus Integrated Drug and Alcohol Recovery Service (AIDARS), Ninewells Hospital and Medical School, Dundee, UK
| | - Richard Aspinall
- Gastroenterology & Hepatology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Sara Bardell
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vikram Bains
- Liver Transplant Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Ryan Buchanan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lynsey Corless
- Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Ian Davidson
- NHS Fife Addiction Services, NHS Fife, Kirkcaldy, UK
| | - Pauline Dundas
- Peter Brunt Centre, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Jeff Fernandez
- Alcohol and Drug Liaison, Royal Free London NHS Foundation Trust, London, UK
| | - Ewan Forrest
- Dept of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Erica Forster
- Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dennis Freshwater
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ruth Gailer
- Islington Primary Care Federation, London, UK
| | - Robert Goldin
- Department of Digestive Diseases, Department of Medicine, Imperial College London, London, UK
| | | | - Steve Hood
- Digestive Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Arron Jones
- Pharmacy, Barts and The London NHS Trust, London, UK
| | | | - Deborah Lindsay
- Alcohol Care Team, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - James Maurice
- Gastroenterology and hepatology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Joanne McDonagh
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Tania Nurun
- Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Sally Pannifex
- Hepatology, St George's Healthcare NHS Trust, London, UK
| | | | | | - Nicole Rainford
- Liver Transplant Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Neil Rajoriya
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Richardson
- Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - J Ryan
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Joanne Sayer
- Gastroenterology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK
| | - Mandy Smith
- Alcohol care team, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Ankur Srivastava
- Gastroenterology and hepatology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Emma Stennett
- Gastroenterology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jennifer Towey
- Birmingham Liver Services Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ian Webzell
- Liver Transplant Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wellstead
- Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Ashwin Dhanda
- Faculty of health, University of Plymouth, Plymouth, UK
| | - Steven Masson
- Liver unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| |
Collapse
|
3
|
Oldroyd C, Greenham O, Martin G, Allison M, Notley C. Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol-associated hepatitis. Aliment Pharmacol Ther 2023; 58:763-773. [PMID: 37602505 DOI: 10.1111/apt.17665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Alcohol use is the most important factor in determining the prognosis of patients with alcohol-related cirrhosis and alcohol-associated hepatitis. AIM To conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol-associated hepatitis. METHODS We searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non-randomised studies. Risk of bias was assessed using validated tools. Where possible, meta-analysis was performed. RESULTS Twenty-three studies met the inclusion criteria including six randomised trials and 17 non-randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4-16.1). Three non-randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta-analysis of non-randomised studies that examined the impact of psychological therapies revealed statistically non-significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38-9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12-1.77). CONCLUSIONS Baclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non-randomised studies also point to non-pharmaceutical interventions possibly improving clinical outcomes.
Collapse
Affiliation(s)
- Christopher Oldroyd
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivia Greenham
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham Martin
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Michael Allison
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK
- Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caitlin Notley
- Addiction Research Group, University of East Anglia, Norwich, UK
| |
Collapse
|
4
|
O’Connell MB, Bendtsen F, Nørholm V, Brødsgaard A, Kimer N. Nurse-assisted and multidisciplinary outpatient follow-up among patients with decompensated liver cirrhosis: A systematic review. PLoS One 2023; 18:e0278545. [PMID: 36758017 PMCID: PMC9910708 DOI: 10.1371/journal.pone.0278545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/18/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Liver cirrhosis represents a considerable health burden and causes 1.2 million deaths annually. Patients with decompensated liver cirrhosis have a poor prognosis and severely reduced health-related quality of life. Nurse-led outpatient care has proven safe and feasible for several chronic diseases and engaging nurses in the outpatient care of patients with liver cirrhosis has been recommended. At the decompensated stage, the treatment and nursing care are directed at specific complications, educational support, and guidance concerning preventive measures and signs of decompensation. This review aimed to assess the effects of nurse-assisted follow-up after admission with decompensation in patients with liver cirrhosis from all causes. METHOD A systematic search was conducted through February 2022. Studies were eligible for inclusion if i) they assessed adult patients diagnosed with liver cirrhosis that had been admitted with one or more complications to liver cirrhosis and ii) if nurse-assisted follow-up, including nurse-assisted multidisciplinary interventions, was described in the manuscript. Randomized clinical trials were prioritized, but controlled trials and prospective cohort studies with the intervention were also included. Primary outcomes were mortality and readmission, but secondary subjective outcomes were also assessed. RESULTS AND CONCLUSION We included eleven controlled studies and five prospective studies with a historical control group comprising 1224 participants. Overall, the studies were of moderate to low quality, and heterogeneity across studies was substantial. In a descriptive summary, the 16 studies were divided into three main types of interventions: educational interventions, case management, and standardized hospital follow-up. We saw a significant improvement across all types of studies on several parameters, but currently, no data support a specific type of nurse-assisted, post-discharge intervention. Controlled trials with a predefined intervention evaluating clinically- and practice-relevant endpoints in a real-life, patient-oriented setting are highly warranted.
Collapse
Affiliation(s)
- Malene Barfod O’Connell
- Gastrounit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
- * E-mail:
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| | - Vibeke Nørholm
- Clinical Research Department, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
| | - Nina Kimer
- Gastrounit, Medical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| |
Collapse
|
5
|
Mu Y, Wang K, Yang G, Zhang Z, Xu Y, Dang F, Lv Y, Wang R. Associations of intestinal barrier function, inflammatory factors and nutritional status of liver cancer patients with severity of disease and prognosis. Minerva Med 2022; 113:1047-1048. [PMID: 32940435 DOI: 10.23736/s0026-4806.20.06992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Yiping Mu
- Department of Medical Information Management Office, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaifei Wang
- Department of Emergency, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ganghua Yang
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ziyun Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Xu
- Department of Medical Information Management Office, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fuping Dang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China -
| | - Ruitao Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
6
|
Hyde AM, Watt M, Carbonneau M, Eboreime EA, Abraldes JG, Tandon P. Understanding Preferences Toward Virtual Care: A Pre-COVID Mixed Methods Study Exploring the Perspectives of Patients with Chronic Liver Disease. Telemed J E Health 2021; 28:407-414. [PMID: 34085869 DOI: 10.1089/tmj.2021.0099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Traditionally, outpatient visits for those with chronic liver disease (CLD) have been delivered in-person with the patient traveling to a centralized location to see the health care provider. The use of virtual care in health care delivery has been gaining popularity across a variety of patient populations, especially within the COVID-19 context. Performed before COVID-19, the aim of the present study was to explore the perspectives of patients with CLD toward the use of virtual care with their liver specialists. Methods: A cross-sectional, mixed methods study was used to conduct this work. Results: A total of 101 patients with CLD participated in this study. Participants had a mean age of 54.5 years (range 19-87 years). Quantitative analysis revealed that 86% were willing to attend a virtual visit with their liver specialist in the future. There was a significant relationship between both age and income level and acceptance of virtual care. The themes emerging from the qualitative analysis included: (1) past experiences attending in-person visits, (2) perspectives on the use of virtual visits, and (3) perceived challenges of virtual visits. Conclusions: Although there are many potential benefits of virtual care to both the patient and the health care system, there are instances (older age, low income level) when in-person care may be preferred by patients. A tailored approach that is mindful of the individual patient's health status, ease of access to technology, and preferences must be considered when offering virtual care. These findings are of particular relevance during COVID-19, an era that has forced us into the virtual space.
Collapse
Affiliation(s)
- Ashley M Hyde
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Makayla Watt
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Michelle Carbonneau
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Alberta Health Services, Edmonton, Canada
| | - Ejemai Amaize Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Juan G Abraldes
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, Canada
| |
Collapse
|
7
|
Patel H, Balar B, Irigela M, Vootla V, Chandrala C, Hashmi H, Abdulsamad M, Makker J. Risk Factors for Liver Cirrhosis-Related Readmissions in the Largest Ethnic Minority in United States. Gastroenterology Res 2020; 13:11-18. [PMID: 32095168 PMCID: PMC7011917 DOI: 10.14740/gr1227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background There are very limited data available on 30-day readmissions for ethnic minority patients with cirrhosis. The aim of the study was to identify the risk factors for 30-day readmission in ethnic minority patients admitted for cirrhosis. Methods We did a retrospective review of 1,373 electronic medical records of patients with cirrhosis admitted from 2009 to 2011. Several parameters including alcohol use history, discharge location and cirrhosis severity scores - model for end-stage liver disease (MELD) score and Child-Pugh-Turcotte (CPT) at first admission were assessed. Statistical analysis was done using Chi-square test and t-test for categorical and continuous variables, respectively. Results There were 79 patients in the readmission group (63% male, 54% Hispanics and 22% African Americans) and 104 in the no readmission group (62% male, 58% Hispanics and 24% African Americans). History of alcohol use within a month prior to admission (55% vs. 33%, P = 0.002), platelet count at discharge (89,000 vs. 124,000, P = 0.003), and discharge with more than seven medications per day (7.3 vs. 5.2, P = 0.005) were identified as risk factors for readmissions by multivariate analysis. Conclusion Platelet count, active alcohol use and more than seven medications at discharge are predictors of readmission. These parameters can guide future interventions to reduce readmission rate and health care costs related to cirrhosis readmissions.
Collapse
Affiliation(s)
- Harish Patel
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Bhavna Balar
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Maheswara Irigela
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Vamshidhar Vootla
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Chaitanya Chandrala
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Hafiz Hashmi
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Molham Abdulsamad
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| | - Jasbir Makker
- Department of Medicine, BronxCare Health System, 1650 Selwyn Ave., Bronx, NY 10457, USA
| |
Collapse
|