Virtual multidisciplinary clinic to manage alcohol use disorder in patients with alcohol-related liver disease: A clinic audit

Background: Alcohol abstinence is the mainstay treatment for alcohol-related liver disease (ALD). The Comprehensive Liver Disease and Substance Use Disorder (CLDSUP) clinic was created to provide virtual multidisciplinary care to patients with alcohol use disorder (AUD) and ALD. The aim of the clinic audit is to assess the effectiveness of the CLDSUP clinic in patients with AUD and ALD. Methods: Virtual visits were conducted with a hepatologist, addiction medicine specialist, and social worker from the Ottawa Hospital, in Ottawa, Canada; 61 patients were referred to the clinic. Between April 1, 2020, and February 28, 2021, 32 patients were assessed. Adult patients with AUD and ALD were included. Patients receiving community support were excluded. Results: Retention rate was 90.0%; 24 patients received two or more visits (mean age 54.4 [SD 9.5] y), and 18 (75.0%) patients received medications for AUD. Naltrexone was the most commonly prescribed anti-craving medication (38.9%). Among those who received pharmacotherapy, alcohol consumption decreased significantly between first and last visits (12.3 to 0.0 standard drinks per week, p = 0.01). The number needed to treat for abstinence was 4.5. No significant differences in alcohol consumption were seen among those who did not receive pharmacotherapy. There were no significant differences in hospitalization and ALD-related complication rates between the two groups. Conclusions: Most patients received pharmacotherapy with 11.1% and 50.0% of patients achieving and maintaining abstinence respectively. Our data strongly support the development of virtual, multidisciplinary clinics for patients with AUD and ALD.