IMPACT OF THE COVID-19 PANDEMIC ON THE CARE, OUTCOMES, AND EXPERIENCES OF PATIENTS WITH CHRONIC LIVER DISEASE

Background: The COVID-19 pandemic has a secondary impact on health by disrupting care delivery and patient behaviours. Patients with chronic liver disease (CLD) are a vulnerable population as they require consistent, high level care. Telemedicine has transformed outpatient CLD care, requiring evaluation of patient experiences and health outcomes during the pandemic. Methods: CLD patients of a tertiary Hepatology Clinic in Vancouver, Canada who attended a telemedicine appointment from March-September 2020 were invited to complete an online survey. Survey items included demographic information, care delays, health behaviours, and experiences with telemedicine. To compare clinical outcomes during the pandemic with a control group, 400 randomly selected charts were reviewed: 200 from patients seen between March-September 2020 and 200 from patients seen from March-September 2021. Data extracted included demographic information, clinical status, lab measures, and imaging. Results: Of 399 patients invited to participate, 135 (34%) completed the survey. Median age group was 40-59 years, 60 (49%) were female, and 67 (54%) were East Asian. Liver diagnoses included viral hepatitis (n=63, 41%), nonalcoholic fatty liver disease (NAFLD;n=36, 24%), alcohol liver disease (n=6, 4%), and other (n=36, 24%). Twelve (8%) patients had cirrhosis due to alcohol-related disease (n=3), NAFLD (n=4), viral hepatitis (n=1), and other causes (n=4). Fifty (39%) patients reported 83 care delays, with delay duration >2 months in 59 (71%) patients and >4 months in 24 (41%) patients. More instances of care avoidance were found in patients with care delays than those without (n=54 vs 29). Most patients (75%) were satisfied with telemedicine appointments and 6% preferred telemedicine over an inperson appointment due to convenience. There was a longer delay between lab work and appointments in patients seen during the pandemic than pre-pandemic (67 vs 46 days, p=0.01). During the pandemic, there were also more cases of cirrhosis decompensation (n=26 vs 22), hospitalization (n=12 vs 5), and new suspicious liver lesions (n=10 vs 6), of which 4 were found to be HCC during the pandemic compared to none pre-pandemic. Conclusion: Significant care delays, higher rates of cirrhosis decompensation, and hospitalization were seen in CLD outpatients during this pandemic. Telemedicine was appreciated by most patients. Understanding patient experiences with telemedicine would help optimization and integration into outpatient CLD care.