Interprofessional Team Management of Co-Morbid Chronic Hepatitis C: Discussion and Implications

We employed an interprofessional team-based treatment program for individuals with chronic hepatitis C and comorbid psychiatric illness, operating with an inner-city primary care practice, to meet the needs of this patient population within our community.  Our focus in this care model is a relationship-centered model of care. Given the high prevalence of mental illness among individuals with chronic hepatitis C, our care model focuses on meeting diverse patient needs simultaneously. Our interprofessional team has been successful in treating individuals with chronic hepatitis C and comorbid psychiatric disease as represented by three patient exemplars, all of whom had previously failed treatment attempts but succeeded in our model program. All three patients had significant symptoms of mental illness with borderline traits at baseline.  All three had multiple crises while on treatment.  All required our team to challenge our assumptions about adherence, and to modify usual care in order to preserve and strengthen our relationships with them. Through focused and ongoing evaluation and rapid response to emerging needs, we reexamined and reprioritized needs for each patient in order to continue to work with them. All three patients achieved sustained viral responses, indicating a durable eradication of the virus; essentially a cure. All three patients significantly increased their fund of knowledge about chronic hepatitis C and were able to demonstrate self-care behaviors as a result of our work with them.  As our relationships with each of the patients deepened and their trust in our team increased, challenging behaviors decreased and our sense of collaboration with patients intensified, in a sense becoming co-equal team members in their own care. Each patient was worth the effort.  Our experience with these three patient exemplars brought us closer as a team, better integrated our work,  and also increased our commitment to a care model characterized by flexibility and mobilization of resources specifically meant to address psychosocial barriers (such as mental illness) and link patients to appropriate and successful care.  As a result, we determined that privileging relationship in health care works for patients and also for providers. Based on our experience, we believe this tailored care model can be adapted to treat other chronic illnesses in challenging comorbid patient populations.