title: Integrated psychiatric/medical care in a chronic hepatitis C clinic: effect on antiviral treatment evaluation and outcomes.
abstract: OBJECTIVE
  Psychiatric and substance use disorders are common in hepatitis C patients and represent barriers to antiviral treatment. We 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.
  
  
  METHODS
  Integrated care consisted of screening for psychiatric problems with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), Beck Depression Inventory (BDI), Urine Drug Screen (UDS), and Primary Care Posttraumatic Stress Disorder (PC-PTSD) screens, referral based on specified cutoff scores to an established mental health (MH) provider, to a colocated psychiatric clinical nurse specialist (PCNS), or both. Data were collected retrospectively by chart review.
  
  
  RESULTS
  Most patients (149/184, 81.0%) had at least one positive screen, 25.5% had a positive UDS. Among patients with positive screens, 38.3% had established MH providers, 47.0% had no MH provider and were referred to the PCNS, and 15.0% refused any psychiatric referral. Patients receiving integrated care with a colocated PCNS 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 screens. Patients with positive screens followed by any MH provider had significantly greater adherence to antiviral therapy than patients without positive screens.
  
  
  CONCLUSIONS
  An integrated MH and medical approach was associated with rates of antiviral therapy recommendation and initiation similar to patients without risks for psychiatric or substance use problems. MH 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.
authors.affiliation: Hepatitis C Resource Center, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Astrid
authors.initials: A
authors.lastname: Knott
authors.forename: Eric
authors.initials: E
authors.lastname: Dieperink
authors.forename: Mark L
authors.initials: ML
authors.lastname: Willenbring
authors.forename: Sara
authors.initials: S
authors.lastname: Heit
authors.forename: Janet M
authors.initials: JM
authors.lastname: Durfee
authors.forename: Mary
authors.initials: M
authors.lastname: Wingert
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Paul
authors.initials: P
authors.lastname: Thuras
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Ho
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D000998:Antiviral Agents