Cirrhosis with ascites in the last year of life: a nationwide analysis of factors shaping costs, health-care use, and place of death in England

Hudson, B; Round, Jeff; Georgeson, Brendan; Pring, Andy; Forbes, Karen; McCune, C. Anne; Verne, Julia

doi:10.1016/s2468-1253(17)30362-x

Cited by 43 publications

(50 citation statements)

References 29 publications

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“…The primary drivers of morbidity and cost in cirrhosis are complications of decompensated disease: ascites, hepatic encephalopathy (HE) and variceal hemorrhage. Patients are frequently hospitalized for these conditions, with high 30‐day readmission rates ranging from 25%‐52% . Providers prescribe a variety of medications with narrow therapeutic windows to treat these complications.…”

Section: Introductionmentioning

confidence: 99%

“…Patients are frequently hospitalized for these conditions, with high 30-day readmission rates ranging from 25%-52%. 7,8 Providers prescribe a variety of medications with narrow therapeutic windows to treat these complications. Even for medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Thomson

Lok

Tapper

2018

Liver International

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Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis. The structural barriers in cirrhosis include sheer medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence. Tested interventions have included patient self-education, provider driven patient education, intensive case management including medication blister packs and smartphone applications. Initiatives are needed to improve patient, caregiver and provider education on appropriate use of medications in patients with cirrhosis. A multidisciplinary team should be established to coordinate care with close monitoring, address patient and caregiver concerns, and to provide timely access to outpatient evaluation of urgent/complex issues. Future studies evaluating the clinical outcomes and cost effectiveness of interventions are needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Thomson

Lok

Tapper

2018

Liver International

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“…7 Hudson et al conducted a national retrospective study of 13,818 people who died from liver disease in England (2013-2015), and had at least one large-volume paracentesis procedure in the last year of life. 21 Despite a mean time from first presentation in the last year of life to death of 186 days, patients spent 33.2% of days in hospital. They had a mean of 3.3 emergency hospital admissions, 52.5% within 30 days of a subsequent admission.…”

Section: The Tremendous Symptom Burden Of Advanced Liver Diseasementioning

confidence: 99%

Emerging Role of Palliative Care in Patients with Advanced Liver Disease

Jordan

Tandon

2019

Semin Liver Dis

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Advanced liver disease is increasing in mortality and morbidity worldwide, as a result of growing alcohol consumption, obesity, and viral hepatitis infection. Alongside efforts to reduce these factors, it is clear that we must identify the considerable palliative care needs of these patients in order to improve quality of life and reduce symptom burden. Our review focuses on the current state of palliative and end-of-life care for patients with advanced liver disease, the significant associated symptom burden in this disease group, identified level of involvement and potential benefits of specialist palliative care, as well as possible barriers to accessing this care. We demonstrate that although palliative care involvement varies considerably worldwide, there is much opportunity for improvement. Further research is needed to determine new interventions and models of care that may improve access for patients with liver disease, including an expansion of providers comfortable with generalist palliative care.

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“…Providers should instruct patients to record their current diuretic dose along with daily weights, and to call the clinic for large (≥5 pound) fluctuations in weight. Ensuring availability of and easy access to outpatient therapeutic paracentesis is essential as this has been shown to significantly decrease healthcare costs and 30-day readmission rates (14) (Figure 4). …”

Section: “Dos and Don’ts” In The Clinic (Table 2)mentioning

confidence: 99%