Integrated Psych Care for High-Risk Hep C Patients May Increase Antiviral Treatment

By Rob Goodier

NEW YORK (Reuters Health) Mar 26 - Hepatitis C patients who have psychiatric disorders and problems with substance abuse may benefit from integrated care, a new study has found.

More patients in integrated care began antiviral treatment and achieved a sustained viral response in a trial of 365 patients at three Veterans Affairs medical centers, according to research presented March 20th at the annual meeting of the Society of Behavioral Medicine in San Francisco by Dr. Erick Groessl and a team at the University of California, San Diego and VA San Diego.

"This is just the kind of smart study that addresses the heightened focus in healthcare on identifying interventions that will really work in the real world," said Dr. Kathy Goggin, a psychologist at the University of Missouri-Kansas City who was not involved in the study.

In email to Reuters Health, she added, "Reducing patient burden while improving outcomes is good for everyone and will likely lead to significant cost savings."

The research team screened 1167 patients at the three HCV clinics. Of these, 65% were eligible for antiviral treatment and had psychiatric and/or substance use risk factors. Ultimately, 365 patients were randomized to either integrated care or usual care.

In this high-risk cohort, 51% were homeless at some point five years before treatment, 50.4% were risk-positive for post-traumatic stress disorder, and the mean Beck Depression Index score was 15.34, which indicates mild depression.

Patients who were randomized to receive integrated care were 1.6 times more likely to initiate antiviral therapy at all three treatment centers, at 32.4% compared to 19.7% (p=0.006).

More than twice as many patients achieved a sustained viral response in the integrated-care group, at 24 patients compared to 11 (13.2% vs 6.0%; p=0.016). "It is very important to remember that this is the SVR rate among all people randomized for the study," Dr. Groessl told Reuters Health. "That rate is a function of percent treated and the SVR rate among those treated." For example, he said, 59 patients in the integrated care group were treated, and their SVR rate was roughly 40%. In the usual care group, 36 patients were treated, and their SVR rate was roughly 30%.

There were also fewer deaths in the integrated-care group, at six, compared to 11 in the usual-care group (3.3% vs 6.0%; p=0.022).

"This model has been studied at three VA sites, so we plan to study the implementation of the program at additional VA sites and non-VA sites in the near future," Dr. Groessl said.

Possible barriers to the future adoption of this model of care may be inherent organizational differences at different health care centers and also the potential need for new funding for clinical staff. "We will address both of these factors in our planned implementation study," Dr. Groessl said.

http://www.medscape.com/viewarticle/781460