Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group.
Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group.
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DOI：
10.1016/j.cgh.2020.10.026
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Shah VH
中科院分区：
文献类型：
--
作者：
Im GY;Mellinger JL;Winters A;Aby ES;Lominadze Z;Rice J;Lucey MR;Arab JP;Goel A;Jophlin LL;Sherman CB;Parker R;Chen PH;Devuni D;Sidhu S;Dunn W;Szabo G;Singal AK;Shah VH
虽然促进戒酒的行为疗法和药物疗法是酒精使用障碍(AUD)和酒精相关性肝病(ALD)治疗基础的一部分，但这些疗法以及酒精筛查和教育往往没有得到充分利用。我们的目的是检查肝病患者在酒精筛查、治疗和教育方面的提供者态度和做法。我们对美国境内(80%)和境外(20%)的主要(89%)肝病和胃肠病提供者进行了调查。调查发送给了921名提供者，其中408名(44%)完成了回复，其中343名(80%)在三级肝移植中心工作。虽然肝病患者的酒精筛查率几乎是普遍的，但只有不到一半的提供者报告说，他们使用酒精生物标记物和筛查工具与综合成瘾提供者合作。40%的提供者认为肝病患者使用安全的酒精。虽然60%的提供者报告推荐AUD患者进行行为疗法，但71%的人从未开过AUD药物疗法，因为舒适度较低(84%)。大多数提供者(77%)报告说，他们的成瘾教育程度较低，90%的人希望在胃肠道/肝病团契培训期间接受更多成瘾教育。在处方医生中，巴氯芬是首选，但在药物治疗知识方面存在差距。总体而言，ALD对2019年AASLD实践指南的遵从率较低，尽管肝病专家和经验丰富的提供者的遵从率较高。虽然我们对肝病和胃肠病提供者的调查显示，行为疗法的酒精筛查和转诊比例较高，但我们发现，由于教育不足造成的知识差距，开AUD药物疗法的比例较低。需要进一步的研究来评估干预措施，以改善提供者与治疗AUD和ALD患者的最佳实践的一致性。
While abstinence-promoting behavioral and pharmaco-therapies 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. We conducted a survey of primarily (89%) hepatology and gastroenterology providers within (80%) and outside the US (20%). Surveys were sent to 921 providers with 408 complete responses (44%), of whom 343 (80%) work in a tertiary liver transplant center. 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. 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.
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影响因子：
25.8
作者：
Gustafson, David H.;McTavish, Fiona M.;Chih, Ming-Yuan;Atwood, Amy K.;Johnson, Roberta A.;Boyle, Michael G.;Levy, Michael S.;Driscoll, Hilary;Chisholm, StevenM.;Dillenburg, Lisa;Isham, Andrew;Shah, Dhavan
通讯作者：
Shah, Dhavan
DOI：
10.1016/j.cgh.2019.07.042
发表时间：
2020-04
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Rich NE;Yang JD;Perumalswami PV;Alkhouri N;Jackson W;Parikh ND;Mehta N;Salgia R;Duarte-Rojo A;Kulik L;Rakoski M;Said A;Oloruntoba O;Ioannou GN;Hoteit MA;Moon AM;Rangnekar AS;Eswaran SL;Zheng E;Jou JH;Hanje J;Pillai A;Hernaez R;Wong R;Scaglione S;Samant H;Kapuria D;Chandna S;Rosenblatt R;Ajmera V;Frenette CT;Satapathy SK;Mantry P;Jalal P;John BV;Fix OK;Leise M;Lindenmeyer CC;Flores A;Patel N;Jiang ZG;Latt N;Dhanasekaran R;Odewole M;Kagan S;Marrero JA;Singal AG
通讯作者：
Singal AG
DOI：
10.1016/j.cgh.2017.11.045
发表时间：
2018-08
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Cholankeril G;Ahmed A
通讯作者：
Ahmed A
影响因子：
3.9
作者：
Mellinger, Jessica L.;Winder, G. Scott;Blow, Frederic C.
通讯作者：
Blow, Frederic C.
影响因子：
3.2
作者：
Donnadieu-Rigole, Helene;Olive, Laetitia;Perney, Pascal
通讯作者：
Perney, Pascal