Patients with hepatitis C and psychiatric disorders or substance abuse problems benefit significantly from an integrated care model of treatment, with a randomized controlled trial showing such an approach is linked to greater rates of antiviral therapy and treatment response.
The prospective trial of integrated care versus usual care involved 363 patients attending three hepatitis C (HCV) clinics, with the integrated care being delivered by a midlevel mental health provider within the clinic who served as the regular contact and case manager.
Patients randomized to integrated care, which included brief psychological interventions and case management, were more than twice as likely to start antiviral therapy earlier and achieve a sustained virologic response than those who received usual care, according to Dr. Samuel B. Ho of the VA San Diego Healthcare System and his coauthors.
While individuals with a history of prior psychiatric disorder or active drug use were significantly less likely to achieve sustained virologic response, the integrated-care approach had particularly positive effects on treatment initiative and response for individuals with a risk for active psychiatric disease at baseline, they said (Clin Gastroenterol Hepatol. 2015. doi: 10.1016/j.cgh.2015.02.022).
“To optimize the public health impact of antiviral treatments for HCV, the number of patients who are able to receive these treatments must be expanded,” wrote Dr. Ho and his associates, adding that “new interferon-free regimens have fewer side effects and are expected to expand treatment populations to include a broader range of patients, many with very significant psychiatric and substance abuse disorders.”
The study was supported by VA Health Services Research and Development. Three authors declared research support, grants, advisory board positions or speakers bureau roles with the pharmaceutical industry.