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

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.