Background:
Adherence to ultrasound (US) surveillance for hepatocellular carcinoma (HCC) is known to be poor across all aetiologies of cirrhosis, with a meta-analysis demonstrating rates of 52%. We sought to assess adherence to HCC surveillance over a 2-year period, following the introduction of a one stop shop clinic.
Description of model of care/intervention/program:
Patients were appointed to a clinic appointment for combined HCC US, bloods, BMI and where appropriate blood pressure, followed one to two weeks later by nurse or consultant appointment either virtual (video or telephone) or face to face, according to patient and clinical factors. The patients were phoned one week prior to confirm attendance, and a text reminder was sent the day prior to the appointment. They were given their subsequent (6-month interval) appointment as they left the clinic.
Effectiveness:
Of 854 patients with a minimum of 2 year follow up, 195 (22.8%) had HCV related cirrhosis, of whom 66 (33.8%) were on opioid substitution therapy (14 Buprenorphine, 52 Methadone). Excluding non-attendance due to death (25 (2.9%)), 543 (84.8%) non-HCV attended their first appointment, 139 (73.1%) with HCV cirrhosis and 34 (53.1%) on OST. 265 (41.4%) non-HCV cirrhosis attended 4 consecutive appointments, 56 (29.5%) with HCV cirrhosis and 11 (17.2%) of those on OST. Amongst those who attended their first appointment rates of complete adherence were 265/543 (48.8%), 56/139 (40.2%) and 11/34 (32.3%) amongst non-HCV cirrhosis, HCV cirrhosis and those on OST respectively.
Conclusion and next steps:
Adherence to HCC surveillance remains suboptimal after the introduction of a one stop clinic. Whilst overall rates were suboptimal, these were poorer amongst those with HCV related cirrhosis and poorest amongst those on OST. Further work is required to understand how best to engage and retain people in care following SVR. |