Self-management of HCV improves health

Internal Medicine World Report, Summer 2011, Volume 1, Issue 1

Self-management of HCV improves health

Study shows that, independent of antiviral therapy, proactive and educated patients can avoid transmitting HCV

By Kurt Ullman

Most treatment recommendations for those with the hepatitis c virus (HCV) require active participation by the patient, who are expected to get to numerous clinic visits, have many laboratory tests, avoid certain foods, avoid transmitting the virus to others, and make decisions on the use of antiviral medications. The results of a study on an independent self-management program suggest that this type of intervention can improve the health of patients with HCV, independent of antiviral therapy.

“You need two active participants to achieve quality health care and optimal health,” said lead author Erik Groessl, PhD, from Health Services Research and Development (HSRD) at the Veterans Administration San Diego Health System. “An excellent care provider will provide little benefit if they are not working with a patient that is willing and able to follow health care recommendations. Many people infected with hepatitis C need additional knowledge and skills required to effectively participate in this process.”

One hundred and thirty-two patients with HCV were randomized to either a 6-week self-improvement workshop or an information only intervention. The weekly 2-hour self-management sessions were based on cognitive-behavioral learning principles and adapted from an earlier program that had proven to be effective in other chronic diseases.

The participants had a mean age of 54.6. They were mainly men (95%), unmarried (83%), unemployed/disabled (72%) and homeless in the last 5 years (72%). In addition, 41% were an ethnic minority.

The program was based on the chronic disease self-management program with three disease-specific modules. The program consisted of six weekly workshops lasting about 2 hours each. Those involved took part in a variety of group activities, including learning disease-specific information, problem solving, developing and implementing action plans, and analyzing how to modify the plans as needed.

“Many of our HCV-infected patients struggle to comply with healthcare recommendations and do not follow through with the expected regimen of lab testing and appointments that are precursors to antiviral treatment,” said Dr. Groessl. “We found that participants in our HCV Self-Management Program gained more knowledge about HCV, had less fatigue and depression, and had improved quality of life when compared with the control group.”

When compared to those in the information-only group, those participating in the self-management workshops improved more on HCV knowledge (P < 0.001), HCV self-efficacy (P = 0.011), and the SF-36 energy/vitality scale (P = 0.040). Similar trends were seen in the SF-36 physical functioning (P = 0.055) and health distress (P = 0.055). Attending the self-management program improved health knowledge and health-related quality of life scores 6 weeks later in this disadvantaged group. “This is a relatively low-cost intervention with clear benefits,” said Dr. Groessl. “The program was developed within the VA Healthcare system and may be more appropriate for large healthcare organizations. Work is ongoing to make this available over the Internet and in other formats.”

The study authors disclosed no conflicts of interest. The study was funded by a research grant from the VA HSRD.

Groessl EJ, et al. The hepatitis C self-management programme: A randomized controlled trial. J Viral Hepat. 2011;18:358-368.