P0931 - Navigating Alcohol After Liver Transplant: Understanding Providers' Attitudes and Practices in Screening and Management

Nghiem B. Ha, MD, MAS¹, Maria J. Duarte, MD¹, Lisa X.. Deng, MD¹, Rena Mei, MD¹, Yejoo Jeon, MD¹, Connie W. Wang, MD¹, Triveni DeFries, MD², Bilal Hameed, MD¹, Courtney B. Sherman, MD^1
1University of California, San Francisco, San Francisco, CA; ²San Francisco General Hospital, San Francisco, CA

Introduction: Alcohol-associated liver disease (ALD) is the leading indication for liver transplant (LT) though return to alcohol use occurs up to 22% by year 1 and is associated with poor post-LT outcomes. While alcohol screening along with abstinence-promoting behavioral and pharmacotherapy is the foundation in managing alcohol use disorder (AUD), it is underutilized in hepatology. We aim to examine provider attitudes and practice patterns in screening/management of alcohol use in post-LT patients.

Methods: We surveyed providers including GI/hep/LT fellows, hep/LT faculty, and APP at a single transplant center. The 13-question Likert survey assessed providers’ view and practice patterns in AUD screening and management.

Results: Survey response rate: 57% fellows (16 of 28), 70% faculty (16 of 23), 71% APP (10 of 14) with years since training as 38% current, 31% <10, 31% >10 years. Although most (96%) felt that screening was important, frequency varied among providers with 90% APP screening at most/every visit compared to faculty and fellows (56% vs 50%, p=0.04); 31% of faculty reported never/rarely. Comfort in screening varied among providers with more APP being very comfortable compared to faculty and fellows (90% vs 69% vs 56%, p=0.048). 50% felt uncomfortable using DSM-V to diagnose AUD, particularly fellows (63%). Preferred interventions were community support meetings (76%), referral to social work (55%) or addiction medicine (43%), and use of pharmacotherapy (26%), with the latter being highest among faculty compared to fellows and APP (44% vs 25% vs 0%, p=0.047). Most preferred that primary care (40%) or addiction medicine (23%) initiate interventions rather than GI/hep providers (36%) due to low rates of comfort in AUD counseling (6% vs 13% vs 10%), familiarity with pharmacotherapy (13% vs 6% vs 10%) and discomfort in prescribing pharmacotherapy (38% vs 69% vs 90%, p=0.05) among faculty, fellows, and APP, respectively; though most (79%) were interested in learning best practices for treating ALD patients with AUD (Figure).

Discussion: Screening for alcohol use in post-LT patients is low with one-third of faculty reporting never/rare screening. Notably, three-fourth of providers did not provide behavioral and/or pharmacotherapy interventions for AUD due to low rates of comfort in counseling and prescribing pharmacotherapy. This data highlights the need for further efforts in training and empowering GI/hepatology providers to deliver evidenced-based interventions for AUD among post-LT patients.



Disclosures:


Nghiem B. Ha, MD, MAS¹, Maria J. Duarte, MD¹, Lisa X.. Deng, MD¹, Rena Mei, MD¹, Yejoo Jeon, MD¹, Connie W. Wang, MD¹, Triveni DeFries, MD², Bilal Hameed, MD¹, Courtney B. Sherman, MD¹. P0931 - Navigating Alcohol After Liver Transplant: Understanding Providers' Attitudes and Practices in Screening and Management, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.