title: Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C.
abstract: Background. Despite the introduction of direct antiviral agents, pegylated interferon remains the mainstay of treatment for chronic hepatitis C. However, pegylated interferon is associated with a high rate of severe adverse events and decreased quality of life. Specific interventions can improve adherence and effectiveness. We aimed to determine whether implementing a multidisciplinary approach improved outcomes in the treatment of chronic hepatitis C.
  
  
  METHODS
  We analyzed consecutive patients treated with pegylated interferon plus ribavirin between August 2001 and December 2011. We compared patients treated before and after the implementation of a multidisciplinary approach in 2007. We compared the baseline demographic and clinical characteristics and laboratory findings between groups, and used bivariate logistic regression models to detect factors involved in attaining a sustained virological response, calculating the odds ratios with their respective 95% confidence intervals. To evaluate the effect of the multidisciplinary team, we fitted a multivariate logistic regression model to compare the sustained virological response after adjusting for unbalanced variables and predictive factors.
  
  
  RESULTS
  We included 514 patients [228 (44.4%) in the pre-intervention cohort]. Age, viral genotype, previous treatment, aspartate transaminase, ferritin, and triglyceride were prognostic factors of sustained virological response. After adjusting for prognostic factors, sustained virological response was higher in the multidisciplinary cohort (58 vs. 48%, p = 0.038). Despite higher psychiatric comorbidity and age in the multidisciplinary cohort, we observed a trend toward a lower rate of treatment abandonment in this group (2.2 vs. 4.9%, p = 0.107).
  
  
  CONCLUSIONS
  Multidisciplinary management of chronic hepatitis C improves outcomes.
authors.affiliation: Emergency Department. † Hepatology Unit, Digestive Disease Department. ‡ Hospital Pharmacy.
authors.forename: Marta
authors.initials: M
authors.lastname: Gallach
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Vergara
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Miquel
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Casas
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Sánchez-Delgado
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Blai
authors.initials: B
authors.lastname: Dalmau
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gil
authors.affiliation: Hospital Pharmacy Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Rudi
authors.affiliation: Mental Health Department. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Parra
authors.affiliation: CIBERehd, Instituto Carlos III; Madrid, Spain; Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: López
authors.affiliation: Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Angelina
authors.initials: A
authors.lastname: Dosal
authors.affiliation: Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Moreno
authors.affiliation: Department of Applied Statistics. Universitat Autónoma de Barcelona. Barcelona. Spain.
authors.forename: Oliver
authors.initials: O
authors.lastname: Valero
authors.affiliation: Hepatology Unit, Digestive Disease Department Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
mesh_terms: D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood; D000072085:Dermatologists; D004359:Drug Therapy, Combination; D005260:Female; D005293:Ferritins / Q000097:blood; D000072102:Gastroenterologists; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009726:Nurses; D010348:Patient Care Team; D010353:Patient Education as Topic; D010595:Pharmacists; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011379:Prognosis; D011570:Psychiatry; D011788:Quality of Life; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins / Q000627:therapeutic use; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D014280:Triglycerides; D011092:Polyethylene Glycols; D005293:Ferritins; D001219:Aspartate Aminotransferases; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a