Access to Comprehensive Services for Advanced Liver Disease in the Veterans Health Administration
Access to Comprehensive Services for Advanced Liver Disease in the Veterans Health Administration
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DOI：
10.1007/s10620-019-05785-2
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发表时间：
2019-12-01
影响因子：
3.1
通讯作者：
Beste, Lauren A.
中科院分区：
文献类型：
--
作者：
Dunn, S. Hunter;Rogal, Shari S.;Beste, Lauren A.
背景退伍军人健康管理局（VHA）为美国最大的晚期肝病（ALD）患者队列之一提供护理。我们进行了一项全国性调查，以评估在这个国家综合医疗保健环境中照顾ALD退伍军人的全系统优势和障碍。方法制定了一项52项调查，以评估获得和障碍，在退伍军人与ALD的照顾。该调查于2015年分发给所有VHA医疗中心。使用描述性统计分析结果。结果153个研究中心对本次调查做出了回应。80%以上的研究中心提供现场多学科服务。95%的网站提供心理健康和成瘾治疗，14%的网站在肝脏诊所内提供这些服务。少数研究中心（< 25%）在初级保健或肝病环境中提供酒精使用障碍的药物治疗。72%的研究中心报告至少有一个肝脏相关护理障碍。在报告至少有一个障碍的研究中心中，53%报告了肝移植转诊的障碍，理由是流程复杂，缺乏协调转诊的工作人员/资源。姑息治疗是广泛可用的，但61%的网站报告称，将< 25%的ALD患者转诊至姑息治疗服务。结论多学科服务的退伍军人ALD广泛提供VHA网站，虽然障碍，最佳的护理仍然存在。改善的机会包括扩大具有肝病学专业知识的提供者，将酒精使用障碍的药物治疗纳入肝病学和初级保健，简化移植转诊过程，以及扩大ALD患者的姑息治疗转诊。
Background The Veterans Health Administration (VHA) provides care to the one of the largest cohorts of patients with advanced liver disease (ALD) in the USA. Aims We performed a national survey to assess system-wide strengths and barriers to care for Veterans with ALD in this national integrated healthcare setting. Methods A 52-item survey was developed to assess access and barriers to care in Veterans with ALD. The survey was distributed to all VHA medical centers in 2015. Results were analyzed using descriptive statistics. Results One hundred and fifty-three sites responded to this survey. Multidisciplinary services were available on-site at > 80% of sites. Ninety-five percent of sites had mental health and addictions treatment available, with 14% co-locating these services within the liver clinic. Few sites (< 25%) provided pharmacologic treatment for alcohol use disorder in primary care or hepatology settings. Seventy-two percent of sites reported at least one barrier to liver-related care. Of the sites reporting at least one barrier, 53% reported barriers to liver transplant referral, citing complex processes and lack of staff/resources to coordinate referrals. Palliative care was widely available, but 61% of sites reported referring < 25% of their patients with ALD for palliative services. Conclusion Multidisciplinary services for Veterans with ALD are widely available at VHA sites, though barriers to optimal care remain. Opportunities for improvement include the expansion of providers with hepatology expertise, integrating pharmacotherapy for alcohol use disorder into hepatology and primary care, streamlining the transplant referral process, and expanding palliative care referrals for patients with ALD.