Kuala Muda District Health Office - Day 9

Non communicable Diseases Clinic(KK Bandar SP)

29 November 2011,Tuesday

WElCOME!

Well today our day started off a little bit later than usual, but nevertheless we were greated by Mr.Chong who is one of the four Penolong Pegawai Kesihatan Persekitaran PKD Kuala Muda who is pretty much in control of the NCD in KK Bandar Sungai Petani. He explained and enligthened us on various aspects of the Operations of NCD in Kuala Muda.

Basically the NCD's Discussed today was

1:Diabetes Mellitus

2:Hypertension

3:Asthma

4:Methadone Replacement Theraphy

Before we begin Mr Chong explained to us about why KK bandar SP has a separate clinic for NCD and not together with the existing outpatient clinic.

According to him, the initial plan was to make a dedicated clinic with a special unit which has its own MO and Nurses who are trained on multiple skills to bring about better control and organisation of the NCD in Kuala Kedah.

The congestion in the outpatient department will also reduce, and scheduling of appointments will be better with 2 separate clinics.

The vision of having a dedicated clinic for NCD is not yet fully achieved due to various reasons such as lack of staff, but hopefully in the near future this will be achieved.

In Kuala Muda Diabetes Mellitus is mainly controlled according to the CPG(clinical practice guidelines) for T2 DM and theres also a Quick Reference Guide for Management of T2DM which includes the screening criteria, values for diagnosis, management of T2DM, Recommended pharmacological therapy and also management of concomitant co-morbidities and complications.

Quick Reference for T2DM

In Kuala Muda the diabetic control target is 30% but only 11% is achieved, and the NCD unit is working hard in programs to bring the percentage up.

There is Quality Assurance program for DM by the NCD unit in Kuala Muda there is a continuous study done to record the current control and prevention programs and their effectiveness in reducing T2 DM cases in Kuala Muda.

The flow of patients with DM in the KK Bandar SP starts with the OPD. In the OPD the patients are screened and then directed to the NCD clinic to register as a DM patient. After this registration is done, the management of their diabetes begins.

After the registration and confirmation with OGTT about their condition the patients are then counselled about measures on controlling DM and lifestyle changes to be made in a diabetic patient.

Well this includes preparing healthy meals, exercising, insulin injection techniques, insulin induced hypoglycemia and diabetic foot care.

DM patients are managed by BIDS( bedtime insulin daytime sulfonamide)

As for Asthma and Hypertension the flow of patients is the same as in diabetes, but only the management defers.

As for Asthma patient is screened in the OPD , Emergency or are referred from hospitals to be managed at KKBSP.

Patients usually children are given education on how to use the inhalers and how to prevent from getting asthmatic attack by avoiding the triggers such as pollen, dust, cold weather, animal dander. Parents are also educated on what to be done during such attacks.

In cases of hypertension patients below 140/90 are already classified under prehypertensives and are provided with counselling as to how their BP can be brought down and prevented from shooting even higher.

Whereas in Patients with BP of more than 140/90 are started with treatment and given appointments accordingly to observe improvement and control.

Visit to the card room!

Next Mr. Chong brought us to the card room where all the records of the patients with DM, Hypertension and Asthma are kept. Here are some pictures:-

The cards are coded according to disease

Diabetes- Green

HPT- Blue

Asthma- Pink

Previously the card system started for the diabetic patients only, with a green card. In the early stages hypertension cards were not coded and were just recorded on hardcover notebooks. Now there is cards for all three diseases.

Further about how the card are used will be futher elaborated below, so read on....

Visit to S/N Eiedey Suraiana's Office!

Lets start with a little bit about S/N Eiedey Suraiana....

S/N Eiedey is in charge of registration of the patients, i learned that she is the only person who does patient registration in KKBSP and our group was really grateful that with a busy schedule she managed to explain to us a little about the registration process and statistics.

Here's a picture of her :)

According to her, 10 new cases register each day for diabetes and only after an OGTT and not solely based on a RBS.

An important part of the registration is the card issued. Every patient has 2 cards, one bigger card for hospital records which are kept in the card room and a smaller one which is carried by the patient, an updated each time the patient visits the clinic for appointment.

The cards are audited frequently to check if the CPG(clinical practice guidelines) are followed.

The smaller card is carried by the patient and bigger one kept in the card room of KKBSP

There is also a registry for the patients who default their appointment, this works if a patient does not show up for their appointment, after 2 weeks of no show name is included in the defaulters list.

On average 10-15 patients default their appointment each day. For the month of November, 128 patients defaulted their appointment. Out of which 82 patients contactable, 44 cannot be contacted, and 2 patients died.

Patients who were contacted were given a new date and counselling on the importance of their visit to the clinic.

Visit to the Methadone Clinic

The function of this clinic is to carry out the Methodone Replacement Theraphy for drug(opioid) abusers.

Here the patients are registered and are supposed to come everyday to get their daily dose of methadone which is 25mg/day.

This program is aimed at reducing spread of diseases which spread due to sharing of needles, such as HIV AIDS.

It was started at 2007, and it is run by one FMS, one MO, one AMO and one staff nurse. It is a cooperative program with Agensi Anti Dadah Kebangsaan(AADK).

Here we were briefed by Mr Khairul Hafiz futher on how it is carried out.

The picture above shows the criteria and the flow chart of how a patient is registered under the MRT program.

First HIV screening,Hep B screening, renal profile and LFT is done.

LFT serves as a factor to determine whether the patient would be able to tolerate methodone,not end up with further side effects due to inadequate Liver Function. So patients who do not pass the LFT will not be accepted into the MRT program.

Now the flow of patients from the methadone clinic works as follows....

1.Visit methadone clinic and attendance is taken and each patient is given his own mug ,which looks something like this :-

2. Then this glass is carried to the pharmacy where the pharmacist in charge will dilute the methadone and patient drinks it under observation.

Urine test is done everyday for 2 months for each patient. This is to ensure that the only take the methadone given by the clinic and not add on futher drugs. Patient with positive for other drugs 3 times, are no longer entertained and name striked off the registry.

The problem with this theraphy is mostly due to lack of patient cooperation this is because there are patients who use drugs added to the methadone given by the clinic and try to fake the test results by using other persons urine. A measure taken by the methadone clinic is to observe the urine test. A male MA is to observe the patient urinating and performing the test.

This ensures that the purpose of the test is served.

Today was one of the most beneficial days of our posting so far, Mr Chong who was very enthusiastic about teaching us really helped us understand better the NCD unit.

With that i would like to end my post for the day, if any typo error noted please forgive me :)

Cheers!!

-G.Suriaraja