Hepatitis C, Severe Mental Disorder
Conditions
Keywords
Clinical Paths, Patient Care Planning, Hepatitis C, Severe Mental Disorders
Brief summary
It has been described in the scientific literature that people diagnosed with serious mental disorders, such as psychosis and schizophrenia, have difficulties to access medical treatments for their physical illnesses, which produces excess mortality in this population. This project will consist of three different parts. The first will be the detection and accurate diagnosis of hepatitis C (HCV) in the population diagnosed with a severe mental disorder (SMD). It will find the prevalence of people with infection who have not been diagnosed, as well as that of people diagnosed but who have not completed treatment. Likewise, the characteristics of the sample obtained and the risk factors associated with positive cases will be analyzed. The second part of the study will consist of comparing the effectiveness of an individualized monitoring programme (NURSE-NAVIGATION PROGRAMME), carried out by the specialist mental health nurse, during the treatment of hepatitis C versus the usual health care. In order to fulfill these first two objectives, a Clinical Pathway will be opened in which the Microbiology, Gastroenterology, Pharmacy and Mental Health services of the Regional University Hospital of Malaga will participate. The third objective of the project will be to study how the presence of Hepatitis C influences psychotic symptoms, mainly negative ones, changes in daily functioning and changes in quality of life . For these purposes we will use the PANSS scale, a Quality of Life scale (the Life Skill Profile) and the Euroqol5D Health Questionaire before treatment and after verifying the effective cure of HCV. A third and final evaluation with all the study variables will be carried out 6 months after starting the treatment. In addition, the disappearance of the viral load and, therefore, the patient's cure will be determined with a new blood test.
Detailed description
The objective of this study is to compare the effectiveness of a nurse-navigation program developed by specialist nurses on mental health, for patients with HCV and SMD, against the usual standard care, regarding the detection of the disease, facilitation of access and adherence to treatment, guides through the healthcare system, and cure from HCV. The null hypothesis that this study will test is that there are no differences in the HCV cure rate in SMD subjects who receive the nurse-navigation model versus those who receive usual care. Additionally, a second hypothesis will be tested regarding to the differences in the adherence to HCV treatment.
Interventions
BEHAVIORALNursing monitoring program
A clinical pathway will be activate that allows all the necessary interventions, once the person is diagnosed, to be carried out on the same day, and a mental health nursing team will monitor the entire process.
BEHAVIORALAs usual
Referral to the family doctor for a request for follow-up by the gastroenterologist. The specialist prescribes the tests for the definitive diagnosis that will take place in other units (with their corresponding appointments). After this, the patient will return to the specialist to establish the treatment to follow. Pharmacological treatment will be dispensed at the hospital pharmacy (collected once a month until completion of treatment and confirmation of cure). This last step of the treatment will be done in a new consultation at the gastroenterology service after blood tests to verify the disappearance of the viral load.
Sponsors
University of Malaga
Gilead Sciences
Instituto de Investigacion Biomedica de Malaga
Hospital Regional de Malaga
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Severe mental disorder * Hepatitis C positive with viral load
Exclusion criteria
* Patients who have contraindicated HCV treatment for any reason * Patients in a clear situation of psychopathological decompensation (until recovery) * Patients does not agree to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Healing | 6 months | % healing in both groups (measured as undetectable viral load in a blood test done 3 months after finishing treatment). |
| Adherence | 8-12 weeks | Adherence to treatment in both groups using AIDS Clinical Trials Group method (medications not taken in a period of 4 days prior to the interview: % adherence = (total galenic units prescribed for that period - total units not taken) / total galenic units prescribed for that period) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Negative symptoms | 6 months | Negative symptoms, measured with Positive and Negative Syndrome Scale PANSS, with 30 items that are scored from 1-absent to extreme 7 symptoms where a higher score indicates greater severity of symptoms |
| Changes in health related quality of life | 6 months | Health related quality of life is assessed by the European Quality of Life-5 Dimensions Questionnaire (EQ-5D). A higher score means better health. |
| Changes in daily functioning | 6 months | Changes in daily functioning, measured with Life Skill Profile (LSP) where a higher score means better daily functioning. |
| Detection rate | 2 years | % Detection after screening the severe mental disorder population |
Other
| Measure | Time frame | Description |
|---|---|---|
| Characterization variable 6 | At the beginning and if there are changes (6 months) | Physical comorbidities according to the list of physical diseases proposed by Diederichs et al. (2011) (cancer, diabetes mellitus, hypertension, myocardial infarction, chronic ischemic heart disease, cardiac arrhythmias, heart failure, cerebrovascular accident, chronic obstructive pulmonary disease and arthritis). |
| Characterization variable 7 | At the beginning and if there are new hospital admission (6 months) | Number of admissions to a mental health hospitalization unit in the last 12 months. |
| Characterization variable 4 | At the beginning | Disease evolution time (in months) |
| Characterization variable 2 | At the beginning | Sex (male / female) |
| Characterization variable 3 | At the beginning | Type of diagnosis (classification according to DSM-IV) |
| Characterization variable 1 | At the beginning | Age (in years) |
| Characterization variable 5 | At the beginning and if there are changes (6 months) | Drug treatment (name and dose of all drugs) |
Countries
Spain
Outcome results
None listed