May 29, 2012
EDMONTON — A ‘one-stop’ Alberta Health Services (AHS) clinic is improving the health of people with severe liver disease and reducing their need for emergency department care.
In its first three years, the Portal Hypertension Clinic at the University of Alberta Hospital (UAH) has shortened hospital stays and reduced visits to emergency while providing the fast access to the co-ordinated care and frequent follow-ups needed by this gravely ill population.
“Before the existence of this clinic, many of these patients were on a merry-go-round between the emergency departrment, the hospital ward and home,” says Dr. Vince Bain, UAH Director of Hepatology. “Here they get the continuous care they need. This clinic improves patients’ quality of life and, for those awaiting liver transplantation, helps prepare them for the operation.”
At any given time, the Portal Hypertension Clinic cares for about 100 patients, of which up to a third are awaiting a liver transplant. Clinic staff intensively monitors their health to prevent life-threatening complications caused by cirrhosis (scarring) of the liver, such as abdominal fluid buildup, toxins in the blood, and enlarged blood vessels in the esophagus or stomach that can rupture. Liver cancer can occur if sick liver cells multiply out of control.
“People can live with cirrhosis for a number of years and not know they have it until they develop the major complications,” says Michelle Carbonneau, the nurse practitioner who runs the clinic with hepatalogist Dr. Puneeta Tandon. “Once patients develop one of these complications, their life expectancy is only about two years.”
Also in the team is dietitian Jaya Ramamurthy.
Since 2009, as its caseload grew, this multidisciplinary trio has:
“Physicians are finding they can discharge patients from hospital earlier because they know they’re going to have really close follow-up as an outpatient,” says Carbonneau. “Detecting cancers early, and keeping them healthy, puts or keeps many of them on the transplant list.”
Patient Wade Smith, 43, had his liver transplant cancelled while on the operating table due to adhesions on his abdominal organs that made the surgery impossible.
“Afterwards, all the specialists told me I had weeks, maybe a month or two to live – and that was last July,” recalls Smith.
“Michelle and the clinic team are awesome. Even when I’m not at the clinic, they phone me to see how I’m doing. They treat me simply amazing. If it wasn’t for these guys working with me, I know I wouldn’t be here now.”
Urgent cases can be seen within a week of referral to the clinic, and new referrals are given a two-hour first appointment to ensure all their initial medical questions are answered.
“Our clinic is like one-stop shopping for our patients as they get to meet all the team members on one visit,” says Ramamurthy.
Patient education and nutrition are heavily emphasized.
“Malnutrition is a common feature among our patients due to nausea, vomiting, feeling full early, taste changes and increased fatigue,” says Ramamurthy. “Appropriate nutrition, low salt intake and diet counselling are essential to prevent muscle wasting or weight loss, and also help prevent fluid accumulation.”
The Portal Hypertension Clinic is making inroads at a time when the number of people with significant liver disease is growing in our society. Total liver-related admissions to University of Alberta Hospital have risen in recent years, from about 600 (in 2009) to about 800 (in 2011).
“My quality of life is not perfect,” says Smith, “but with their care, I can get around pretty darn good. I’ve got no complaints, considering that when I went in, the doctors basically said I only had a little bit of time. And I’m months way past that.”
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.7 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.
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