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BACKGROUND/RATIONALE:
Chronic hepatitis C (HCV) is a major health concern that disproportionately affects U.S. veterans. Veterans with HCV experience impaired quality of life as a result of HCV infection and other co-morbid disorders; namely substance abuse and mental health problems. Only a small proportion of these patients currently receive and are cured of HCV with Interferon-based treatments. Treatment recommendations for HCV-infected veterans not scheduled for Interferon-based treatment include additional evaluations/procedures and adherence to behavioral/lifestyle guidelines. However, many patients with HCV and commonly occurring co-morbidities have difficulty following these recommendations without additional assistance. HCV self-management programs are one option for helping these patients adhere to treatment recommendations while improving their quality of life. Patient self-management programs augment traditional information-oriented patient education with problem-solving skills and cognitive-behavioral techniques that enable patients to manage chronic illness and their lives as a whole.
OBJECTIVE(S):
Our primary objective is to assess the efficacy of a 6-session self-management workshop designed to improve health outcomes for veterans with HCV who are not receiving Interferon-based treatment.
METHODS:
Veterans with HCV who receive health care at VA San Diego Healthcare System facilities will be recruited and randomized to either the HCV Self-Management Workshop (HCV-SMW) or to the Information intervention study arm. The self-management intervention includes six 2.5-hour weekly workshop sessions in addition to the basic information provided to Usual Care. The HCV-SMW is co-led by a health educator and a peer-leader, and has been adapted from an existing self-management program that has been effective for patients with other chronic illnesses. Efforts will be made to recruit women and minority veterans into the study. The primary outcome for the study is health-related quality of life. Secondary outcome variables include attendance at recommended health care visits, self-reported health behaviors related to preventing viral transmission, substance use/abuse, and patient-provider communication. Data will be collected at baseline, end-of-intervention (6 weeks), and at a 12-month follow-up visit using questionnaires. In accordance with HIPAA guidelines, VA medical records and other databases will be accessed to gather data on health care utilization and mortality. Data will be analyzed using repeated-measures analysis of variance, MANCOVA, and linear mixed-model approaches. In addition, an exploratory cost analysis will be conducted.
FINDINGS/RESULTS:
As of 8/26/08 data collection continues but data are not currently available for analysis.
IMPACT:
The study aims to contribute to a determination of whether existing patient self-management approaches can be used to improve the quality of health care and overall health status of veterans with HCV and common co-morbidities who are not candidates for Interferon-based therapies. If the workshop is successful, it may offer a cost-effective approach for treating that patient subgroup. In addition, the workshop may prepare veterans for Interferon-based treatment and could potentially improve the health outcomes of pharmacological treatment.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Mental Illness
DRE:
Quality of Care, Communication and Decision Making, Prevention
Keywords:
Behavior (patient), Quality of life, Self-care
MeSH Terms:
none
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