Psychiatric and substance use disorders are common in Hepatitis C patients and represent barriers to antiviral treatment.
Dr Samuel Ho and colleagues from California evaluated the effect of integrating psychiatric and medical care in treating Hepatitis C.
The researchers evaluated a cohort of 184 patients with chronic Hepatitis C.
Integrated care consisted of screening for psychiatric problems with Alcohol Use Disorders Identification Test-Consumption.
Beck Depression Inventory, Urine Drug Screen, and Primary Care Posttraumatic Stress Disorder screens were also used.
Referral was based on specified cutoff scores to an established mental health provider or to a colocated psychiatric clinical nurse specialist, or both.
| Positive screens followed by any mental health provider improved adherence|
|American Journal of Gastroenterology|
The researchers collected data retrospectively by chart review.
The team found that 81% of patients had at least one positive screen, 26% had a positive urine drug screen.
Among patients with positive screens, 38% had established mental health providers.
A further 47% had no mental health provider and were referred to the nurse specialist.
The researchers noted that 15% refused any psychiatric referral.
Patients receiving integrated care with a psychiatric clinical nurse specialist were more likely to complete evaluation for and start antiviral treatment.
These patients were more likely to complete treatment than other patients with positive screens, and at a rate similar to that of patients with negative screens.
The team observed that patients with positive screens followed by any mental health provider had greater adherence to antiviral therapy.
Dr Ho's team concludes, “An integrated mental health and medical approach was associated with rates of antiviral therapy recommendation and initiation similar to patients without risks for psychiatric or substance use problems.”
“Mental health care was associated with improved adherence to antiviral therapy.”
“Integrated care offers promise as an approach for addressing psychiatric comorbidity in this traditionally difficult to treat population.”