Erhebung der Versorgungsstrukturen an Transplantationszentren für Patient*innen mit äthyltoxischer Leberzirrhose vor einer Lebertransplantation. Eine qualitative Befragung von Behandler*innen.

 

 Buy Article Permissions and Reprints

Zusammenfassung

Ziel der Studie Ziel dieser Untersuchung war es, die derzeitigen Versorgungs- und Kontrollstrukturen für Patient*innen mit äthyltoxischer Leberzirrhose in der Vorbereitung auf eine Lebertransplantation (LTX) an deutschen Transplantationszentren zu erfassen. Es sollten zudem die damit einhergehenden Barrieren sowie die Sicht der Behandler*innen auf Verbesserungsmöglichkeiten für die Versorgung der Patient*innengruppe analysiert werden.

Methodik In einem explorativen, deskriptiven, qualitativen Design wurden 11 Interviews mit Behandler*innen aus 10 der 22 deutschen LTX-Zentren geführt und inhaltsanalytisch ausgewertet.

Ergebnisse Es zeigten sich deutliche Unterschiede in den Versorgungs- und Kontrollstrukturen der einzelnen Zentren. In das Behandlungskonzept integrierte suchttherapeutische Angebote gab es nicht an allen Zentren. Strukturelle Barrieren entstanden durch eine unzureichende Finanzierung und personelle Ausstattung. Behandler*innen wünschten sich erweiterte Behandlungsangebote sowie vereinheitlichte Behandlungskonzepte.

Schlussfolgerungen Es zeigte sich Handlungsbedarf sowohl im Bereich der Strukturen der einzelnen LTX-Zentren als auch übergreifend auf Systemebene. Diese Ergebnisse könnten unter Berücksichtigung aktueller suchtmedizinischer Erkenntnisse als Grundlage zur Entwicklung von Behandlungskonzepten und -empfehlungen zur Optimierung der Versorgung vor LTX dienen.

Abstract

Objective The aim of this study was to record the current care and control structures in place for patients with ethyltoxic liver cirrhosis while being prepared for a liver transplant (LTX) at German transplant centers. In addition, it was also intended to analyze the associated barriers as well as the view of the practitioners on ways to improve care of this patient group.

Methods In an exploratory descriptive qualitative design, 11 interviews with practitioners from 10 of the 22 German LTX centers were conducted and analyzed using qualitative content analysis.

Results There were considerable differences in the care and control structures in place at the LTX centers. Addiction therapy counseling or treatment were not integrated into the treatment concept at all centers. Structural barriers arose from insufficient funding and staffing. Practitioners recommended expansion of treatment options as well as standardizing treatment concepts.

Discussion The results of our study point to a need for action both in the area of the structures of the individual LTX centers and overall at the system level. Taking into account current standards of addiction medicine, our results could serve as a basis for the development of treatment concepts and recommendations for optimizing standard care before LTX.

Publication History

Article published online:
14 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Bundesärztekammer. Richtlinie gemäß § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG für die Wartelistenführung und Organvermittlung zur Lebertransplantation Deutsches Arzteblatt International 2021. DOI: 10.3238/arztebl.2021.rili_baek_OrgaWlOvLeberTx20211029
• 2 Adam R, Karam V, Cailliez V. et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR)–50–year evolution of liver transplantation. Transplant International 2018; 31: 1293-1317
  CrossrefPubMedGoogle Scholar
• 3 Müller PC, Kabacam G, Vibert E. et al. Current status of liver transplantation in Europe. International Journal of Surgery 2020; 82: 22-29
  CrossrefPubMedGoogle Scholar
• 4 Pose E, Torrents A, Reverter E. et al. A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement. Journal of Hepatology 2021; 75: 275-283
  CrossrefPubMedGoogle Scholar
• 5 Primc N.. Das „framing “der sechsmonatigen Karenzregel in der Lebertransplantation. Ein Beispiel für sprachlich vermittelte Deutungsmuster zur Eingrenzung des Indikationsgebietes. Ethik in der Medizin 2020; 32: 239-253
  CrossrefPubMedGoogle Scholar
• 6 Dew MA, DiMartini AF, Steel J. et al. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver transplantation 2008; 14: 159-172
  CrossrefPubMedGoogle Scholar
• 7 Kodali S, Kaif M, Tariq R. et al. Alcohol relapse after liver transplantation for alcoholic cirrhosis—impact on liver graft and patient survival: a meta-analysis. Alcohol and alcoholism 2018; 53: 166-172
  CrossrefPubMedGoogle Scholar
• 8 Rice JP, Eickhoff J, Agni R. et al. Abusive drinking after liver transplantation is associated with allograft loss and advanced allograft fibrosis. Liver Transplantation 2013; 19: 1377-1386
  CrossrefPubMedGoogle Scholar
• 9 Kiefer F, Batra A, Bischof G. et al. S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen “. Sucht. 2021
  PubMedGoogle Scholar
• 10 Thursz M, Gual A, Lackner C. et al. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. Journal of hepatology 2018; 69: 154-181
  CrossrefPubMedGoogle Scholar
• 11 Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie e.V. (DGPM) DKfPMeVD. S3-Leitlinie Psychosoziale Diagnostik und Behandlung von Patientinnen und Patienten vor und nach Organtransplantation; AWMF Registernummer 051 – 031. In. 1.1 ed
  PubMed
• 12 Nielsen AS, Askgaard G, Thiele M.. Treatment of alcohol use disorder in patients with liver disease. Current Opinion in Pharmacology 2022; 62: 145-151
  CrossrefPubMedGoogle Scholar
• 13 Addolorato G, Leggio L, Ferrulli A. et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. The Lancet 2007; 370: 1915-1922
  CrossrefPubMedGoogle Scholar
• 14 Khan A, Tansel A, White DL. et al. Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clinical Gastroenterology and Hepatology 2016; 14: 191-202. e194
  CrossrefPubMedGoogle Scholar
• 15 Georgiou G, Webb K, Griggs K. et al. First report of a psychosocial intervention for patients with alcohol-related liver disease undergoing liver transplantation. Liver Transplantation 2003; 9: 772-775
  CrossrefPubMedGoogle Scholar
• 16 Morris M, Johnson D, Morrison DS.. Opportunities for prevention of alcohol-related death in primary care: results from a population-based cross-sectional study. Alcohol 2012; 46: 703-707
  CrossrefPubMedGoogle Scholar
• 17 Erim Y, Beckmann M, Tagay S. et al. Stabilisation of abstinence by means of psychoeducation for patients with alcoholic liver disease awaiting liver transplantation. Zeitschrift fur Psychosomatische Medizin und Psychotherapie 2006; 52: 341-357
  CrossrefPubMedGoogle Scholar
• 18 Erim Y, Böttcher M, Schieber K. et al. Feasibility and acceptability of an alcohol addiction therapy integrated in a transplant center for patients awaiting liver transplantation. Alcohol and Alcoholism 2016; 51: 40-46
  CrossrefPubMedGoogle Scholar
• 19 Helfferich C.. Leitfaden-und Experteninterviews. In Handbuch Methoden der empirischen Sozialforschung. Springer; 2019: 669-686
  CrossrefGoogle Scholar
• 20 Malterud K, Siersma VD, Guassora AD.. Sample size in qualitative interview studies: guided by information power. Qualitative health research 2016; 26: 1753-1760
  CrossrefPubMedGoogle Scholar
• 21 Patton MQ.. Qualitative research & evaluation methods: Integrating theory and practice. Sage publications; 2014
  Google Scholar
• 22 Denzin NK.. The research act: A theoretical introduction to sociological methods. Routledge; 2017
  CrossrefGoogle Scholar
• 23 Kuckartz U.. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. Weinheim Basel: Beltz Juventa; 2018
  Google Scholar
• 24 Helfferich C.. Die Qualität qualitativer Daten. Springer; 2011
  CrossrefGoogle Scholar
• 25 Kruse J, Schmieder C.. Qualitative interviewforschung. Beltz Juventa; 2014
  Google Scholar
• 26 O’Brien BC, Harris IB, Beckman TJ. et al. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Academic Medicine 2014; 89: 1245-1251 DOI: 10.1097/acm.0000000000000388.
  CrossrefPubMedGoogle Scholar
• 27 Björnsson E, Olsson J, Rydell A. et al. Long-term follow-up of patients with alcoholic liver disease after liver transplantation in Sweden: impact of structured management on recidivism. Scandinavian journal of gastroenterology 2005; 40: 206-216
  CrossrefPubMedGoogle Scholar
• 28 Addolorato G, Mirijello A, Leggio L. et al. Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcoholism: Clinical and Experimental Research 2013; 37: 1601-1608
  CrossrefPubMedGoogle Scholar
• 29 Donnadieu-Rigole H, Jaubert L, Ursic-Bedoya J. et al. Integration of an addiction team in a liver transplantation center. Liver Transplantation 2019; 25: 1611-1619
  CrossrefPubMedGoogle Scholar
• 30 Herzer K, Sterneck M, Welker M-W. et al. Current challenges in the post-transplant care of liver transplant recipients in Germany. Journal of Clinical Medicine 2020; 9: 3570
  CrossrefPubMedGoogle Scholar
• 31 Schomerus G, Leonhard A, Manthey J. et al. The stigma of alcohol-related liver disease and its impact on healthcare. Journal of Hepatology. 2022
  PubMedGoogle Scholar
• 32 Hoffmann H, Koschinowski J, Bischof G. et al. Medical Students’ Readiness for Cutbacks in Health Care Expenditures of Alcohol-Dependent Individuals. Sucht. 2020
  PubMedGoogle Scholar
• 33 Meltzer EC, Suppes A, Burns S. et al. Stigmatization of substance use disorders among internal medicine residents. Substance Abuse 2013; 34: 356-362
  CrossrefPubMedGoogle Scholar