Selection of Opportunities for Improvement
Since 2015, there was increasing numbers of drop out methadone clients from the Methadone Maintenance Therapy at Klinik Kesihatan Butterworth. We also noticed that low retention rate leads to rise in illegal drug abuse. By conducting this study, our aim is to improve retention rate up to 70% by reducing the number of drop out clients.
Key Measures for Improvement
The key indicator for improvement measured with standard 70% based on methadone team SPU consensus and MMT study done as pilot project in 2005 where retention rate as implemented 10 years ago was 70.1%.
Process of Gathering Information
A cross-sectional study was conducted using universal sampling of all methadone clients remained at the study period with calculated sample size of 213 subjects in two consecutive phases. Data was collected using different types of sampling tools as following: checklist for registry screening, tracing defaulter, clinical assessment done by prescribers, side effects and withdrawal symptoms assessment by pharmacist towards newly registered clients, appointment set up date for monitoring, screening of pharmacist counseling session and pharmacist’s knowledge cross-check list.
ANALYSIS AND INTERPRETATION
The contributing factors for poor retention rate include incomplete information on clients address and contact number (85.75%), defaulted client was not traced, lack of assessment by physician (61.48%), no monitoring side effect and withdrawal symptoms for newly registered client (42.14%) and no appointment date to monitor client’s side effect and withdrawal symptoms, all pharmacist do not have standardized methadone counseling method and were not assessed on methadone knowledge.
STRATEGY FOR CHANGE
The implementation of strategies included reviewing methadone client registry, create defaulter tracing form, preparing DOT monitoring form for prescriber, monitor newly registered clients using first week dispensary assessment form, using a monitoring card block a date for client side effect monitoring and withdrawal symptoms, prepare methadone counselling checklist, and cross check pharmacist using cross check assessment checklist.
EFFECT OF CHANGE
Methadone retention rate improved from 60% to 62.82% in first cycle and increased to 68.96% in second cycle. Achievable benefit not achieved (ABNA) was improved by 2.82% and 8.96% in second cycle. We manage to improve the methadone retention rate via several remedial actions in our study.
THE NEXT STEPS
To further improve methadone retention rate, we need to explore other contributing factors in order to formulate other strategies for improvement. We hope to implement these current strategies to other clinics at SPU district, Penang.