 |
|
|
| |
Psychiatric/Substance Use Barriers to HCV Treatment
|
| |
| |
...About 45% of patients deferred from IFN therapy for substance use or psychiatric comorbidities, and only 13% became eligible for therapy at a later visit. Interventions are needed to address these comorbidities so patients can become eligible for HCV therapy...
"Psychiatric & Substance Use issues: the need for additional Interventions"
Reported by Jules Levin
DDW
May 2005
authors: DM Evon, A Verma, KA Dougherty, B Batey, M Russo, D Theodore, S Zacks, R Shrestha, MW Fried
Combination therapy with peginterferon & ribavirin eradicates HCV in 50-80% of patients. However, patients with comorbid psychiatric & substance use issues are often deferred from therapy for safety reasons. Up to one-third of patients are deemed ineligible for therapy for psych/substance use. Previous studies have explored reasons for deferral, but none have explored whether patients deferred initially become eligible for therapy during subsequent follow-up.
The aims of this study were to evaluate the outcomes of patients initially deferred from IFN therapy for psych or substance use & determine subsequent eligibility for therapy.
A retrospective review of electronic medical records was conducted for 238 patients with HCV referred to a university-based hepatology clinic during two periods, first quarter 2002 & first quarter 2003. Follow-up was available through June 2004. Deferral reasons were grouped into eight categories: substance use, psychiatric issues, finances, mild disease, patient choice/personal reasons, advanced liver disease, other medical issues, and previous failure of therapy.
Of 238 patients, 176 (74%) were deferred from IFN therapy for any reason. Seventy-nine (45%) were deferred for substance use, psych, both psych & substance use, both psych & substance use & another deferral reason. Out of the 79 patients deferred for psych/substance use, 47 (59%) returned for at least one follow-up visit, and only 10 (13%) were ultimately deemed eligible for IFN therapy. Of these, 7/10 (70%) started antiviral therapy.
About 45% of patients deferred from IFN therapy for substance use or psychiatric comorbidities, and only 13% became eligible for therapy at a later visit. Interventions are needed to help these patients follow through with treatment recommendations for psychiatric or substance use comorbidities that would enhance chances of becoming eligible candidates for antiviral therapy.
|
|
| |
| |
|
|
|
|
|
