A nurse‐led FibroScan® outreach clinic encourages socially deprived heavy drinkers to engage with liver services

Abstract

Aims and objectives To determine whether a portable FibroScan® device can be an acceptable screening tool for chronic liver disease in a community alcohol support service, through recording uptake, determining apparent prevalence of undiagnosed fibrosis/cirrhosis in participants and report engagement following referral to specialist liver services of those individuals referred because of a FibroScan® reading ≥ 7.1 kilopascals (kPa).

Background Alcohol‐related liver disease, including cirrhosis, is a major cause of death in the UK. Liver disease is silent and usually presents late. Socially deprived patients with alcohol‐related liver disease are a “hard to engage” population and at higher risk of death than less deprived. A FibroScan® device is a non‐invasive tool for measuring liver stiffness. A result of ≥7.1 kPa can indicate possible chronic liver disease.

Design Prospective observational study.

Method Individuals who self‐identified as harmful drinkers were recruited. Consented individuals attended for a liver FibroScan®. Those with a reading ≥7.1 kPa were referred to a nurse‐led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for compliance over a 6‐month period.

Results Seventy‐nine consented individuals participated, an uptake of 67% of those informed of the study. Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® ≥7.1 kPa requiring referral on to the nurse‐led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n = 12) was ≥90%.

Conclusion A nurse‐led FibroScan® outreach clinic encourages socially deprived drinkers to engage with liver services.

Relevance to clinical practice A 67% uptake suggests a nurse‐led FibroScan® service in a community alcohol service is acceptable. High engagement gives potential for early intervention and improved health outcomes.

What does this paper contribute to the wider global clinical community? Findings from this study should instil confidence in centres planning to deliver early intervention through nurse‐led screening for chronic liver disease with a portable FibroScan® device in community settings. These findings should inform future research in this area.