期刊
JOURNAL OF HEPATOLOGY
卷 73, 期 2, 页码 441-445出版社
ELSEVIER
DOI: 10.1016/j.jhep.2020.04.005
关键词
Liver disease; Varices; Telemedicine; Hepatocellular carcinoma; Hepatic encephalopathy
资金
- National Institutes of Health through the NIDDK [1K23DK117055]
- Baylor Foundation
The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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