Project Details
About the Project
In 2021 the Victoria Liver Care Clinic (LCC) began as a multidisciplinary outpatient care model pilot program to support South Island residents living with severe and decompensated liver disease. Over the past two years, the LCC has operated as a permanent clinic, achieving positive clinical outcomes and while significantly reducing acute health care resource utilization.
Fueled by the recognition that most clinic patients have liver disease on the basis of alcohol and live with alcohol and other substance use disorders, the clinic visit integrates aspects of addiction
medicine with liver care. However, the high morbidity and mortality of substance use disorders in this clinic setting combined with the high acuity of this patient population made it clear there was a need for stronger addiction support and more direct links with existing acute care and addiction programs in the local area.
To accomplish this, Dr. Jessica McLellan collaborated with her colleagues Dr. Brian McArdle, Dr. Rohit Pai, Dr. Ben Cox, Dr. David Reading, Dr. Theodore Jankowski, Dr. Abhinav Joshi along with Clinical Nurse Specialist Rozalyn Milne, Umbrella support worker Derek Ford, and Island Medical Program student Josie Thompson to engage across addiction medicine, internal medicine, family practice, Island Health clinicians, social workers, and Umbrella Society peer support workers.
Once formed, this group tackled several key initiatives as part of the broader aim of improving patient care coordination. The group identified several key gaps in liver – addictions care and strategized various solutions to improve patient care and clinical outcomes. They drew on data compiled by IMP student Josie as part of their FLEX project to understand the impacts of various multidisciplinary team members, highlighting the particular value of peer support and social workers. They worked to improve communications between the liver clinic and the inpatient addiction team and the medicine inpatients team by creating posters with their contact information and referral process, and held lunch and learn sessions with the hospitalists on liver disease related to alcohol to familiarize them with the LCC clinic as a resource. They were also able to create more direct links with outpatient addiction services such as detoxification to prioritize the high-risk clients served by the LCC.
As a result of these myriad activities, the team reports a greater flow of information between the liver clinic and the other care providers involved in caring for liver clinic patients, including the
Addiction Medicine Consult Service team. “This project has allowed us to first understand gaps in liver-addiction care, which largely relate to challenges with communication among the complex network of stakeholders, and to create workable solutions to address those gaps”, shared Dr. McLellan. “Our liver/addiction care providers now have closer working relationships with improved communication and as a team we can better streamline care for this socially vulnerable population. The outcome of this project is dramatic improvements in patient care and identification of the next challenges to tackle.”