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Factors Related to Hepatitis C Treatment Completion in the VHA

Clark JA, Drainoni M, Koppelman E, Gifford A. Factors Related to Hepatitis C Treatment Completion in the VHA. Paper presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ.


Objectives: Hepatitis C (HCV) is common and causes significant morbidity in veterans; treatment can be curative but also very difficult to endure, leading to low levels of completion. Although a variety of HCV treatment models are used in the VA, no consensus exists on the best model to support patients or how to effectively incorporate patient perspectives to set up systems for optimal HCV care. Our goal is to understand veterans' experiences and perspectives of HCV treatment, reasons for completing or withdrawing, and factors associated with treatment completion or withdrawal. Methods: In-depth qualitative interviews are underway with patients who have recently completed or withdrawn from HCV treatment at two VA New England facilities. Interviews examine patients' experiences with HCV treatment, perspectives regarding how care is organized and delivered, and factors that led them to withdraw, or assisted them to complete, treatment within the VA. Results: Early results indicate some personal factors, social support and characteristics of the treatment system are important in assisting veterans to complete HCV treatment. These factors include motivation and reasons for undergoing treatment, information and expectations about treatment, relationship with clinic providers, support from treatment staff, care coordination, social networks and behavioral skills of patients to manage negative aspects (including side effects) of treatment. One patient described the importance of the HCV clinic nurse's support, "I very rarely saw Dr. X.But Nurse Y., that's who I saw every appointment. It was mostly her and she helped me quite a bit.she said, 'Please, dear God, tell me. If you are ever depressed for any reason, you know, give me a call. Talk to me. Whatever, we can set you up in a program. Don't worry about it. You don't have to feel guilty, embarrassed, whatever. Trust me.' So she helped me quite a bit, quite a bit." Conclusions: Successful HCV treatment requires social and psychological support as well as good medical diagnosis and therapeutics. Programs should be developed to organize HCV treatment within a structure which includes strong case management and care coordination. Future effectiveness and implementation research should explore how best to help patients draw from their internal resources and motivation to cope with the negative side-effects of HCV treatment. Impact statements: Whether through primary care, specialty care, or another model, our results indicate that including a strong case management or support component within HCV treatment is important in supporting patients own strengths and enabling HCV treatment completion within the VA.

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