Opportunities and challenges for a person-centered approach to viral hepatitis
Keywords:Biopsychosocial model, HBV, HCV, multi-disciplinary approach, person-centered approach, viral hepatitis
AbstractViral hepatitis is a major cause of mortality and morbidity, accounting for the majority of end-stage liver disease and being the most common underlying cause of liver transplantation. Despite significant progress in the understanding of the etiology and pathophysiology of the disease, several factors relating to the disease’s clinical expression remain unclear. In particular, the significant variety in clinical phenotypes post-exposure, as well as the unjustified differentiation in the natural history of the chronic stage of the disease, remain to be explained. At the same time, the biomedical paradigm fails to take other aspects of the disease into account, in particular those pertaining to its significant social and cultural consequences and their contribution to the total disease burden for the patient. In reality, the effects of the disease in the individual’s professional life, family serenity and community acceptance may be so detrimental that they can surpass the biological consequences per se in terms of their impact on loss of quality of life. Thus, it might be justified to re-examine the current management of the disease by applying the biopsychosocial model of care and the person-centered approach to the affected individual. In this context, a multi-disciplinary team is available to support the patient in his/her various needs and the content, structure and duration of therapy is tailored to his/her specific demands. Treatment success or failure cannot be determined solely by biological criteria, but rather via short- and long-term goals agreed in advance by the patient and his clinicians/carers and evaluated in a systematic manner.
European Association for the study of the liver. (2009). EASL Clinical Practice Guidelines: management of chronic hepatitis B. Journal of Hepatology 50, 227-242.
European Association for the study of the liver. (2011). EASL Clinical Practice Guidelines: management of HCV virus infection. Journal of Hepatology 55, 245-264.
National council for community behavioural healthcare. (2010). Substance Use Disorders and the Person-Centered Healthcare Home. Discussion paper. Available on-line at: http://www.thenationalcouncil.org/galleries/business-practice%20files/Substance%20Use%20Condition%20Report.pdf (valid as of 04.10.11)
Liaw, Y.F. (2009). Antiviral therapy of chronic hepatitis B: opportunities and challenges in Asia. Journal of Hepatology 51 (2) 403-410.
Mezzich, J.E. & Salloum, I.M. (2008). Clinical complexity and person-centered integrated diagnosis. World Psychiatry 7 (1) 1-2.
Dove, L.M. (2004). A general approach to the management of chronic hepatitis C. Gastroenterology Clinics of North America 33 (3) 463-477, vii.
Yu, M.L. & Chuang, W.L. (2009). Treatment of chronic hepatitis C in Asia: when East meets West. Journal of Gastroenterology and Hepatology 24 (3) 336-345.
Teoh, N.C., Farrell, G.C. & Chan, H.L. (2010). Individualisation of antiviral therapy for chronic hepatitis C. Journal of Gastroenterology and Hepatology 25 (7) 1206-1216.
Mishra, L. (2011). Health care reform: how personalized medicine could help bundling of care for liver diseases. Hepatology 53 (2) 379-381.
Tsubota, A., Fujise, K., Namiki, Y. & Tada, N. (2011). Peginterferon and ribavirin treatment for hepatitis C virus infection. World Journal of Gastroenterology 17 (4) 419-432.
Silverman B.C., Kim, A.Y. & Freudenreich, O. (2010). Interferon-induced psychosis as a "psychiatric contraindication" to hepatitis C treatment: a review and case-based discussion. Psychosomatics. 51 (1) 1-7.
Lan, C.L., Guillygomarch, A., Danielou, H., Dréau, G.L., Lainé, F., Védeilhié, C., Deugnier, Y., Brissot, P., Guyader, D. & Moirand, R. (2012). A multi-disciplinary approach to treating hepatitis C with interferon and ribavirin in alcohol-dependent patients with ongoing abuse. Journal of Hepatology 56 (2) 334-340.