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BACKGROUND/RATIONALE:
The prevalence of hepatitis C virus (HCV) infection among VA patients is 3x higher than in the general population. Recent VA data indicate that only about 14% of all HCV-infected VA patients have ever received antiviral therapy, which has the potential to reduce complications and sequelae of HCV infection. Barriers to receiving antiviral treatment include factors such as pre-existing psychiatric illness, ongoing substance abuse, and other medical co-morbidity. Clinical protocols are needed that can increase the number of patients with chronic HCV able to receive safe and effective antiviral treatment.
OBJECTIVE(S):
Primary Objective: To determine the effectiveness of a protocol-based integrated care model for increasing treatment rates and the number of patients with successful antiviral treatment as measured by an increase in percentage of all new HCV patients achieving a sustained virologic response (SVR). We hypothesize that this model will increase the proportion of patients who are fully evaluated for treatment, who initiate treatment, and who complete treatment compared with patients that receive usual care. Secondary Objectives: Assess the effects of an integrated care model on patient involvement in care (appointment attendance) and patient questionnaire forms (PQF) (substance abuse, depression, etc). We hypothesize that veterans managed with the integrated care model will have better attendance at HCV clinic appointments, have improved rates of drug and alcohol abstinence, and fewer psychological symptoms.
METHODS:
RESEARCH DESIGN: The intervention is an integrated clinical care model developed and initally studied at the Minneapolis VA HCV Clinic. The preliminary study found that integrated care resulted in higher treatment rates, higher SVRs, reduced substance use, and improved psychological functioning. This study is a prospective patient level randomized design to study the effectiveness of this intervention at 3 major VA medical centers.
METHODOLOGY: All clinic patients will be screened for depression, anxiety, PTSD, or recent SUDs and all patients that screen positive on 1 or more of these measures will be asked to participate. Preliminary data suggest that 85% of HCV clinic patients screen positive on at least one measure. Eligible patients will be randomized to either usual or integrated care at each site. The integrated care intervention follows a manulaized protocol consisting of a series of brief intervention tailored to the patients' main barriers to treatment along with a case management approach in which the integrated care mental health provider actively tracks each patients progress through the evaluation and treatment process. The integrated care mental health provider can be a clinical nurse specialist, psychologist, or licensed clinical social worker that has experience and training in the provision of psychiatric and SUD interventions. They will receive additional training on the integrated care protocol. Data will be collected at baseline, pre-treatment, and post-treatment intervals. Clinical data will be obtained from VA medical records by the study coordinator at each site. PQFs will be assessed using validated measures. Data will be analyzed using hierarchicall linear modeling (HLM) techniques.
FINDINGS/RESULTS:
Study is being initiated and there are no findings to date
IMPACT:
Using a new protocol-based model of care that centers around integrating psychiatric care and case management into VA HCV clinics, it may be possible to increase treatment rates, improve rates of sustained viral response (SVR), and improve health outcomes for veterans with hepatitis C.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Substance Abuse, Addictive Disorders
DRE:
Treatment, Quality of Care, Resource Use and Cost
Keywords:
Clinical practice guidelines, Hepatitis C, Care Management
MeSH Terms:
none
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