Telehealth interventions in patients with chronic liver diseases: a systematic review

BACKGROUND AND AIM: Telehealth (TH) interventions may improve access to care, disease-specific and quality outcomes in chronic liver diseases (CLD). We aimed to systematically evaluate outcomes of TH interventions in CLD.METHODS: We used key terms and searched PubMed/EMBASE from inception to 01/10/2022. Two authors independently screened abstracts. Disagreements were resolved by a third reviewer. We included any type of CLD, including post-transplant patients, and extracted outcomes as defined by authors for each etiology of CLD (sustained virological response (SVR) in Hepatitis C (HCV) or weight loss in nonalcoholic fatty liver disease, NAFLD). Meta-analysis was not performed due to the heterogeneity of data. Quality assessment was performed using the Newcastle Ottawa scale for observational studies and the Cochrane Risk of Bias tool for clinical trials.RESULTS: Of 4,250 studies screened, forty-three met the inclusion criteria. Of these, twenty-eight reported HCV treatment outcomes. All studies showed no statistically significant differences between SVR rates in TH groups compared to control groups or historic cohorts. Eight studies evaluating liver transplant-related processes and outcomes demonstrated improved rates of transplant evaluation and referrals and decreased short-term readmission rates. Three randomized controlled trials and one observational study on NAFLD showed improved weight loss outcomes. One retrospective study showed reduced mortality risk in CLD patients with at least one TH encounter.CONCLUSION: TH interventions in patients with CLD consistently show equivalent or improved clinical outcomes compared to traditional encounters. TH in CLD can bridge the gap in access while maintaining the quality of care for underserved populations.