Self-Management Program for Veterans with Hepatitis C Improves Health, Independent of Antiviral Therapy
Hepatitis C virus (HCV) infects about 1.8% of the US population, and often co-occurs with substance abuse problems, homelessness, and poverty. Treatment with antiviral medications eliminates the virus in many patients, but treatment rates are low. Common reasons for not receiving treatment are substance abuse, psychiatric disorders, and poor clinic attendance. This randomized controlled trial sought to examine the effects of an HCV self-management intervention on the quality of life of Veterans with HCV, who are not currently on or scheduled to start antiviral treatment. Self-management interventions are more comprehensive than traditional patient education, and focus on facilitating change, teaching problem-solving skills, and engaging patients in the management of their illness. In this trial (HCV Self-Management Program), 132 VA patients with HCV infection were randomized to either a 6-week self-management workshop or an information-only intervention between 5/07 and 11/08. Investigators assessed outcomes that included health-related quality of life (HRQOL), HCV knowledge, self-efficacy (ability to manage one’s health condition), depression, energy, and health distress at baseline and six weeks later.
Findings show that the HCV Self-Management Program was well attended and produced significant improvements along a number of dimensions of HRQOL and other outcomes six weeks later. When compared to the information-only group, Veterans who attended the self-management workshop improved more on HCV knowledge, self-efficacy, and had more energy and vitality. Increased energy and vitality is important because fatigue is the most commonly reported symptom of chronic HCV infection. Thus, the authors suggest that this intervention can improve the health of Veterans with HCV infection, independent of antiviral therapy. Planned research will examine longer-term outcomes, as well as clinical outcomes and costs. If successful, the intervention may serve as a model for a larger scale implementation in VA and other healthcare systems with large numbers of disadvantaged patients with HCV.
Groessl E, Weingart K, Stepnowsky C, Gifford A, Asch S, and Ho S. The Hepatitis C Self-Management Program: A randomized controlled trial. Journal of Viral Hepatitis May 31, 2010;e-pub ahead of print.
This study was funded by HSR&D (IAC 05-067). Drs. Groessl, Weingart, and Stepnowsky are part of the VA San Diego Healthcare System. Drs. Gifford and Asch are part of VA/HSR&D’s HIV/Hepatitis Quality Enhancement Research Initiative (QUERI).