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Access to GI specialty care increases survival for patients with liver disease

Patients with liver disease achieved increased 5-year survival when they had access to gastrointestinal specialty care, according to data published in The American Journal of Gastroenterology.

“Patients with liver disease may experience problems with access to subspecialty care, due to many factors such as geographic clustering of specialists in tertiary-care centers,” Grace Su, MD, director of the Liver Specialty Care Access Network-Extension for Community Healthcare Outcomes program at VA Ann Arbor Healthcare System, Michigan, and colleagues wrote. “The goal of this study was to examine access to subspecialty care and its impact on survival prior to implementation of the [Specialty Care Access Network-Extension for Community Healthcare Outcomes program], a knowledge network [implemented by the Department of Veterans Affairs] linking primary care physicians to tertiary subspecialists.”

Grace Su

The researchers studied 28,861 patients enrolled in the Veterans Administration Veterans Integrated Service Network (VISN) 11 Liver Disease cohort diagnosed with liver disease between January 2000 and May 2011. The VISN 11 is a service network within the VA health care system that provides inpatient and outpatient care to veterans across Michigan, central Indiana and northwest Ohio.

Access to gastrointestinal (GI) care was defined as a patient having attended and completed an outpatient clinic visit with a gastroenterologist or hepatologist at any time after diagnosis of liver disease.

Fifty-five percent of all the patients received a GI referral and 37% had completed a GI visit (n = 10,710).

Multivariable regression analysis showed older patients (OR = 0.98; P < .001), patients with more comorbidities such as ascites or hepatocellular carcinoma (OR = 0.98; P = .01) and patients living far away from a tertiary-care center (OR = 0.998/mile; P < .001) were less likely to be seen in a clinic for a GI visit.

Patients diagnosed with hepatitis C virus infection (OR = 1.5; P < .001) or cirrhosis (OR = 3.5; P < .001) prior to their initial GI visit were more likely to be seen than patients with any other form of liver disease. Patients who lived in an urban area also were more likely to be seen (OR = 1.1; P < .001).

Patients with an ambulatory GI visit any time after diagnosis were less likely to die 5 years post-diagnosis compared with propensity-score–matched controls (HR = 0.81; P < .001). An additional propensity-adjusted survival analysis of patients above and below the median number of visits was performed and researchers found that patients who attended more than two GI visits (HR = 0.72; P < .001) had increased 5-year survival compared with patients who attended between one and two GI visits.

“Having access to subspecialty consultation is important for patients with liver disease,” Su told Healio.com/Hepatology. “In fact, having a clinic visit with a subspecialist is actually associated with increased life expectancy in these patients.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.