Integrated behavioral care in general hepatology increases alcohol use disorder treatment in veterans

BACKGROUND: Hepatology visits present an opportunity to engage patients with alcohol-associated liver disease in care. This quality improvement pilot integrated a behavioral health provider (BHP) into the hepatology clinic at one Veterans Health Administration site and assessed its impact on alcohol use disorder (AUD) treatment. METHODS AND RESULTS: Hepatologists across Veterans Health Administration facilities developed a workflow to refer patients with signs of unhealthy alcohol use to a BHP co-located in the hepatology clinic. Data during the first year of BHP integration (December 2022 to January 2024) were obtained through chart reviews and the Veterans Health Administration Corporate Data Warehouse. t tests and χ2 tests compared baseline characteristics and assessed the associations of referral status with receipt of evidence-based AUD treatments within 6 months of referral or index liver clinic appointment. Two hundred ninety-three patients with signs of unhealthy alcohol use were identified, representing 19.9% of all liver clinic patients engaged in care during the pilot. Of these, 86.4% had a prior mental health diagnosis, 79.2% had an AUD diagnosis, 57.7% had a positive AUDIT-C screen, 40.3% had an alcohol-associated liver disease diagnosis, and 71 patients (24% of patients with unhealthy alcohol use) were referred to the BHP. Referred patients were more likely to receive AUD psychotherapy and/or pharmacotherapy and had significantly more AUD pharmacotherapy fill days (35.2 vs. 10.3, p<0.001) but not AUD psychotherapy visits (5.2 vs. 3.2, p=0.172). CONCLUSIONS: Referral to a co-located BHP was associated with a higher likelihood of receiving AUD treatment and a greater amount of AUD treatment, but gaps in referral remain and need to be addressed. Integrating BHPs into general hepatology clinics may improve AUD treatment uptake, addressing an important gap in care.