O5 Impact of a joint clinical specialist nurse and dietitian clinic on health related quality of life outcome in patients with decompensated liver disease

<h3>Background and Aims</h3> It is well documented that chronic liver disease, particularly decompensated liver disease is associated with poor health related Quality of Life (HrQoL). A joint Clinical Nurse Specialist (CNS) and Dietitian outpatient clinic was established to provide holistic advice for patients with decompensated liver disease. The interventions provided included disease education, diuretic management, medication review and nutritional assessment. We aimed to review the clinical outcomes and patient reported HrQoL for patients who attended a newly established joint CNS and Dietitian outpatient clinic. <h3>Method</h3> HrQoL was assessed using the Eq5D-5L questionnaire. All patient’s HrQoL was assessed on initial assessment, and repeated once within 4–6 months. Clinical outcomes were assessed at the same time frame. All patients included in this review attended at least 3 appointments over a 4–6 month period. <h3>Results</h3> The aetiology of liver disease was 82% alcohol related, 9% metabolic dysfunction-associated steatohepatitis, 9% cryptogenic. 55% were males. 27% were Asian and 50% Caucasian. 23% were from other ethnic backgrounds. The median age was 60. Ascites was the main cause of decompensation for 82%. 86% were managed with diuretics. 27% required enteral feeding for nutritional optimisation. 75% had a Child Pugh score of B. The mean MELD score was 12.5. The average number of appointments attended was 3.8. Due to improved nutritional status, 27% re-compensated and did not require a TIPSS procedure as previously planned. 9% are now optimised for consideration for liver transplantation. 13% are now palliative and for conservative management. A comparison of baseline HrQoL scores compared to review at 4–6 months demonstrated 42% had improved mobility, 63% had improved ability to wash and dress themselves, 57% had improved ability to carry out usual activities, such as working and shopping, 68% reported improvement in pain and discomfort and 57% reported improvement in anxiety and depression. Average overall HrQoL scores improved from an average of 48% to 68% over a 4–6 month period. 32% of patients reported an overall improvement in HrQoL of between 30–55%. <h3>Conclusion</h3> A combined nursing and dietetic outpatient review has demonstrated the ability to improve clinical outcomes for patients with decompensated liver disease, in particular inducing recompensation with diuretic management, nutritional optimisation and abstinence support. Close monitoring, and a combined, holistic assessment has also proven beneficial for patients in relation to HrQoL scores. Analysis should be undertaken to evaluate the cost-effectiveness of this specialist multi-disciplinary clinic as part of a hepatology outpatient service.