Telemedicine Approaches for Patients with Cirrhosis, Including Vulnerable Populations: A Narrative Review.

Background: The COVID-19 pandemic accelerated the adoption of telemedicine in health care. However, telemedicine in cirrhosis care remains underexplored. In particular, patients with alcohol use disorder (AUD) and hepatitis C virus (HCV) may be overrepresented among vulnerable populations, but have limited access to telemedicine.

Method: We performed a literature review on telemedicine approaches for patients with cirrhosis as well as patients with AUD and HCV with or without cirrhosis. Peer-reviewed studies involving direct patient-physician interactions were searched on PubMed and Google Scholar. Keywords used included cirrhosis, AUD, HCV, and telemedicine. Abstracts were screened. Full texts were reviewed.

Results: Among patients with cirrhosis, videoconferencing at satellite sites shortened the time from liver transplant referral to evaluation and listing. Telephone calls were less effective, especially for those with decompensated cirrhosis. Among patients with AUD, videoconferencing at satellite sites was effective, with patients being five times more likely to be prescribed medications. Treatment programs involving videoconferencing and telephone calls demonstrated retention rates above 50%. Among patients with HCV, videoconferencing was effective, with high (>90%) sustained virological response rates. Across all approaches, concerns raised included audiovisual quality, patient privacy, and licensing restrictions.

Conclusion: Videoconferencing at satellite sites is most promising if audiovisual quality and other barriers are optimized. Telemedicine may not be appropriate for management of decompensated cirrhosis.