Integrated Care Model for Improving HCV Outcomes (HCV)

​The prevalence of hepatitis C virus (HCV) infection among VA patients is 3 times higher than in the general population. Recent VA data indicate that only about 14% of all HCV-infected VA patients have ever received antiviral therapy. Barriers to receiving antiviral treatment include factors such as pre-existing psychiatric illness, ongoing substance abuse, and other medical co-morbidity. Using a new protocol-based model of care that centers around integrating psychiatric care and case management into VA HCV clinics may increase treatment rates, improve rates of sustained viral response (SVR), and improve health outcomes for veterans with hepatitis 

The HCV study aims to determine the effectiveness of this protocol-based integrated care model for increasing treatment rates and the number of patients who receive successful antiviral treatment. The study will also assess the effects of an integrated care model on patient involvement in care.

The HCV study uses a prospective patient level randomized design to examine the effectiveness of this intervention at 3 major VA medical centers. All clinic patients who screen positive on 1 or more measures of depression, anxiety, PTSD, or recent SUDs are asked to participate. These questionnaire data, which are processed, stored, and maintained at HSRC, have the potential to significantly impact patient care and future healthcare decisions. Preliminary data suggest that 85% of HCV clinic patients screen positive on at least one measure.

Eligible patients are randomized to either usual or integrated care at each site. The integrated care intervention follows a standardized protocol consisting of a series of brief interventions tailored to each patient’s main barriers to treatment. In addition, it employs a case management approach in which the integrated care mental health provider actively tracks each patient’s progress through the evaluation and treatment process. The integrated care mental health providers—clinical nurse specialists, psychologists, or licensed clinical social workers—all have experience and training in the provision of psychiatric and SUD interventions and also receive additional training on the integrated care protocol.

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