Hepatology clinician readiness to provide addiction treatment in hepatology clinics: A mixed-methods formative evaluation.

BACKGROUND: Addiction commonly co-occurs with liver disease; however, few patients receive addiction treatment. Although integrated models are emerging, hepatology clinician perspectives on the implementation of alcohol (AUD), opioid (OUD), and tobacco (TUD) use disorder treatment within hepatology clinics are rarely evaluated. We assessed readiness and associated barriers and facilitators to providing treatment of AUD, OUD, and TUD in hepatology clinics. METHODS: A mixed-methods formative evaluation, including a survey and in-depth semi-structured interviews of hepatology clinicians grounded within the Promoting Action on Research Implementation in Health Services implementation science framework, was conducted at a large urban academic medical center from July to September 2022. Practice patterns, attitudes, readiness, barriers, and facilitators toward treating AUD, OUD, and TUD were evaluated. RESULTS: Among 50 survey respondents (94% response rate; median age 41, 56% female), 35 completed interviews. Overall, 84%, 38%, and 49% routinely asked patients about alcohol, opioid, and tobacco use, respectively. Furthermore, 86%, 52%, and 42% considered it very important to provide AUD, OUD, and TUD treatment within hepatology clinics, respectively. Among prescribers, 41%, 11%, and 34% felt ready to provide medications for AUD, OUD, and TUD, respectively. In addition, 50% preferred hepatology clinicians directly provide AUD treatment, compared with 26% and 38% for OUD and TUD, respectively. Themes emerging from interviews included knowledge gaps regarding addiction treatments, practical concerns such as time constraints, and the need for flexible care models, new clinical tools, multidisciplinary resources, and training to facilitate addiction treatment. CONCLUSIONS: Hepatology clinicians prioritize providing AUD treatment; however, less than half of prescribers feel ready to provide medications. Initiatives to incorporate addiction treatments within hepatology clinics will require tailored approaches that address knowledge gaps and contextual issues.