Theme: Models of Care Year: 2024
Background: Liver cancer (HCC) is the fourth most common cause of death worldwide. Regular monitoring of people with diagnosed liver disease is key to early HCC detection. People using drugs and/or alcohol are often underserved by conventional models of healthcare and disease surveillance, whilst simultaneously being at high risk of liver disease and HCC.
The HELIXR pilot was developed to support patients with diagnosed liver disease who have struggled to attend monitoring appointments into HCC early detection and care.
Model of care: HELIXR operates in Wessex, England. Peer staff have lived experience and a professional background working with target communities. Eligible patients are referred by hospitals; peers then support attendance at six-monthly liver ultrasound scans (US) and other cirrhosis pathway appointments. The model has been progressively refined and adapted since June 2023. Peers facilitate attendance by engaging with each individual patient in their own communities prior to appointments, visiting homes after making first contact by phone and driving patients to appointments.
Effectiveness: 242 patients have been supported by the programme with 78 (32%) referred to Hep C Trust peers. Each patient had missed numerous previous appointments, some spanning years.
55% of patients attended their US appointments. 21% have been supported to secondary appointments including CT scans, MRI, DEXA, pathology and hepatology clinics. 76% of patients provided with education on liver health.
Lack of trust in services, mobility issues, social isolation, drug and alcohol use, mental health needs and poor public transport are common barriers among people supported. Patient feedback has been highly positive.
Conclusion and next steps: HELIXR successfully engages patients with complex needs and poor healthcare access. A range of barriers to accessing health services have been overcome by the community support on offer. If expanded, the programme could substantially reduce inequalities in liver disease outcomes for under-served patients.