Integrated Care Increases Treatment and Improves Outcomes of Patients With Chronic Hepatitis C Virus Infection and Psychiatric Illness or Substance Abuse
Integrated Care Increases Treatment and Improves Outcomes of Patients With Chronic Hepatitis C Virus Infection and Psychiatric Illness or Substance Abuse
复制标题
DOI：
10.1016/j.cgh.2015.02.022
复制
发表时间：
2015-11-01
影响因子：
12.6
通讯作者：
Groesslk, Erik J.
中科院分区：
文献类型：
--
作者：
Ho, Samuel B.;Braeu, Norbert;Groesslk, Erik J.
背景与目的：丙型肝炎病毒（HCV）感染伴精神疾病和/或药物滥用的患者在抗病毒治疗方面面临重大障碍。需要新的战略来提高治疗率和结果。我们调查了综合护理（IC）协议，其中包括多学科护理协调和患者病例管理，是否可以增加慢性HCV感染患者接受抗病毒治疗（干扰素为基础的组合和直接作用的抗病毒药物）的比例，并实现持续的病毒学应答（SVR）。方法：我们进行了一项前瞻性随机试验，在美国的3个医疗中心。参与者（n = 363名参加HCV诊所的患者）已被筛选并检测为抑郁症，创伤后应激障碍和/或物质使用阳性;他们被随机分配到2009年3月至2011年2月接受IC或常规护理（对照）的组。根据正式协议，在每个HCV诊所都安排了一名中级心理健康医生，为IC提供简短的心理健康干预和病例管理。主要终点是SVR.Results：在研究参与者中，63%为非白人，51%在过去5年中无家可归，64%患有精神疾病，65%在入组前1年内滥用药物，57%有创伤后应激障碍的风险，71%有活动性抑郁症，80%感染HCV基因型1，23%有晚期纤维化。在平均28个月的随访期内，IC组开始接受抗病毒治疗的患者比例更高（31.9% vs 18.8%对照组; P = 0.005），并实现了SVR（15.9% vs 7.7%对照组;比值比，2.26; 95%置信区间，1.15-4.44; P= 0.005）。018）。有组之间的严重不良事件没有差异。结论：综合护理增加比例的HCV感染和精神疾病和/或药物滥用的患者谁开始抗病毒治疗，并实现SVRs，没有严重的不良事件。
BACKGROUND & AIMS: Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies are needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multidisciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct-acting antiviral agents) and achieve a sustained virologic response (SVR).METHODS: We performed a prospective randomized trial at 3 medical centers in the United States. Participants (n = 363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were assigned randomly to groups that received IC or usual care (controls) from March 2009 through February 2011. A midlevel mental health practitioner was placed at each HCV clinic to provide IC with brief mental health interventions and case management, according to formal protocol. The primary end point was SVR.RESULTS: Of the study participants, 63% were non-white, 51% were homeless in the past 5 years, 64% had psychiatric illness, 65% were substance abusers within 1 year before enrollment, 57% were at risk for post-traumatic stress disorder, 71% had active depression, 80% were infected with HCV genotype 1, and 23% had advanced fibrosis. Over a mean follow-up period of 28 months, a greater proportion of patients in the IC group began receiving antiviral therapy (31.9% vs 18.8% for controls; P = .005) and achieved a SVR (15.9% vs 7.7% of controls; odds ratio, 2.26; 95% confidence interval, 1.15-4.44; P=. 018). There were no differences in serious adverse events between groups.CONCLUSIONS: Integrated care increases the proportion of patients with HCV infection and psychiatric illness and/or substance abuse who begin antiviral therapy and achieve SVRs, without serious adverse events.