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

Karen Matthews (Lead / Corresponding author), Alastair MacGilchrist, Margaret Coulter-Smith, Jacklyn Jones, Roseanne Cetnarskyj

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)650-662
Number of pages13
JournalJournal of Clinical Nursing
Volume28
Issue number3-4
Early online date5 Sep 2018
DOIs
Publication statusPublished - Feb 2019

Fingerprint

Nurses
Liver Diseases
Liver
Nurses' Practice Patterns
Referral and Consultation
Alcohols
Fibrosis
Reading
Chronic Disease
Equipment and Supplies
Secondary Care
Social Welfare
Compliance
Observational Studies
Cause of Death
Prospective Studies
Health

Keywords

  • alcoholic
  • FibroScan
  • liver cirrhosis
  • nursing assessment
  • screening
  • transient elastography
  • Prospective Studies
  • Liver Cirrhosis/diagnostic imaging
  • Humans
  • Middle Aged
  • Male
  • United Kingdom
  • Alcoholism/complications
  • Adult
  • Female
  • Referral and Consultation/statistics & numerical data
  • Community Health Services
  • Mass Screening/methods
  • Elasticity Imaging Techniques

Cite this

Matthews, Karen ; MacGilchrist, Alastair ; Coulter-Smith, Margaret ; Jones, Jacklyn ; Cetnarskyj, Roseanne. / A nurse-led FibroScan ® outreach clinic encourages socially deprived heavy drinkers to engage with liver services. In: Journal of Clinical Nursing. 2019 ; Vol. 28, No. 3-4. pp. 650-662.
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abstract = "Aims and objectives: To determine whether a portable FibroScan {\circledR} 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 {\circledR} 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 {\circledR} 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 {\circledR} . 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 {\circledR} ≥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 {\circledR} outreach clinic encourages socially deprived drinkers to engage with liver services.Relevance to clinical practice: A 67{\%} uptake suggests a nurse-led FibroScan {\circledR} service in a community alcohol service is acceptable. High engagement gives potential for early intervention and improved health outcomes.",
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A nurse-led FibroScan ® outreach clinic encourages socially deprived heavy drinkers to engage with liver services. / Matthews, Karen (Lead / Corresponding author); MacGilchrist, Alastair; Coulter-Smith, Margaret; Jones, Jacklyn; Cetnarskyj, Roseanne.

In: Journal of Clinical Nursing, Vol. 28, No. 3-4, 02.2019, p. 650-662.

Research output: Contribution to journalArticle

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T1 - A nurse-led FibroScan ® outreach clinic encourages socially deprived heavy drinkers to engage with liver services

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AU - MacGilchrist, Alastair

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AU - Jones, Jacklyn

AU - Cetnarskyj, Roseanne

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N2 - 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.

AB - 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.

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KW - liver cirrhosis

KW - nursing assessment

KW - screening

KW - transient elastography

KW - Prospective Studies

KW - Liver Cirrhosis/diagnostic imaging

KW - Humans

KW - Middle Aged

KW - Male

KW - United Kingdom

KW - Alcoholism/complications

KW - Adult

KW - Female

KW - Referral and Consultation/statistics & numerical data

KW - Community Health Services

KW - Mass Screening/methods

KW - Elasticity Imaging Techniques

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U2 - 10.1111/jocn.14660

DO - 10.1111/jocn.14660

M3 - Article

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JO - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

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