March 19, 2014
Adding a social worker to the hepatitis C healthcare team might be the last thing on a clinic or hospital administrator's mind, but it shouldn't be, say experts looking for ways to expand care. They suggest the benefits can be substantial, at minimal cost.
"Social workers bring unique skills and knowledge to the interdisciplinary team treating hepatitis C patients, making the team more effective," said Catherine Amory, MSW, LCSW, from the Mount Sinai Medical Center in New York City.
They have engagement skills to help get hepatitis C patients into care and understand the value of fostering a good relationship with the treating physician and members of the healthcare team, especially in high-risk marginalized populations. This can help them build a sense of community between the patient and the team, she told Medscape Medical News.
Amory described the role social workers play on the interdisciplinary hepatitis C treatment team here at the International Conference on Viral Hepatitis 2014 in New York City.
Her talk was selected as 1 of 2 top-rated abstracts and was given at a special oral session at the conference.
People in underserved urban areas "have a significant incidence of chronic hepatitis C, but face many psychosocial barriers to appropriate care," Amory explained.
The systems management skills social workers have, such as the ability to deal with homelessness and poverty, housing and legal issues, and immigration, can help patients "surmount many of these barriers," she pointed out.
"We can help patients maneuver their world, translate between the doctor and the patient, and hopefully make their lives better and give them more stability so they can complete treatment," she said.
Tackling Psychosocial Barriers to Care
"The doctors at Mount Sinai wanted a social worker on the team because they were coming across many people who were homeless, mentally ill, actively using illegal substances, getting thrown out of their house, or all of the above," Amory explained. "Some had lost their social security disability insurance and didn't know why, some didn't have car fare to come in for their next appointment so did not take their medicine, and some had changed insurance and didn't know what to do. These are barriers that prevent the doctors from doing their job."
“The doctors at Mount Sinai wanted a social worker on the team because many people were homeless, mentally ill, and actively using illegal substances.”
The psychologist on the team was able to address mental illness issues and readiness for treatment, "but when he assessed someone who was not ready for treatment, there wasn't a lot he could do about the psychosocial issues, and he could not refer for outside mental illness or substance abuse care. I think the impetus came from our psychologist, who felt he needed his skills to be supplemented with a social worker," Amory said.
"I'm also cheaper than a psychologist," she added.
Unfortunately, lack of funding often keeps social workers off interdisciplinary hepatitis C treatment teams.
Formal study is needed to prove the cost-effectiveness of having a social worker as part of the hepatitis C healthcare team, Amory said.
Hospital administrators would be more likely to fund a social worker from the hospital budget if an increase in physician productivity and the effectiveness of treatment is proven, she said.
In addition, insurance companies might allow providers to bill directly for social work services, instead of requiring hospital administrators to cover the cost from operations budgets.
"This would make our funding sustainable, so that the administrators would not have to apply for a grant for funding every year," Amory said.
Benjamin Young, MD, vice president and chief medical officer of the International Association of Providers of AIDS Care, said he fully endorses having social workers on hepatitis C healthcare teams.
"Modern treatments promise a cure for the vast majority of infected people," he told Medscape Medical News. However, "many who are infected with hepatitis C face social and structural barriers to successful engagement in care and the prescription of medications."
The expansion of care for people infected with hepatitis C "will require the most effective use of limited human health resources," he added. "In this light, understanding the role of social workers on an interdisciplinary team for hepatitis C care is most welcomed."
Ms. Amory has disclosed no relevant financial relationships. Dr. Young reports financial relationships with Gilead Sciences, Merck, and ViiV Healthcare.
International Conference on Viral Hepatitis (ICVH) 2014: Abstract 60. Presented March 17, 2014.