title: Instrumental support to facilitate hepatitis C treatment adherence: working around shortfalls in shared-care.
abstract: Adherence to treatment for hepatitis C virus (HCV) infection is associated with the successful eradication of infection. However, patients often have difficulty adhering to HCV treatment because of factors such as the psychiatric side effects of regimens and social disadvantage. Commonly, health professionals including specialist physicians, nurses, social workers and psychologists work together under a multidisciplinary model of shared-care to support patients' adherence to HCV treatment. In some HCV treatment clinics, shared-care is not always available, or only partially implemented and this has implications for patient adherence. To explore the facilitators of adherence, an interview-based study was conducted in 2012 with a purposive sample of Australian physicians and nurses (N = 20). The findings reveal that when comprehensive shared-care was limited or unavailable, physicians and nurses filled in the gaps by assuming roles outside of their expertise to help patients adhere to HCV treatment. Physicians and nurses applied instrumental support strategies based on psychosocial interventions, namely patient advocacy, pragmatic problem-solving, treatment engagement and emotional support. These strategies were provided by dedicated physicians and nurses to address shortfalls in multidisciplinary shared-care. Although these interventions were reported to assist adherence, there is an increased risk of complications when physicians and nurses move beyond the bounds of their disciplinary training, for example, to assess and manage patients' psychiatric side effects or advocate on their behalf for social services. Future research should measure the effectiveness of instrumental support strategies on HCV treatment adherence, and explore the costs associated with physicians and nurses providing instrumental support in the absence of comprehensive multidisciplinary shared-care.
authors.affiliation: a Clinical School , University of Sydney , Sydney , Australia.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Sublette
authors.forename: Max
authors.initials: M
authors.lastname: Hopwood
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Sian K
authors.initials: SK
authors.lastname: Smith
authors.forename: Kathryn Nicholson
authors.initials: KN
authors.lastname: Perry
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
authors.forename: Mark W
authors.initials: MW
authors.lastname: Douglas
mesh_terms: D000328:Adult; D005260:Female; D006296:Health Services / Q000592:standards*; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research; D012944:Social Support
keywords: hepatitis C treatment adherence; instrumental support; qualitative research methods; shared-care