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Program methadone kkm hrpz2
- 1. Dr Hj Mohd Ariff Mohd Noor Pakar Perunding Psikiatri HRPZ II, Kota Bharu Pusat Latihan Bachok, 26 Mei 2010
- 2. General : • To improve the health and quality of life of persons with opiate dependence through drug substitution therapy. OBJECTIVE
- 3. Specific: • To reduce relapse among opiate dependent. • To improve the physical and mental condition of opioid dependents. • To reduce spread of infection through IVDU and sharing needles. (e.g HIV, hepatitis B and C ) • To treat opiate dependents pregnant women. • To improve psychosocial functioning, including ability to gain or maintain employment and to improve their social adaptation and integration into the society. • To reduce criminal activities amongst opiate dependent. OBJECTIVES
- 4. Opiate Dependent Register Inclusion Consent Initial Assessment - Blood/urine - Questionnaire - Physical examination DST Counseling Evaluations Detox 2 / 52 1 / 52 Jika gagal Lampiran 1 Lampiran 2
- 5. Lampiran 1 - No take away doses DST 6 / 52 2 / 7 & Weekend doses Daily 3 / 7 & Weekend doses Urine negative Regular follow-up & Counseling
- 6. Lampiran 1 - No take away doses DST DOT Daily DOT Urine negative Regular follow-up & Counseling -No take away doses
- 7. Opiate dependent Register,inclusion,personal information Consent Initial assessment - QOL, OTI - P/E - Blood/Urine
- 8. CRITERIA • Inclusion - Volunteer - Drug dependent > 2years - Proof of identity - capable of informed consent - complication of opiate dependence • Exclusion - Age < 19 - Drug dependent <2 years - Polysubstance abuse - Abnormal LFT(more than 3x) - ac. Med/psy disorder (severe/with complication)
- 9. CRITERIA…additional inform • Inclusion - accept HIV negative - non IVDU • Exclusion - No compromise if it is excluded - Abn LFT Allow DOT if ALT >3fold with no clinical significant finding & repeat LFT in 2/52 No DOT if ALT>5fold & repeat LFT in 2/52 Exclude if clear clinical significant finding. - poor personal information (register but waiting for include into the program) - psy disorder with poor supervision/compliance/ frequent admission/cognition
- 10. Consent…..inform about Emphasize on the rule Terminate if persistent against the rule such as fraud, violence toward staff No compromise on drug dealing & theft/damage property Not by proxy for takeaway except able to show evidence such letter from Doctor. Show other evidence or bring family if they want temporary takeaway. To be taken preferably with family Blood taking after consent
- 11. INITIAL ASSESSMENT Questionaire - WHOQOL - Personal data - OTI - W0, W12, W24,W48 - W0 (on the day before DOT) Physical examination - sign intox,withdrawal,needle track - medical problem e.g. liver disease Blood - LFT,HIV,Hep B,C - after consent,3/12 first 1yr, then 6/12 Urine - weekly 1st 1/12 -2 weekly for next 1/12 - randomly each month
- 12. Getting consent from pt and family
- 13. Mendaftar Nama Untuk Menentukan Nombor Giliran
- 14. Penilaian Semula Status Kesihatan Klien Dengan Borang WHOQOL-BRIEF
- 15. Client sedang dinilai keberkesanan rawatan & penilaian OTI oleh pegawai perubatan yg telah diberi latihan
- 16. Sesi Kaunseling
- 17. INITIAL ASSESSMENT….blood Blood - LFT,HIV,Hep B,C - after consent,3/12 first 1yr, then 6/12 - HIV,Hep B,C once assessment if positive - TO BE TAKEN at least 1/52 before at initial DOT on the same day (after consent) - Blood is taken for selected number of pts from same group by different day of the week monthly scheduled.
- 20. INITIAL ASSESSMENT….urine Urine - weekly 1st 1/12 -2 weekly for next 1/12 - randomly each month - No need randomly/month if the individual show poor behavioral performance.
- 21. Treatment effectiveness = Urine Test result ?
- 22. Bahan sampingan penagih ditemui dalam “flush” tandas
- 23. ASSESSMENT BY THE PRESCRIBER • Induction/stabilisation – Patients are reviewed every 3 days or 2x a week for 2/52 (e.g.Sunday & Wednesday). – Review PRN between those days if withdrawal or intoxication occur – Highly supervised setting. – No take home dose.
- 24. ASSESSMENT BY THE PRESCRIBER • Maintenance Phase – Patient should be seen: • Weekly for 2 week. • Fortnightly – 2 months. • Monthly – after that. – Allow take away not more than 3 days – Preferably with family supervision.
- 25. ASSESMENT TAKEAWAY Takeaway Not mandatory if urine result persistent negative Avoid from giving takeaway Unlikely involve with gang or came with outsider Busy and comitted with work especially involve with people Never seen with “hang around” Don’t empathy/sympathy
- 26. TAKEAWAY cont… Takeaway Suspended if urine persistently positive Share with others Selling to others Bring the bottle to their friend’s house Bring back bottle of the similar identity Strictly warning or suspend takeaway if repeatedly bring suspicious ‘friend’
- 27. Client sabar menunggu,tabiat lama yg perlu dibuang, BAGAIMANA MENANGANINYA ????
- 29. How to plan… • Review pt • Blood specimen • OTI • Urine • Counselling • ….if possible all plan are systemic,well organised, time consuming and predictable
- 30. APPROACH • Identify group MO only looking at clinical aspect. MO came to review according to their turn because has to review other activities. • The committee would arrange time table base on MMT GUIDELINE FOR 1) review client according the group 2) blood specimen taken /OTI/QOL 3) urine test • All procedure done before review by MO and then dispensing by pharmacist
- 31. Sun/dilihat oleh MO Mon/*OTI/ Dilihat oleh MO Tue/ consent &blood Ix Wed Thurs/ dilihat oleh MO 22/10 1 29/10 1 1 5/11 1 1 12/11 1 2 19/11 1,2 2 26/11 2 2 3/12 1,2 3 10/12 2, 3 3
- 32. Sunday/ dilihat oleh MO Mon/ dilihat oleh MO & OTI Wed/ Pengambilan darah 18/2 PH 3,9,11 7* 25/2 4,8,10 11 9(28/2) 4/3 5,6, 3 9* 11/3 1,2,7 10.11 10 (14/3) 18/3 3 10* 25/3 4,8,11 1/4 5,6,9 11 (4/4) 8/4 1,2,7 11 3,9
- 33. Kump 1 Kump 2 kump 3 Kump 4 kump 5 1/12 Urine 2/12 3/12 Sun 4/12 5/12 Tue 6/12 urine urine 7/12 urine 8/12 urine
- 38. Client dimaklumkan tarikh awal jumpa doktor
- 40. Peraturan lebih ketat lagi ….agar client tidak berkeliaran
- 41. Masa pendispensan yg ketat dan mesti dipatuhi oleh client
- 42. Client baru dapat peluang minum ubat
- 43. Pegawai Farmasi di bilik pendispensan
- 44. Repeater Pump give better time management
- 45. Each group either…. • To be reviewed by MO • For Urine test • QOL/OTI • Blood investigation • And end up medication dispensed by Pharmacist.
- 46. Patient Registered Blood test Urine test Dispensed Methadone Review by MO/Sp/C QOL/OTI Gp 1 Gp 3,4 Gp2 Gp 5 Gp 6 Flow Chart
- 47. Working committee meet at least 3 monthly – LATERAL & STRATEGIC THINKING
- 48. Menyusun Keputusan Ujian Makmal dan borang OTI/QOL untuk dihantar ke JKN/KKM
- 49. File lama/pasif (kiri) dan file baru/aktif (kanan)
- 50. Rekod client mengikut kumpulan dalam simpanan
- 51. Conclusion • Systematic • Traceable - personal file - the procedure schedule & its defaulter - result test & its defaulter • Better time management • Easy to arrange work plan • Predictable • Enforce the rule and be assertive
- 52. Substance & Consultancy Unit Ministry of Health LITHUANIA, MAC 2005
- 53. KOTA BHARU, MAC 2006
- 55. Treatment effectiveness = Urine Test result ?
- 56. Maintaining abstinence Response Functional,Quality of Life, Remission Functional and Social Autonomy Recovery What is successful treatment ? Improvement of Dependency?
- 57. Perjalanan masih jauh TERIMA KASIH….kita jumpa lagi
- 58. THANK YOU…
Editor's Notes
- Although not much is known on the etiology of mental disorders and how the different factors for intervention impact on the outcome, three major factors have shown a consistent relevance. 1 Biological 2 Psychological 3 Social and environmental Use them as: a model for « etiology » a model for treatment a model for the organisation of mental health care