Access Issues Reduce Survival Rates for Patients With Liver Disease

Access to specialists for veterans with liver disease was associated with better survival outcomes, according to a new study. University of Michigan researchers led by Jessica L. Mellinger, MD, MSc, studied over 28,800 veterans in the Veterans Administration (VA) VISN 11 Liver Disease cohort who had a diagnostic code for liver disease from January 1, 2000, through May 30, 2011. Thirty-seven percent had a visit with a gastroenterologist.

The data showed that patients having at least one appointment with a gastroenterologist or hepatologist any time after diagnosis were less likely to die at 5 years compared with patients who did not see a specialist. Survival rates were also shown to be better among those who had 2 or more gastrointestinal (GI) visits compared with those who had one or 2 visits.

The study, “Access to Subspecialty Care and Survival Among Patients with Liver Disease,” was published in the American Journal of Gastroenterology. The investigators said that the low number of subspecialist visits, especially for an integrated health system such as the VA, may point to access issues. Patients in the study drove an average of 69 miles for their visit with a GI specialist. Patients living farther from a specialty care center were less likely to be seen. Those with a diagnosis of hepatitis C and cirrhosis were more likely to be seen, the data suggests.

The investigators tried to pinpoint what was most important to improved survival in the interaction with GI specialists. Higher rates of screening for hepatocellular carcinoma, greater familiarity with and rapid recognition of complications, and greater likelihood of referral for a liver transplant when appropriate may all have a role in the better outcomes resulting from specialists’ care, the study’s authors said.

“The association between GI specialty care and improved survival may not be related to GI specialty care exclusively, but may result from a connection to health care in general,” senior author Grace L. Su, MD, chief of gastroenterology at the VA Ann Arbor Healthcare System and professor of internal medicine at the University of Michigan Health System, said in a statement. “Improvement in mortality may reflect the combined effects of both primary and specialty care of the patients’ liver disease and other health issues.”

Although the researchers note that the study’s finding might not be generalizable to all adults because of the limited study population, they said the results show that identifying the best way to treat liver diseases across the public is an important topic because hepatitis C is a growing problem, and obesity is increasing rates of non-alcoholic fatty liver disease in the population.