Hepatitis C Translating Initiatives for Depression Into Effective Solutions
Condition: Hepatitis C; Depression
MeSH terms: Hepatitis A; Hepatitis C; Hepatitis; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Chronic infection with hepatitis C (CHC) is a common and expensive condition, and it
      disproportionately affects Veterans. Treatment with antiviral therapy reduces liver disease
      progression and improves health related quality of life. However, ~70% of Veterans with CHC
      are considered ineligible for antiviral treatment. Most of these patients are excluded due to
      the presence of co-existing depression and substance use. The proposed project will adapt and
      adopt an evidence-based collaborative depression care model in CHC clinics. By removing the
      leading contraindication for antiviral treatment, this project will potentially yield
      benefits that go far beyond the obvious quality of life benefit from antidepressant therapy
      itself.
    

Detailed description: 
      Project Background and Rationale: Depression is highly prevalent, yet under-diagnosed and
      under-treated in CHC. Treatment models that increase collaborative management of depression
      by mental health and physical health clinicians can improve quality and outcomes, and
      collaborative care models have been identified as the best-practice for depression in VA
      primary care settings. However, the antiviral treatment for CHC patients may not benefit from
      the existing primary care-mental health integration because the antiviral treatment is
      time-limited and conducted in specialty clinics. Although there is little evidence evaluating
      the effects of collaborative depression care in specialty settings, QUERI HIV-hepatitis
      initiated one of the first such efforts that effectively implemented collaborative depression
      care in HIV clinics. Built on this experience, an intensive yet focused collaborative care
      model in CHC clinics may be effective in improving not only depression but also CHC care.
      This proposed study, "Hepatitis-Translating Initiatives for Depression into Effective
      Solutions (HEP-TIDES)" will target this issue.

      Project Objectives: The proposal has three overarching primary aims and one exploratory aim.
      The primary aims are (1) adapt and adopt the collaborative care model for improving
      depression care in specialty CHC care settings, (2) compare the effectiveness of HEP-TIDES to
      usual care in improving CHC care, and (3) compare the effectiveness of HEP-TIDES to usual
      care in improving depression care. The exploratory aim is to evaluate the cost-effectiveness
      of HEP-TIDES versus usual care.

      Project Methods: HEP-TIDES is a multi-site, multi-method implementation project. HEP-TIDES
      will use evidence-based quality improvement (EBQI) methods to adapt and implement depression
      screening and the collaborative care model for depression in the CHC clinics at 4 disparate
      VA facilities (aim 1). HEP-TIDES will involve CHC and mental health providers working with an
      off-site depression care team comprised of a depression care nurse manager, pharmacist, and a
      psychiatrist. The purpose of the team will be to support CHC and mental health clinicians in
      delivering evidence-based stepped-care depression treatment. The adapted model will also take
      into account the substance use disorders among CHC patients. HEP-TIDES implementation will be
      assessed using a formative evaluation of the implementation process and a summative
      evaluation of a randomized controlled implementation trial of collaborative depression care
      in 242 patients (aims 2 and 3).
    

Intervention name(s): Depression collaborative care model
Intervention type(s): Other
Intervention description(s): The intervention will include a stepped-care model. The 5 steps include symptom and self-management monitoring by a depression care manager (DCM) and the following: 1) watchful waiting, 2) treatment recommendations (counseling or pharmacotherapy), 3) pharmacotherapy recommended by a Clinical Pharmacist, 4) combination pharmacotherapy and specialty mental health counseling, and 5) referral to mental health. The DCM: provides education about depression and depression treatment options; assesses the patient's treatment preferences and barriers, and the patient's current depression severity and mental health comorbidity; initiates a patient self-management plan, and assess treatment adherence. The DCM uses standard alcohol screening and brief intervention. The DCM also screens for street drug use and recommends referral for to the local substance abuse treatment programs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Hepatitis C; Depression; Collaborative care; Antiviral treatment