1027 — Collaborative Care for Depression in Chronic Hepatitis C Clinics

Kanwal F, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine; Pyne JM, Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System; Psychiatric Research Inst, Univ of AR for Medical Sciences; Tavakoli-Tabasi S, Section of Infectious Diseases, Michael E DeBakey VA Medical Center, Houston, TX; Dieckgraefe B, Sections of Gastroenterology Hepatology, John Cochran Veterans Affairs Medical Center, St Louis, MO; Washington Univ School of Medicine, St Louis,MO; Goetz MB, Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles CA; Smith DL, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Kramer JR, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine; Sansgiry S, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Baylor College of Medicine; Gifford AL, VA Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP), Bedford, MA; Dept Health Policy & Mgmt, Dept of Medicine, Boston Uni; Asch SM, Center for Innovation to Implementation (Ci2i) VA Palo Alto Healthcare System, Division of General Medical Disciplines, Stanford Univ, Palo Alto, CA

Objectives:
Depression is highly prevalent, yet under-diagnosed and under-treated in patients with chronic hepatitis C virus (HCV) infection. Treatment models that increase mental and physical health clinicians' collaborative depression management have improved patients' mental health in primary care, but few data are available testing such methods in specialty HCV care.

Methods:
We tested a collaborative depression care model in a randomized trial at 4 Veterans Affairs HCV clinics (Hepatitis C Implementation of Translating Initiatives for Depression Into Effective Solutions [HEPTIDES]). The HEPTIDES intervention consisted of an offsite depression care team (a depression care manager, pharmacist, and psychiatrist) that delivered collaborative care backed by a web-based decision support system. Participant interview data were collected at baseline, 6-month, and 12-month follow-up. The outcome was depression severity measured using the 20-item Hopkins Symptom Checklist (SCL-20) and reported as treatment response ( > = 50% decrease in SCL-20 item score) and remission (mean SCL-20 item score, < 0.5).

Results:
A total of 292 patients completed baseline interviews. Follow-up interviews were completed for 263 participants (90%) at 6 months and 242 participants (83%) at 12 months. In unadjusted analyses, intervention participants' reports trended toward more treatment response (18.7% vs. 11.4%) and remission (12.2% vs. 6.5%) at 6-month follow up. The intervention effect was stronger at 12-month follow up, where intervention participants were significantly more likely to report response (31.6% vs. 14.8%) and remission (19.3% vs. 7.0%) than usual care participants. These differences remained statistically significant after adjusting for baseline depression and liver disease severity: response (OR = 3.55, 95% CI = 1.79 - 7.18) and remission (OR = 3.56, 95% CI = 1.49 - 8.51).

Implications:
Depression collaborative care resulted in significant improvement in HCV patient depression outcomes.

Impacts:
Although depression may no longer be an exclusionary criterion for the new interferon-free treatments, it may continue to play a role in predicting receipt and success of HCV treatment through its effect on retention in care and adherence to treatment. HCV clinics should consider collaborative care interventions to improve outcomes for their patients. This collaborative care model may also be effective for other high-risk patients with depression who are primarily managed in specialty care settings.