Improving Outcomes in Alcoholic Liver Disease: Integrating Behavioral Interventions into the Hepatology Clinic

改善酒精性肝病的治疗效果：将行为干预措施纳入肝病临床

• 批准号: 10450674
• 负责人: Jessica Leigh Mellinger
• 金额: $ 19.44万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450674
• 关键词: Address; Alcohol consumption; Alcoholic Liver Diseases; Alcohols; Behavior Therapy; Behavioral; Behavioral Sciences; Belief; Cessation of life; Clinic; Clinical; Clinical Investigator; Complex; Data; Disease; E-learning; Education; Goals; Health; Health Care Costs; Healthcare Systems; Hepatology; Individual; Intervention; Interview; Learning Module; Legal patent; Literature; Liver; Liver Dysfunction; Liver diseases; Medical; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Patient Preferences; Patient-Focused Outcomes; Patients; Psyche structure; Readiness; Recovery; Research; Research Methodology; Research Project Grants; Research Proposals; Research Technics; Risk; Structure; Time; Training; United States; Visit; Woman; addiction; alcohol abstinence; alcohol abuse therapy; alcohol intervention; alcohol misuse; alcohol risk; alcohol use disorder; base; career; cost; design; drinking; experience; improved; improved outcome; innovation; liver function; men; mortality; motivational enhancement therapy; multimodality; non-alcoholic fatty liver disease; novel; novel strategies; online intervention; personalized approach; pilot test; preference; prevent; therapy design; tool; treatment research; willingness

ABSTRACT Alcoholic liver disease (ALD) causes nearly half of the liver-related deaths in the US, and with recent increases in alcohol use disorders, ALD-related deaths are expected to rise. Unfortunately, medical treatments to arrest liver dysfunction in ALD are of limited efficacy. Cessation of alcohol use, by contrast, is the only factor proven to curb long-term mortality, even in the most advanced stages of ALD. Yet many patients with ALD never cease alcohol use. Widely studied in the addiction literature, behavioral interventions for alcohol cessation have not been a major focus of research in hepatology, and we know little about why such severely ill patients continue to drink. Motivational interviewing may have benefit, but alone, may not be enough for these complex patients. Creating patient-specific interventions by finding and correcting errors in how patients view the risks of alcohol use and liver disease and understanding how these views impact alcohol treatment engagement (the “mental models” method) combined with tailored alcohol intervention engagement may be a more effective way of helping patients stop drinking. ALD patients often seek medical treatment for their liver disease while avoiding formal treatment to stop alcohol use. The hepatology visit is therefore a unique opportunity to transform existing liver health and alcohol use discussions into effective behavioral interventions to help ALD patients stop drinking. The goal of this project is to improve outcomes in ALD patents by developing a novel multimodal behavioral intervention, to be deployed in the hepatology clinic, to help patients stop drinking. We will accomplish this by 1) eliciting patient mental models of the liver-related risk of ongoing alcohol use and exploring how those beliefs are related to engagement in alcohol interventions, 2) developing a behavioral intervention combining tailored risk education with motivational enhancement and preference-sensitive alcohol treatment engagement, and 3) pilot testing this multimodal behavioral intervention in ALD patients. To accomplish these aims, Dr. Mellinger will receive mentorship and focused didactic coursework and training in alcohol misuse/use disorder treatment and research, behavioral intervention design and implementation, and advanced mixed-methods research techniques. Dr. Mellinger's long-term goal is to become a leading independent clinical investigator and expert in both hepatology and behavioral science in order to design behavioral interventions to improve outcomes for patients with alcoholic liver disease (ALD) by helping them stop drinking. An NIAAA K23 award will provide Dr. Mellinger with the protected time and needed training to achieve her career goals and improve outcomes for patients with ALD by helping them stop drinking.

摘要

项目成果

Impact of direct-acting antivirals for hepatitis C virus therapy on tacrolimus dosing in liver transplant recipients.

• DOI: 10.1111/tid.13078
• 发表时间: 2019-06
• 期刊: Transplant infectious disease : an official journal of the Transplantation Society
• 作者: Bixby AL;Fitzgerald L;Leek R;Mellinger J;Sharma P;Tischer S
• 通讯作者: Tischer S

Meeting Report: The Dallas Consensus Conference on Liver Transplantation for Alcohol Associated Hepatitis.

• DOI: 10.1002/lt.25681
• 发表时间: 2020-01
• 期刊: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
• 作者: Asrani SK;Trotter J;Lake J;Ahmed A;Bonagura A;Cameron A;DiMartini A;Gonzalez S;Im G;Martin P;Mathurin P;Mellinger J;Rice JP;Shah VH;Terrault N;Wall A;Winder S;Klintmalm G
• 通讯作者: Klintmalm G

Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis.

• DOI: 10.1016/j.jhep.2020.12.004
• 发表时间: 2021-06
• 期刊: Journal of hepatology
• 影响因子: 25.7
• 作者: Avanceña ALV;Miller N;Uttal SE;Hutton DW;Mellinger JL
• 通讯作者: Mellinger JL

Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation.

评估肝移植的酒精性肝病患者的性别差异。

• DOI: 10.1097/tp.0000000000002843
• 发表时间: 2020-02
• 期刊: Transplantation
• 影响因子: 6.2
• 作者: McElroy LM;Likhitsup A;Scott Winder G;Saeed N;Hassan A;Sonnenday CJ;Fontana RJ;Mellinger J
• 通讯作者: Mellinger J

Interprofessional teamwork is the foundation of effective psychosocial work in organ transplantation.

• DOI: 10.1016/j.genhosppsych.2021.02.002
• 发表时间: 2021-03
• 期刊: General hospital psychiatry
• 影响因子: 7
• 作者: Winder GS;Clifton EG;Fernandez AC;Mellinger JL
• 通讯作者: Mellinger JL