I am a final year medical student at the University of Edinburgh. In my third year I intercalated in Global Health and Public Policy, covering a range of topics from social determinants of health to infectious diseases. During this I completed a dissertation focussing on England’s mental health strategy and achieving ‘parity of esteem’. Other projects during medical school included looking at nutrition within the homeless population in Edinburgh and their barriers in accessing meals. I am now drawn to pursuing psychiatry; in particular I am interested in addiction and perinatal psychiatry care. I am hoping to be considered to undertake a Psychiatry Foundation Fellowship in my foundation years.
A service evaluation of patients prescribed methadone at high doses and/or concurrently taking rack cocaine
Aims: To evaluate the adherence by both primary care (Muirhouse Medical Group – MMG) and secondary care (Substance Misuse Directorate – SMD) to UK Guidelines on clinical management for drug misuse and dependence. Specifically, to investigate patients prescribed methadone at high doses and/or on crack cocaine and whether the risk of QTc prolongation in this group has been recognised and reported in patient notes. Furthermore, to investigate whether the patients at risk have had an ECG in the past year to assess for QTc changes and assess whether any differences in adherence exist between primary and secondary healthcare.
Methods: ‘Trak’ and ‘Vision’ systems were used to collect data from patients prescribed methadone via MMG or SMD as true 10/09/19. This includes age, gender, dose of methadone, cocaine use and ECGs. Data was analysed using Microsoft Excel. Results:108 /179 in primary care and 15/29 in secondary care were found to have taken cocaine with methadone and/or on a methadone dose >100mg/day. Of these 18/108 had received an ECG via MMG and 10/15 via SMG in the past year to assess for QTc prolongation.
Conclusion: Findings suggest there is significantly more adherence to the National Guidelines by secondary care than primary care. However, there is scope for improvement in practice of ECG recording in high risk patients and a need for education to staff on recent guidelines. Further research is required to determine the value of regular ECG monitoring.