Background The incidence of alcohol induced cirrhosis in the UK tripled in the last decade and approximately 4000 people die from alcoholic cirrhosis every year in the UK. National Institute for Health and Care Excellence (NICE) guidelines assert that the early identification and treatment of people who misuse alcohol could largely prevent the occurrence of alcohol related disorders. However, it still remains unclear how often people who misuse alcohol visit healthcare providers and therefore whether opportunities exist to identify and treat them at an early stage. In this study, we retrospectively assessed patterns of healthcare use before the diagnosis of alcoholic cirrhosis to determine whether there were early opportunities within primary health care settings to provide interventions.
Methods Using UK longitudinal primary care data from the Clinical Practice Research Datalink and secondary care data from Hospital Episode Statistics, we identified adults with an electronically coded diagnosis of alcoholic cirrhosis between January 1997 to December 2012, together with controls frequency matched by age and GP practice. We calculated overall and yearly primary care consultation rates for cases during the period before alcoholic cirrhosis diagnosis and compared them with that of controls. We further explored the extent to which cases were asked about their alcohol use and offered any alcohol intervention before alcoholic cirrhosis diagnosis.
Results A total of 2479 cases of alcoholic cirrhosis and 24,790 controls were available for analysis. The median observation time was 5.9 years for cases and 4.6 years for controls. Cases consulted more frequently than controls within the entire study period (19.8 vs. 12.9 consultations per person-year). Within 10 years before diagnoses, their yearly consultation rate also increased substantially over time from 11.2 consultations per person year (10th year before diagnosis) to 30.5 consultations per person year (year of diagnosis), representing an excess over controls of approximately 3 to 7 consultations respectively. In total, 84.1% (n = 2085) of cases had records indicating that they were asked about their alcohol use before alcoholic cirrhosis diagnosis. Of these, 68% (n = 1418) had records indicative of excessive drinking but only around a quarter (n = 416) had records of receiving an alcohol intervention.
Conclusion We have been able to demonstrate that people who misuse alcohol and are at risk of alcoholic cirrhosis visit primary care at a relatively high rate even as far back as 10 years before their diagnosis. Such consultations represent potential opportunities that could be used to screen and deliver appropriate interventions for alcohol misuse.
- alcohol misuse
- primary care
- brief interventions