Barriers to outpatient care in patients with chronic liver disease can significantly increase their likelihood of requiring hospitalization.

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Barriers to outpatient care among patients with chronic liver disease (CLD) may significantly increase their likelihood of requiring hospitalization, according to new findings published today in PLoS One revealed.¹ Compared to those facing minimal barriers, patients unable to obtain care were 85% more likely to require recurrent hospitalizations. This group included a disproportionate number of women and people with physical limitations affecting their health.

“We need to address barriers to community health care, particularly for people who have difficulty obtaining care, as a potential approach to reducing recurrent hospital use among adults with chronic liver disease in the United States “, study author Carrie Wong, MD, PhD, assistant professor of medicine at the David Geffen School of Medicine at UCLA, said in a statement.²

According to CDC data, 1.8% of adults, or approximately 4.5 million Americans, are diagnosed with CLD,³ and they generally require more hospital care than those with other chronic illnesses.¹

Using data from the National Health Survey (2011-2017), the new research analyzed responses from more than 5,000 people representing 4.7 million U.S. adults with CLD.¹ Respondents answered 13 questions about their experiences facing barriers such as inability to afford specialty care, difficulty obtaining prescriptions, or delays due to transportation issues.

The median age was 55 years, and more than half of the respondents were female (51.5%) and non-Hispanic White (65.8%). The CLD population experienced significant health challenges, with 41.4% reporting fair or poor health and 68.2% experiencing functional limitations due to their health. Although most participants had at least a high school diploma (92.8%), economic vulnerabilities were evident, with 20.1% living in poverty and 57.8% unemployed. While half of the sample had private insurance, 11.2% were uninsured, highlighting disparities in coverage.

Four risk groups identified

The study identified 4 distinct risk groups based on the types of obstacles encountered:

1. Minimal barriers (78.1%): This largest group was older, had fewer social and economic limitations, and reported better overall health.
2. Unaffordability of health care (10.7%): Members of this group were most likely to be uninsured.
3. Delays in care (6.5%): Mainly policyholders who experienced delays in care due to logistical problems.
4. Inability to establish care (4.8%): the smallest but most vulnerable group, including young adults, women, the unemployed and people living in poverty.

Compared to those facing minimal barriers, individuals in the “unable to establish care” group were 85% more likely to require recurrent hospitalizations. This group also included a disproportionate number of women and people with physical limitations affecting their health.

People in the minimal barrier group were older, had the best health, and faced the least economic hardship. Conversely, the unaffordable group was the youngest and least insured, while the delayed care group, which was predominantly insured, had higher rates of fair or poor health and included more nonwhite respondents. Failure to establish a care group, predominantly female, experienced the highest rates of unemployment (70.6%), poverty (35.3%), and health-related functional limitations (84, 6%).

Barriers to care varied between groups. In the unaffordable group, 78.5% reported not being able to afford specialty care, while 90.1% of the care delay group had difficulty getting appointments in a timely manner. Alarmingly, 95% of cases of failure to establish a care group were declined as new patients, making this group most likely to require recurring acute care, including hospital visits. and in emergencies. This association was more pronounced among those with public insurance and was particularly significant for women, suggesting unique gender challenges in accessing care.

The researchers noted that community health care interventions targeting organizational barriers could play a crucial role in reducing hospital care among groups most at risk.

Limitations and future directions

The study’s cross-sectional design did not allow causal conclusions to be drawn, and some key details, such as severity of chronic illness and specific health insurance plans, were not captured. Despite these limitations, the researchers said the findings provide a basis for future research and policy development.

“Our findings can guide efforts to prioritize interventions for the most vulnerable people with chronic liver disease,” the researchers wrote, “particularly those facing significant organizational barriers to accessing care.”

References
1. Wong CR, Crespi CM, Glenn B, Han SHB, Macinko JA, Bastani R. There are distinct risk groups with different healthcare barriers and acute care utilization in the US population with chronic liver disease . PLoS One. 2024;19(11):e0311077. doi:10.1371/journal.pone.0311077

2. More than 4 million U.S. adults with chronic liver disease can be grouped into unique risk groups based on barriers to care. University of California, Los Angeles Health Sciences. November 18, 2024. Accessed November 20, 2024. https://www.newswise.com/articles/over-4-million-us-adults-with-chronic-liver-disease-can-be-grouped-into-unique-risk-groups-based-on-barriers- take care

3. Chronic liver disease and cirrhosis. CDC. Updated November 6, 2023. Accessed November 20, 2024.