P025 OSHI (open source healing initiative): an example of patient-led innovation in liver services

IntroductionAlcohol use disorders and alcohol related liver disease have a significant adverse impact on individuals, healthcare and society. Although abstinence is highly effective, engagement with traditional community alcohol support services (CASS) is poor, thereby reducing opportunities to improve outcomes. Reasons for this are complex, but inflexibility of access to existing services is important, and many patients do not feel comfortable discussing alcohol in clinical/group settings.To address these potential barriers to engagement, we introduced a personalized intervention. OSHI, which stands for Open Source Healing Initiative as well as being the Japanese word for ‘friend that supports’, was developed and delivered by a patient who joined our team as a peer-support volunteer.MethodsOSHI accepts referrals from community and secondary care and is targeted to those with moderate-severe alcohol dependence and recent hospital attendance. A review of the first 9 months was undertaken in June 2021. Demographic details were collated, alongside data including numbers engaging, and/or achieving abstinence. We also sought user feedback via a structured survey.Results48 patients were referred to OSHI over 9 months [31% female; mean age 45 (24–60)]. Across all referrals, 23 (47.9%) were currently abstinent with the majority (n=21; 91.3%) being OSHI users. 31 patients (64.6%) were actively engaging with OSHI. Of those, 21 (67.7%) were abstinent which compares favourably to rates achieved through CASS. More than half of abstainers (n=12; 57.1%) engaged with OSHI exclusively. For the 14 (29.2%) patients using OSHI not previously known to CASS, engagement and abstinence were particularly high (n=12; 85.7%; n=9; 75%, respectively). Patient feedback was uniformly excellent. Everyone welcomed the personalized approach. Many highlighted the on-demand support (‘you’re never alone…’; ‘a friend…rather than…an official appointment’; ‘…can call, even just to chat’), as well as the perceived informality compared to other services.ConclusionsThe results show high rates of engagement and abstinence with OSHI. We will next determine if rates are maintained longer term, and work to better understand reasons for non-engagement with CASS/OSHI, so interventions are targeted effectively. We hope to expand OSHI to include mentors from a variety of backgrounds and life experiences, and to enable referrals from other sources. Our team has been enriched by the integration of a peer-sup