S1876 Integrating Care for Alcohol-Associated Liver Disease With Alcohol Use Disorder: Unique Single Center Experience
Bibliographic record
Abstract
Introduction: Alcohol Use Disorder (AUD) has significant health, economic, and social consequences often leading to alcohol liver disease (ALD). Despite the necessity of alcohol cessation, < 5% of patients receive appropriate AUD care. In Canada, the underutilization of AUD treatment is compounded by geographic and socioeconomic disparities that further hinder access to care. This study examines the impact of integrated care on initiating AUD treatment, enhancing patient engagement, and reducing alcohol consumption in ALD patients. Methods: The study included patients who received integrated care at the Interdisciplinary ALD clinic at Health Sciences Centre, Winnipeg, Canada from March 2022 to June 2024. The interdisciplinary team comprised a hepatologist, addiction medicine specialist, psychiatrist and a patient partner. Participants included those with alcohol-associated cirrhosis or alcoholic hepatitis willing to engage in AUD treatment. Individualized care plans were developed, tailored to patient needs. The plans combined ALD management with AUD treatment and relapse prevention strategies, including behavioural therapy, psychotherapy, and pharmacotherapy. Patients completed AUDIT and EQ-VAS at baseline, 3 and 6 months. Baseline demographic, medical, liver disease and AUD treatment data were collected. Results: Overall, 52 patients were enrolled, median age 52 years (23-79), 60% males and 46% rural dwellers. Among participants, 37% were employed and 35% were on disability. Eighty percent had decompensated cirrhosis, 2 had hepatocellular carcinoma and 2 had liver transplantation. A significant majority (70%) had severe AUD. Of the participants, 72% received pharmacotherapy for relapse prevention, and 28% were referred for cognitive behavioural therapy. Additionally, 18% received prescriptions to address co-occurring psychiatric disorders, 20% were referred to local peer support groups, and 10% were facilitated to residential treatment facilities. During the 6-month follow-up, AUDIT scores decreased notably from 21 to 11. Approximately 35% of patients achieved abstinence or maintained sobriety. However, there were no significant changes in MELD-Na and Child-Pugh scores, nor in hospital admissions 6 months post-integrated care. Conclusion: The study highlights the positive impact of integrated care on patient engagement and uptake of AUD interventions among individuals with ALD, evidenced by a significant reduction in AUDIT scores and increased sobriety. An ongoing qualitative study will further evaluate patient experiences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".