Yes, Telemedicine Can Reduce Alcohol Use for Liver Disease Patients
Alcohol use disorder is a major cause of disease and premature death worldwide. For people with chronic liver disease (CLD), there is no safe level of alcohol consumption. Yet many patients with this condition still drink alcohol, which puts their health at risk. In addition to liver damage, adverse effects of drinking include depression, anxiety, impaired cognition, and lower quality of life.
Despite practice guidelines recommending integrated, multidisciplinary alcohol use treatment such as routine screening, behavioral interventions, pharmacotherapy, and referral to specialized addiction treatment, these evidence-based strategies are infrequently implemented in hepatology settings where patients receive liver care. Patients often have misconceptions about treatment and lack understanding about the serious consequences of continuing alcohol use. Additionally, hepatology clinics may not have access to intervention models adapted to patient needs and without links to addiction specialists.
To improve treatment for CLD patients, UC San Francisco researchers set out to assess the efficacy and feasibility of delivering Stepped Alcohol Treatment (SAT) — an integrated approach that provides individualized care for people with unhealthy alcohol use — via telemedicine.
“Integrated alcohol interventions remain rarely implemented in liver clinics,” said study senior author Mandana Khalili, MD, UCSF professor of Medicine, chief of clinical hepatology, and director of clinical and transitional research in hepatology at the Zuckerberg San Francisco General Hospital (ZSFG). “This treatment gap is particularly serious given that current guidelines advise offering these interventions to all patients with CLD. The stigma around alcohol use in our patients with liver disease can also influence their engagement in treatment.”
Their study, appearing June 24 in Hepatology, found that the telehealth-delivered SAT approach was effective in helping patients with CLD reduce their level of alcohol consumption over a six-month period.
The researchers conducted a multicenter randomized controlled trial of SAT across three hepatology clinics based in publicly funded health care systems. The researchers evaluated whether participants with CLD receiving SAT would demonstrate greater reductions in alcohol use and improved liver-related clinical outcomes than those receiving usual care treatment. Usual care was defined as routine alcohol screening and counseling to reduce alcohol use by hepatology clinic providers.
Study outcomes included measures of alcohol use quantity and frequency. SAT demonstrated greater efficacy than usual care in reducing the mean number of drinks per week at six months. The researchers also found that the 30-day abstinence rates at this point were 29% for SAT and 18% for usual care. Effects of SAT on alcohol use reduction were even stronger among female participants, those with Latino ethnicity, and those with greater motivation to reduce alcohol use at the time of study enrollment.
A valuable tool for clinicians
Participants in the SAT cohort received three sessions of motivational interviewing (an evidence-based counseling intervention designed to enhance motivation to reduce drinking) via telemedicine and were stepped up to more intensive addiction specialty treatment services (including pharmacotherapy and psychotherapy) when predetermined treatment goals were not met.
“This patient population can be very challenging to engage and treat effectively” said study first author, Derek Satre, PhD, a clinical psychologist and UCSF professor in the Department of Psychiatry and Behavioral Sciences, and an expert in use of motivational interviewing for alcohol treatment in various health care settings. “SAT via telemedicine may be a very valuable tool for clinicians to reduce alcohol consumption and improve psychological well-being and quality of life for these patients.”
The researchers say that future research into the effectiveness and implementation of stepped care models should include greater attention to psychiatric comorbidities, socioeconomic challenges that influence alcohol treatment access, and strategies for training hepatologists to deliver motivational interviewing and alcohol use treatment in hepatology settings.
Additional Authors: Leila Taj, Robert J Wong, Hannah R Snyder, Ramsey Cheung, William Hua, Alexander Monto, Steven L Batki, Michael J Ostacher, Priti Parekh, Amy M Shui, Taylor Fakadej, Jennifer Y Chen, Michele Tana, Meimei Liao, Christina G Haight.
Funding: This study was supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) R01AA029312 (Mandana Khalili and Derek D. Satre), K24AA022523 (Mandana Khalili), K24AA025703 (Derek D. Satre), T32DK060414 (Leila Taj), and the UCSF Liver Center P30 DK026743.
Disclosures: Mandana Khalili is a recipient of research grants (to her institution) from Gilead Sciences and Intercept Pharmaceuticals, and she has served as a consultant for Gilead Sciences and GlaxoSmithKline. Robert J. Wong has received research grants (to his institution) from Gilead Sciences, Exact Sciences, Madrigal Pharmaceuticals, and Thera Technologies and has served as a consultant (without honorarium) to Gilead Sciences, Salix, and Mallinckrodt Pharmaceuticals. Jennifer Y. Chen is a recipient of a research grant from Merck and from Pliant Therapeutics and has served as a consultant for Pliant Therapeutics. Michele Tana has served as a consultant for Merck & Co.
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