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Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

  • Practice and Public Health Policy
  • Published:
Translational Behavioral Medicine

ABSTRACT

The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.

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Author information

Authors and Affiliations

  1. Gastroenterology and Hepatology, San Francisco Veterans Affairs Medical Center, 4150 Clement, Mail Code 111B, San Francisco, CA, 94121, USA

    Catherine Rongey MD, MSHS

  2. Department of Medicine, Gastroenterology, University of California at San Francisco, San Francisco, CA, USA

    Catherine Rongey MD, MSHS

  3. Medicine Service, Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA, USA

    Steven Asch MD, MPH

  4. Department of Medicine, Stanford University, Stanford, CA, USA

    Steven Asch MD, MPH

  5. Mental Health and Urology Services, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, USA

    Sara J Knight PhD

  6. Departments of Psychiatry and Urology, University of California at San Francisco, San Francisco, CA, USA

    Sara J Knight PhD

Authors
  1. Catherine Rongey MD, MSHS
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  2. Steven Asch MD, MPH
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  3. Sara J Knight PhD
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Corresponding author

Correspondence to Catherine Rongey MD, MSHS.

Additional information

Implications

Policy: Implementation science offers strong conceptual frameworks to support the successful translation of healthcare delivery programs into practice.

Practice: This conceptual model provides a framework to inform the implementation of integrated behavioral medicine and specialty care for veterans with hepatitis C.

Research: Our hybrid framework that integrates the Andersen behavioral model and the Promoting Action on Research Implementation for Health Services model can be used to identify key patient and healthcare system variables important in the evaluation of early phases of program implementation prior to national dissemination.

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Rongey, C., Asch, S. & Knight, S.J. Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation. Behav. Med. Pract. Policy Res. 1, 644–651 (2011). https://doi.org/10.1007/s13142-011-0098-z

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  • DOI: https://doi.org/10.1007/s13142-011-0098-z

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