Mental health concerns reduce likelihood of hepatology referral in alcohol use disorder
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Key takeaways:
- Only 37% of patients with excessive alcohol use and a high FIB-4 received a referral for liver care.
- Mental health admissions or diagnoses and increasing age were associated with a lower likelihood of referral.
Nearly two-thirds of patients with excessive alcohol use and a high fibrosis-4 index were not referred for liver-related care, with fewer referrals among those with mental health disorders or alcohol-related mental health hospitalizations.
“We need to have greater education of all health care providers who take care of patients with AUD to ensure that advanced liver disease is not missed and adequate referrals are made,” Jasmohan S. Bajaj, MD, MS, FACG, study author and professor in the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University School of Medicine, told Healio.
To determine whether hepatology and mental health services could be better integrated in alcohol use disorder (AUD), Bajaj and colleagues conducted a retrospective cohort study of patients with excessive alcohol use between 2013 and 2023 in the largest public health system in Virginia.
Of 942 patients who met eligibility criteria, the researchers included 316 patients (mean age, 60.4 years; 72% men; 60% white) with active excessive alcohol use and a high FIB-4 score (> 2.67). The mean Charlson Comorbidity Index (CCI) was 3.57 for this patient sample.
According to results published in Alcohol, Clinical and Experimental Research, only 37% of these patients received a hepatology referral, despite active excessive alcohol use and a high FIB-4. Those who received referrals were more likely to have a higher FIB-4 (6.22±5.73 vs. 5.04±3.01), higher comorbidities per CCI (4.17±2.36 vs. 2.97±2.1) and be hospitalized with alcohol-related liver or gastrointestinal concerns (10% vs. 2.5%).
Conversely, patients were less likely to be referred if they presented with mental health disorders (12% vs. 25%) or were hospitalized for alcohol-related mental health concerns (17% vs. 40%) or trauma-related injuries (3% vs. 12 %).
Multivariable analysis showed that alcohol-related liver hospitalizations (OR = 9.25; 95% CI, 4.9–17.47) and a CCI greater than 3.4 (OR = 6.23; 95% CI, 3–12.94) were associated with higher referrals, while alcohol-related mental health hospitalizations (OR = 0.36; 95% CI, 0.15–0.48), mental health diagnoses (OR = 0.36; 95% CI, 0.15–0.82) and increasing age (OR = 0.95; 95% CI, 0.92–0.97) were associated with lower referrals.
These associations remained unchanged when accounting for race and male sex.
“We need to make sure that patients with AUD with high FIB-4 or other suggestions for chronic liver disease are made aware of these issues and they are provided education regarding resources for AUD and liver care simultaneously,” Bajaj told Healio. “Educate all health care professionals who encounter patients with AUD to check FIB-4 or ensure that chronic liver disease is not missed.”
He continued: “If they find it, we need to ensure prompt referral and patient education.”
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