Background Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between medical conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. Methods This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Multivariable models were used to assess the factors associated with subsequent AUD treatment and 5-year mortality. Results Among 436 patients with cirrhosis due to alcohol, 65 patients (15%) received AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (2%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after a baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. Thirty percent of patients had hepatology-documented AUD treatment recommendations and 26% had primary care-documented AUD treatment recommendations. Most hepatology (86%) and primary care (88%) recommendations discussed behavioral therapy alone. Among patients with ongoing alcohol use at baseline, AUD treatment one year later was significantly, independently associated with AUD treatment discussions with hepatology (adjusted odds ratio (aOR): 3.23, 95% confidence interval (CI): 1.58, 6.89) or primary care (aOR: 2.95; 95% CI: 1.44, 6.15) and negatively associated with having Medicaid insurance (aOR: 0.43, 95% CI: 0.18, 0.93). When treatment was discussed in both settings, high rates of treatment ensued (aOR: 10.72, 95% CI: 3.89, 33.52). Over a 5-year follow-up period, 152 (35%) patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma were significantly associated with mortality in the final survival model. Conclusion AUD treatment discussions were documented in less than half of hepatology and primary care encounters in patients with alcohol-related cirrhosis, though such discussions were significantly associated with receipt of AUD treatment.

Background Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. Methods This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Results Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14–1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36–2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04–1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94–4.01), depression (AIRR = 1.93, 95% CI = 1.60–2.32), anxiety (AIRR = 1.84, 95% CI = 1.53–2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67–2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22–1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47–0.66). Conclusion Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.

Background: Treatment adherence remains a potential barrier to achieving population-level hepatitis C virus (HCV) elimination by 2030. We aimed to understand barriers to and facilitators of HCV treatment adherence pre-and post-directacting antiviral (DAA) treatment.Methods: A cohort of US Veterans who were initiating DAA treatment completed pre-and post-treatment surveys assessing demographic information, psychological symptoms and perceived barriers to adherence. DAA adherence was assessed through self-report and pharmacy records. Sustained virologic response (SVR) was evaluated using the medical record. Mann-Whitney U, Fisher's exact tests, and logistic regression were employed to evaluate associations of patient characteristics and survey responses with adherence and SVR.Results: Of 97 participants, the majority were male (98%), white (62%), low-income (less than 35 000/y; 82%), and had a history of self-reported prior substance use (93%). The most common anticipated adherence barrier prior to treatment was having side effects (21%). Over follow-up, 62% of participants missed doses and 84% achieved SVR. Decreased pain (OR 0.32, 95% CI 1.06-1.72), agreeing with 'the medication will improve my health' (OR 4, 95% CI 1.22-15.8) and disagreeing with being 'worried about my liver disease getting worse' (OR 0.2, 95% CI 0.05, 0.59) predicted successfully achieving SVR. After treatment, the most commonly reported barriers to adherence were being busy (13%) and being away from home (13%). Veterans reported non-significantly decreased substance use after treatment (38% vs 28%, P = .18). Conclusion:In this population of Veterans with high rates of substance use, most participants missed doses but still achieved SVR. HCV treatment may also serve as an opportunity for substance use treatment.

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Background. Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between hepatology-led conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. Methods. This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Regression models were used to assess the factors associated with treatment initiation and 5-year mortality. Results. Among 496 patients with alcohol-related cirrhosis, 65 patients (13%) were receiving AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (4%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after the baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. One third of patients had documentation of AUD treatment discussions in their hepatology notes, in which behavioral treatment was the commonly recommended treatment modality (86%). Among patients not receiving baseline AUD treatment, treatment initiation was significantly associated with treatment discussion with a hepatologist (AOR:4.04, 95% CI:1.88-9.09) and having compensated cirrhosis (AOR:3.15 95% CI:1.04-8.62). Over 5-year follow-up, 152 patients died (35%), and ongoing alcohol use, age, hepatic decompensation, and HCC were significantly associated with mortality in the final survival model. Conclusion. AUD treatment discussions were documented in less than half of hepatology encounters in patients with alcohol-related cirrhosis, though such discussions were strongly associated with AUD treatment initiation.