The intersection of alcohol use disorder (AUD) and alcohol-related liver disease (ARLD) presents a significant challenge in healthcare, with treatment engagement remaining a critical unmet need. A recent qualitative study explores the barriers and facilitators influencing treatment engagement among patients with comorbid AUD and ARLD, applying a multidimensional adherence model proposed by the World Health Organization (WHO). This investigation provides insights into the complexities of patient engagement and the potential for developing more effective interventions.

Study Overview and Methodology

The study involved 24 participants with comorbid AUD and ARLD recruited from an inpatient clinical setting. Data were gathered through in-depth interviews, analysed using the Framework method, and organised according to the WHO’s multidimensional adherence model. This model considers factors at various levels, including social and economic, patient, condition, treatment, and healthcare system factors.

Systematic Challenges in Treatment Engagement

One of the key findings of the study is the identification of systematic challenges in maintaining continuity between primary, secondary, and community care. Participants reported significant barriers related to social and economic contexts, such as the UK’s cost of living crisis, which exacerbated staff shortages and resource constraints in healthcare settings. Travel costs and mobility issues also hindered treatment engagement, with many patients citing financial constraints as a barrier to accessing outpatient services.

The Role of Family and Support Systems

The study highlights the participatory role of family as a crucial facilitator for treatment engagement. Family members often acted as early detectors of high-risk drinking patterns and liver disease progression, prompting patients to seek medical intervention. The support provided by family members was also instrumental in maintaining ongoing engagement with treatment services, offering both practical assistance and emotional motivation.

Healthcare System and Treatment-Related Factors

The healthcare system itself presented both barriers and facilitators to engagement. Participants valued the therapeutic alliance with healthcare providers, noting the importance of empathy and understanding in sustaining their engagement with treatment. However, gaps in the care continuum, such as poor communication and informational continuity, were noted as significant obstacles. Many patients experienced difficulties in navigating treatment pathways due to administrative inefficiencies and miscommunication regarding appointments and referrals.

Patient and Condition-Related Factors

Patient-related factors, such as readiness to change and intrinsic motivation, significantly influenced treatment engagement. Participants expressed that their own ambivalence towards behaviour change and experiences of negative self-conscious emotions acted as barriers. The complexity of their health conditions, often involving multiple comorbidities, also impacted their ability to prioritise AUD treatment, with many patients focusing on managing other pressing health issues.

Implications for Healthcare Providers and Policy

The study emphasises the need for healthcare providers to develop person-centred, tailored interventions that consider the multifactorial nature of treatment engagement. The integration of addiction medicine and hepatology within a multidisciplinary care model is suggested as a means to improve continuity of care and patient outcomes. Additionally, the study calls for policy reforms at macro levels to address the systemic challenges faced by this clinical population, enhancing access to health-enabling resources and reducing health inequalities.

The findings underscore the importance of addressing both intentional and unintentional non-engagement factors, ensuring the continuity of care necessary for sustained behavioural change. By understanding the barriers and facilitators from a service user’s perspective, healthcare providers and policymakers can better design interventions that bridge the treatment gap for patients with comorbid AUD and ARLD.

Source: Wiley Online Library