P110 Prison based hepatology clinics: improving access for a high risk group

<h3>Introduction</h3> Prisoners have a higher rate of liver disease (1) with poorer outcomes that the general population (2) . Did not attend (DNA) rates to our local hepatology clinic for prison patients are high and costly. We started a prison-based liver clinic at Northumberland prison and assessed outcomes. <h3>Methods</h3> We carried out two prison-based liver clinics, comprising of a combination of clinical reviews and fibroscans with referrals directly from the prison medical team. We compared DNA rates to this clinic and those for prisoners to our liver clinics at the local hospital using Fisher’s exact test. We carried out a patient experience survey in the second clinic and carried out a brief cost analysis. <h3>Results</h3> Over the previous 12 months, 3 patients from the prison attended our liver clinics at the local hospital from 9 appointments (DNA rate 66.67%). 24 patients attended the prison clinics from 47 appointments (DNA rate 48.9%, p=0.47). Of those that attended 14 patients (58.3%) had F0 or F1 fibrosis and 5 (20.8%) had F4 fibrosis/cirrhosis. The remaining 5 either did not have a scan, F2 or F3 fibrosis (not reported individually due to low numbers) Patient experience (n=4 respondents) showed: All patients felt they had enough time to discuss their disease, and they were involved in decision making. 3 patients felt they’d rather attend future clinics at the prison, with one preferring virtual appointments. All patients thought the service provided was either good or very good. A cost analysis showed that each visit to the local hospital for an appointment costs approximately £200. Therefore £4,800 was saved given 24 patients attended the prison clinic, with potential for £9,400 saving if every patient attended. <h3>Conclusions</h3> Prison based hepatology clinics have a lower DNA rate compared to hospital-based clinics, although DNA rates remain high. This difference didn’t reach statistical significance, likely due to small patient numbers. They are viewed positively by patients and save significant amounts of money. We have rolled this service out to 4 clinics each year and efforts are being made to improve attendance. <h3>References</h3> Rivera-Esteban J, Jiménez-Masip A, Muñoz-Martínez S, Augustin S, Guerrero RA, Gabriel-Medina P, Ferrer-Costa R, Rodríguez-Frías F, Turu E, Marco A, Pericàs JM, On Behalf of The Prisonafld Study Group Collaborators. Prevalence and risk factors of MASLD and liver fibrosis amongst the penitentiary population in catalonia: the PRISONAFLD study. <i>J Clin Med.</i> 2023 Nov 24;12(23):7276. doi: 10.3390/jcm12237276. PMID: 38068330; PMCID: PMC10707608. Baillargeon J, Soloway RD, Paar D, Giordano TP, Murray O, Grady J, Williams B, Pulvino J, Raimer BG. End-stage liver disease in a state prison population. <i>Ann Epidemiol.</i> 2007 Oct;17(10):808–13. doi: 10.1016/j.annepidem.2007.04.005. Epub 2007 Aug 6. PMID: 17689260.