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Reuters Health Information (2006-11-10): Integrated care improves chronic hepatitis C outcome


Integrated care improves chronic hepatitis C outcome

Last Updated: 2006-11-10 13:44:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - An integrated psychiatric and medical care approach improves antiviral therapy initiation and adherence among patients with chronic hepatitis C virus (HCV) infection, according to a report in the October issue of the American Journal of Gastroenterology.

"Substance use and psychiatric comorbidities are common among hepatitis C patients and are often cited as reasons for withholding antiviral therapy," explain Dr. Astrid Knott from Veterans Affairs Medical Center, Minneapolis, Minnesota and colleagues.

The authors investigated the effects of the integrated medical and psychiatric model, consisting of routine mental health and substance use screening, referral of patients who screened positive for HCV to a psychiatric clinical nurse specialist at a chronic hepatitis clinic.

Of 184 patients, 149 (81%) tested positive at least once for HVC. Twenty-six percent of the patients had a positive urine drug screen.

Patients followed by the psychiatric clinical nurse specialist were more likely to complete evaluation for antiviral treatment and more likely to start antiviral therapy than were patients followed by an existing mental health provider or patients with no psychiatric follow-up, the investigators report.

In a logistic regression model that accounted for various factors, the only significant predictors of having antiviral treatment recommended were fibrosis of at least stage 2 and being seen by the psychiatric clinical nurse specialist.

Controlling for the number of positive drug or mental health screens, patients who saw the psychiatric clinical nurse specialist were five times as likely to start antiviral treatment.

There were no significant differences in early or sustained virologic responses, the report indicates. The authors attribute this lack of difference to the small numbers of patients in each group.

"This report provides preliminary support for integrating psychiatric and mental health care into existing hepatitis C clinic operations," the investigators conclude. "While this model of integrated psychiatric and medical care in its current form is especially relevant to clinics within the VA system, it is highly relevant to other managed care or integrated delivery systems, in which more support for collaborative practices would exist."

"Randomized controlled trials examining the efficacy and cost-effectiveness of integrated versus separate care models are urgently needed," the authors add. "Additionally, further study is needed to identify strategies for engaging patients with severe mental illnesses and reluctant substance users."

Am J Gastroenterol 2006;101:2254-2262.

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