title: Education by a nurse increases response of patients with chronic hepatitis C to therapy with peginterferon-α2a and ribavirin.
abstract: OBJECTIVE
  Education of patients with chronic hepatitis C has been proposed to increase response to therapy with peginterferon and ribavirin. We performed a prospective study to determine the effects of systematic consultation by a nurse on patient adherence and the efficacy of therapy.
  
  
  METHODS
  We analyzed data from 244 patients who received either systematic consultation after each medical visit from a nurse who used a standard evaluation grid and provided information about the disease and treatment (group A [GrA], n = 123) or the conventional clinical follow-up procedure (group B [GrB], n = 121). Treatment lasted 24 to 48 weeks.
  
  
  RESULTS
  Characteristics of each group were similar at baseline, including prior treatment (42.6% in GrA and 36.0% in GrB). Overall, GrA had significantly better adherence to treatment than GrB (74.0% vs 62.8%), especially among patients who received 48 weeks of treatment (69.7% vs 53.2%; P < .03). Significantly more patients in GrA had a sustained virologic response, compared with GrB overall (38.2% vs 24.8%; P < .02), as well as treatment-naive patients (47.1% vs 30.3%; P < .05), and those with genotypes 1, 4, or 5 infections (31.6% vs 13.3%; P < .007). There were no differences between GrA and GrB in response of patients with genotypes 2 or 3 infections or advanced fibrosis. Prognostic factors for a sustained virologic response (based on bivariate and multivariate analyses) were virologic response at week 12 (odds ratio [OR], 1.9; P < .0001), genotypes 2 or 3 (OR, 2.9; P < .0001), therapeutic education (OR, 2.5; P < .02), and lack of previous treatment (OR, 2.3; P < .005).
  
  
  CONCLUSIONS
  Therapeutic education by a specialized nurse increases the response of patients with hepatitis C to therapy, particularly in difficult-to-treat patients.
authors.affiliation: Hepato-Gastroenterology, Saint Eloi Hospital, Montpellier, France. dom-larrey@chu-montpellier.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Larrey
authors.forename: Annie
authors.initials: A
authors.lastname: Salse
authors.forename: Didier
authors.initials: D
authors.lastname: Ribard
authors.forename: Olivier
authors.initials: O
authors.lastname: Boutet
authors.forename: Valérie
authors.initials: V
authors.lastname: Hyrailles-Blanc
authors.forename: Birame
authors.initials: B
authors.lastname: Niang
authors.forename: Georges Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Vaucher
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Arpurt
authors.forename: Guy
authors.initials: G
authors.lastname: Boulay
authors.forename: Natalia
authors.initials: N
authors.lastname: Karlova
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Daures
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage*; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a