Abstract：
BACKGROUND: Opioid Agonist Treatment (OAT) is the gold standard for managing Opioid Use Disorder (OUD). It is highly effective at reducing all-cause mortality and drug-related harms. Prescribing OAT, particularly methadone, is becoming increasingly complex as Scotland\'s OUD population ages. Older patients, with increased polypharmacy and multimorbidity, are more susceptible to QTc interval prolongation associated with methadone use. Therefore, adherence to ECG monitoring guidelines for patients prescribed methadone is crucial, though insights from substance use services indicate suboptimal compliance. Medically Assisted Treatment guidelines established by the Scottish Government advocate for shared care agreements, thus transferring OAT prescribing responsibilities to primary care. Understanding ECG monitoring guideline implementation in non-specialist services is vital for developing safe OAT services in primary care.
OBJECTIVE: This audit assessed adherence to NICE guidelines for ECG monitoring in OUD patients prescribed methadone in a Scottish primary care practice.
METHODS: The notes of patients prescribed methadone were assessed using NICE criteria to determine eligibility for ECG monitoring. Eligible patients\' medical records were reviewed to identify previous ECG investigations.
RESULTS: Of 21 patients prescribed methadone, 16 qualified for ECG monitoring. Only 25% of eligible patients received ECG monitoring per NICE guideline, meaning 75% did not.
CONCLUSIONS: These findings highlight that the issue of poor compliance with ECG monitoring guidelines is not limited to specialist services, but also affects primary care. Further exploration of barriers to guideline implementation is essential. Perhaps more resources are needed to integrate OAT services into primary care, which has taken on increased responsibilities without corresponding investment.
OBJECTIVE: This audit assessed adherence to NICE guidelines for ECG monitoring in OUD patients prescribed methadone in a Scottish primary care practice.
METHODS: The notes of patients prescribed methadone were assessed using NICE criteria to determine eligibility for ECG monitoring. Eligible patients\' medical records were reviewed to identify previous ECG investigations.
RESULTS: Of 21 patients prescribed methadone, 16 qualified for ECG monitoring. Only 25% of eligible patients received ECG monitoring per NICE guideline, meaning 75% did not.
CONCLUSIONS: These findings highlight that the issue of poor compliance with ECG monitoring guidelines is not limited to specialist services, but also affects primary care. Further exploration of barriers to guideline implementation is essential. Perhaps more resources are needed to integrate OAT services into primary care, which has taken on increased responsibilities without corresponding investment.
摘要：
背景：阿片类激动剂治疗（OAT）是治疗阿片类药物使用障碍（OUD）的金标准。它在降低全因死亡率和药物相关危害方面非常有效。处方OAT,尤其是美沙酮,随着苏格兰OUD人口的老龄化，它变得越来越复杂。老年患者,随着多药和多发病率的增加，更容易受到与美沙酮使用相关的QTc间期延长的影响。因此,坚持服用美沙酮的患者的心电图监测指南至关重要，尽管来自物质使用服务的见解表明合规性欠佳。苏格兰政府倡导共享护理协议建立的医学辅助治疗指南，从而将OAT规定的责任转移到初级保健。了解非专科服务中的ECG监测指南实施对于在初级保健中开发安全的OAT服务至关重要。
目的：本审核评估了苏格兰初级保健实践中OUD患者对NICE心电图监测指南的依从性。
方法：使用NICE标准评估使用美沙酮处方的患者的注意事项，以确定ECG监测的资格。审查符合条件的患者的医疗记录，以确定以前的心电图检查。
结果：在21名服用美沙酮的患者中，16合格的心电监测。根据NICE指南，只有25%的合格患者接受了心电图监测，这意味着75%没有。
结论：这些发现突出表明，心电监测指南依从性差的问题不仅限于专科服务，但也会影响初级保健。进一步探索准则实施的障碍至关重要。也许需要更多的资源来将OAT服务整合到初级保健中，在没有相应投资的情况下承担了更多的责任。
目的：本审核评估了苏格兰初级保健实践中OUD患者对NICE心电图监测指南的依从性。
方法：使用NICE标准评估使用美沙酮处方的患者的注意事项，以确定ECG监测的资格。审查符合条件的患者的医疗记录，以确定以前的心电图检查。
结果：在21名服用美沙酮的患者中，16合格的心电监测。根据NICE指南，只有25%的合格患者接受了心电图监测，这意味着75%没有。
结论：这些发现突出表明，心电监测指南依从性差的问题不仅限于专科服务，但也会影响初级保健。进一步探索准则实施的障碍至关重要。也许需要更多的资源来将OAT服务整合到初级保健中，在没有相应投资的情况下承担了更多的责任。
