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Access to Comprehensive Services for Advanced Liver Disease in the Veterans Health Administration

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Abstract

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.

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Funding

This study was supported by the VHA’s HIV, Hepatitis, and Related Conditions Programs in the Office of Specialty Care Services and by the HAIG. There was no specific grant support for this study.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    S. Hunter Dunn

  2. Departments of Surgery and Medicine, VA Pittsburgh Healthcare System, 1 University Drive, Pittsburgh, PA, 15240, USA

    Shari S. Rogal

  3. Division of Infectious Diseases, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA

    Marissa M. Maier

  4. HIV, Hepatitis, and Related Conditions Programs Office of Specialty Care Services, U.S. Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC, 20571, USA

    Maggie Chartier

  5. Gastroenterology Section, VA Long Beach Healthcare System, 5901 E. Seventh Street, Long Beach, CA, 90822, USA

    Timothy R. Morgan

  6. General Medicine Service, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA

    Lauren A. Beste

Authors
  1. S. Hunter Dunn
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  2. Shari S. Rogal
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  3. Marissa M. Maier
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  4. Maggie Chartier
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  5. Timothy R. Morgan
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  6. Lauren A. Beste
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Corresponding author

Correspondence to S. Hunter Dunn.

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Conflict of interest

TRM would like to disclose that he receives funding for clinical trials from AbbVie, Merck, Gilead, and GenFit, not directly related to the current study. SR would like to disclose that her institution has received funding for research from Gilead, not directly related to the current study.

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Dunn, S.H., Rogal, S.S., Maier, M.M. et al. Access to Comprehensive Services for Advanced Liver Disease in the Veterans Health Administration. Dig Dis Sci 64, 3471–3479 (2019). https://doi.org/10.1007/s10620-019-05785-2

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  • DOI: https://doi.org/10.1007/s10620-019-05785-2

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