Implementing an Enhanced Social Work Intervention Model within the HCV Cascade of Care

Introduction:  Highly effective therapy is currently available for the management of hepatitis C viral infection (HCV); however, infected individuals face obstacles preventing engagement in care.  Social workers (SW) are highly trained in the identification and resolution of these barriers that may affect patients, providers, and systems.  A SW intervention model has been established within the HCV care cascade to quantify and address barriers.

Methods: Patients seeking HCV care at MedStar Washington Hospital Center undergo an enhanced SW intake assessment prior to their first visit. The assessment includes immediate barriers to care and pertinent medical and psychosocial history; it is then uploaded into the HER. A QOL and biopsychosocial assessment to identify strengths and barriers to accessing future medical care and additional HCV education is completed post-visit. A support group has been initiated to accommodate additional needs.  Patients are followed depending on acuity level; barriers are reassessed. A qualitative analysis is presented.

Results: Since March 2014, 85 patients have been evaluated. The top three barriers are lack of resources (e.g., transportation, finances), insurance related issues, and inadequate support (e.g., family, community). Patients have expressed satisfaction regarding the assessments with increased empowerment, support, adherence, open issue discussions, and medical question calls.

Conclusion:  This patient centered, coordinated care approach appears to have been beneficial to engagement in care; it facilitates more intimate interactions with patients, increases patient health literacy and self-determination. Patient education and empowerment are vital in addressing the social and medical needs of HCV patients and ultimately addressing barriers to care.