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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3035 — Effects of the Hepatitis C Self-Management Program at 1-Year

Groessl EJ (VA San Diego Healthcare System), Weingart KR (VA San Diego Healthcare System), Asch SM (Edith Nourse Rogers Memorial Veterans Hospital), Gifford AL (VA Greater Los Angeles Healthcare System), Ho SB (VA San Diego Healthcare System)

Objectives:
Chronic hepatitis C (HCV) affects a disproportionate number of Veterans in the US. Antiviral treatments are available for HCV but have side effects, have limited success, and are not offered to everyone. Self-management interventions are one option for improving the health of HCV-infected individuals. Post-intervention (6-week) data showing improved outcomes has been presented. Here, we present data on group differences at the final 12-month follow-up.

Methods:
134 VA patients with HCV (mean age 54.6, 95% male, 41% ethnic minority, 83% unmarried, 72% unemployed/disabled, 48% 5-year homelessness) were randomized to one of two self-management interventions, a 6-week workshop or information-only. The six 2-hour self-management workshop sessions were co-led by a peer-leader and a health care professional. The workshop intervention was developed by adding HCV-specific modules to an existing chronic disease self-management program that was efficacious in other chronic diseases. Outcomes including HRQOL, HCV knowledge, self-efficacy, depression, energy, and health distress were measured at baseline, 6-months, and 12-months. Data were analyzed using repeated measures ANOVA controlling for baseline differences.

Results:
Data were available for 93 of the 134 participants at 12-month follow-up. Attrition rates were not significantly different between groups. When compared to the information-only group, participants attending the self-management workshop improved more on HCV knowledge (F (2,89) = 7.84, p = .001), SF-36 energy/vitality (F (2,90) = 3.41, p = .038), and total Quality of Well-being (QWB) score (F (2,90) = 3.20, p = .044). Similar non-significant trends were found for depression (p = .091). Using QWB scores, preliminary cost-effectiveness analysis found an incremental cost-effectiveness ratio of about $3350/QALY for the workshop, assuming the groups had similar health care costs over time.

Implications:
Positive health effects (HCV-related knowledge, energy, and overall HRQOL) of the Hepatitis C Self-Management Program were sustained at 12-month follow-up, well after the intervention ended, despite limited statistical power. The intervention does not require many resources to implement.

Impacts:
The Hepatitis C self-management program appears to be a cost-effective way to improve the health of Veterans with Hepatitis C, independent of their candidacy or success with antiviral treatment. Plans are proceeding for implementing the intervention in other VA and community settings.


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