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IMPACT OF SOCIAL SUPPORT SYSTEMS ON TREATMENT COMPLIANCE AND COMPLETION OF THERAPY IN HEPATITIS C PATIENTS TREATED WITH PEGYLATED INTERFERON AND RIBAVIRIN
R Bailey4, A Morrison1, D Meyer1, D Wishard1, K Wasyliw1, C Sherstenka1, S Garg2, J Osinchuk3
1Hepatitis Support, Edmonton; 2Epicore; 3Department of Psychiatry; 4Division of Gastroenterology, Edmonton, Alberta
Aims: Patient compliance and completion of treatment for Hepatitis C is critical for optimal sustained viral response. Adverse events and pre-existing psychiatric disorders are recognized influences on treatment outcomes. Psychosocial factors, particularly social support systems, are thought to encourage compliance and completion of therapy, but, information is limited. The aim of this study is to identify the impact of patients' social support systems (spouse, family, friends and outside community support) on treatment compliance and completion. A secondary aim is to assess whether patients' coping skills (distraction methods - watching TV, crossword puzzles, and playing computer games; relaxation methods - naps, warm bath, holidays; exercise; medication; and others - hobbies, and work) are an influence.
Methods: A retrospective chart analysis of 100 consecutive Hepatitis C RNA positive patients of all genotypes who were treated with Pegylated Interferon and Ribavirin in 2005-2007 at a Hepatitis Referral Centre was performed. All patients had access to psychiatric support and were monitored monthly or bi-monthly by specialized hepatitis support nurses. A psychiatric assessment, including analysis of support systems and coping skills, was performed before treatment initiation and reviewed throughout the course of treatment. A logistic regression model was used to see the effect of co-variables on the compliance and completion of therapy.
Results: The mean age was 51.9 years. 63% of the patient population was male, 37% female. Past addictions (drugs and/or alcohol) were recorded in 72% of the patients. Spousal support (p=0.0054) and distraction methods (p=0.0640) affected treatment. Spousal support increased the odds of completing treatment by 3.6 times. The gender of the spouse was insignificant. Distraction methods increased the odds of completing treatment by 2.5 times. No other social support systems or coping skills were significant. There was no statistical significance between compliance and completion of treatment with genotype. 68% of patients required monitoring for mood disturbances.
Conclusions: Physicians and nurses treating patients with hepatitis C should encourage spouses and significant others to be involved in their care. Recommended distractions such as TV, crossword puzzles, and computer games help with compliance and completion of treatment.