Integrating Medical and Mental Health Care Improves Likelihood of Initiation and Adherence to Hepatitis C Treatment

Psychiatric and substance use disorders are common in hepatitis C patients and represent a barrier to antiviral treatment. In particular, some studies have shown that individuals with a history of psychiatric conditions and substance use are more likely to experience depression as a side effect of interferon-based therapy.

As reported in the October 2006 American Journal of Gastroenterology, researchers with the Veterans Affairs Medical Center in Minneapolis retrospectively evaluated the effect of integrating psychiatric and medical care on evaluation for and initiation of antiviral treatment in a cohort of 184 patients with chronic hepatitis C.

Integrated care consisted of screening for psychiatric problems using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), Beck Depression Inventory (BDI), and Primary Care Posttraumatic Stress Disorder (PC-PTSD) screens, as well as urine drug tests. Based on specific cut-off scores, patients were referred to an established mental health provider, to a co-located psychiatric clinical nurse specialist, or both.

Results

	Most patients (149 out of 184; 81.0%) had at least 1 positive mental health screening result, and 25.5% had a positive urine drug test.
	Among patients with positive mental health screens, 38.3% had established mental health providers, 47.0% had no mental health provider and were referred to the psychiatric clinical nurse specialist, and 15.0% refused any psychiatric referral.
	Patients receiving integrated care with a co-located psychiatric nurse specialist were significantly more likely to complete evaluation for and start antiviral treatment than other patients with positive screens, and at a rate similar to that of patients with negative mental health screens.
	Patients with positive screens followed by any mental health provider had significantly greater adherence to antiviral therapy than patients without positive screens.

Conclusion

"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," the authors concluded. "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."

A Knott, E Dieperink, M L Willenbring, and others. Integrated psychiatric/medical care in a chronic hepatitis C clinic: effect on antiviral treatment evaluation and outcomes. American Journal of Gastroenterology 101(10): 2254-2262. October 2006.