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."
11/21/06
References 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.
