Management of Chronic Hepatitis C in Veterans: The Potential of Integrated Care Models
| Autor: | Samuel B. Ho, David Kravetz, Shannon K. Robinson, Eric Dieperink, Adrian Dollarhide, Erik J. Groessl |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Mental Health Services
medicine.medical_specialty Substance-Related Disorders Hepatitis C virus Population medicine.disease_cause law.invention Chronic hepatitis Randomized controlled trial law medicine Humans Intensive care medicine education Veterans Patient Care Team education.field_of_study Routine screening Hepatology business.industry Gastroenterology Hepatitis C Chronic Models Theoretical medicine.disease Mental health United States Surgery Integrated care Substance abuse business |
| Zdroj: | The American Journal of Gastroenterology. 103:1810-1823 |
| ISSN: | 1572-0241 0002-9270 |
| Popis: | The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, but only about 14% of all identified infected veterans have ever received antiviral therapy. High rates of comorbid psychiatric and substance use disorders are major barriers to receiving antiviral treatment for veterans, and characteristics associated with poor virologic response are more common in this population. However, accumulating evidence indicates that patients with psychiatric and substance use disorders can successfully receive interferon-based antiviral therapies in an integrated or multidisciplinary health-care setting. The broad aims of integrated care models include reducing fragmentation and improving continuity and coordination of care. Although, to date, there are no randomized controlled trials of specific care models for patients with HCV, studies of integrated care for other chronic diseases suggest several strategies for optimizing outcomes for patients with HCV. Components of an HCV clinic incorporating these principles have been tested in a nonrandomized setting and include routine screening of all patients for psychiatric and substance use disorder risk factors, collaboration with mental health providers within the HCV clinic, following a defined integrated medical/psychiatric clinical protocol, provision of ongoing integrated support during antiviral treatment or retreatment, and educating patients on principles of chronic disease self-management. |
| Databáze: | OpenAIRE |
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