Date : 9 January 2012 ( Monday )
Time : 8.30 am - 11.30 am
Topic : Briefing on unit NCD and OPD
Person in charge : PPPK Mohd Amin bin Saad
Time : 8.30 am - 11.30 am
Topic : Briefing on unit NCD and OPD
Person in charge : PPPK Mohd Amin bin Saad
Diabetic Clinic
First of all, Encik Amin briefed us about diabetes mellitus in this District Kubang Pasu. There is about 5000 active patients in all Klinik Kesihatan and 5000 active patients in Hospital Jitra.Everyday, there is about 200 patients came for follow up in Klinik Kesihatan Kepala Batas.
The objectives of this clinic is
- To provide efficient management on diabetes,including treatment and control of HbA1c <6.1
- To create awareness about diabetes and its complications among the patients
- To improve patient's compliance in treatment, diet control and follow-up treatment
- To reduce the number of defaulter among the diabetic patients
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| Carta Organisasi Klinik Kesihatan Kubang Pasu |
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| Process in OPD |
After registration, patient will be examined for Random Blood Sugar.
1)if it is well controlled, he/she will be followed up after 3-4 months
2)if not well controlled and <20, he/she will be followed up after 1 month
3)if not well controlled and 20-30, he /she will be referred to Hospital Jitra
Monitoring
BP
Weight
Fundoscopy
Fundoscopy
if abnormalities detected , patient will be referred to ophthalmologist in Hospital Sultanah Bahiyah
Foot examination
sensation, vibration, pin-prick, pulse
patient will be referred to Hospital Jitra/Hospital Sultanah Bahiyah
Lab investigation
Random Blood Sugar,HbA1c, Fasting Blood sugar,Full Blood Count, Renal Profile, , urinanalysis
Cholesterol
once a year
ECG
Diabetic Registry Malaysia
Adult diabetes registry known as An Adult of Diabetes Control and Management (ADCM) and Diabetes in children and Adolescents Registry (DiCARE) will come under one umbrella.This registry is under MOH to collect details about patient, including investigation results and treatment details. There is 2 same Green Book for this registry, 1 big and 1 small. Both contents are the same. Big green book is kept in Klinik Kesihatan while the small green book will be kept by the patient himself.
Tagging system for Green Book:
Green sticker-- Blood Sugar Level, blood pressure normal with no complication
Yellow sticker--Blood Sugar Level 7.1-10mmol/L
Red sticker-- Blood Sugar Level High(>10mmol/L) and BP high with complication
Hypertension
Hypertension is also found in the community of Kubang Pasu and there is about 6000 hypertensive patients follow up in all the klinik kesihatan. There is 1 blue book specially for hypertensive patients to record their hypertensive status.
Both Diabetes and Hypertension(they always come together!)
This is a programme held in every districts in every state.In District Kubang Pasu , this programme is held under Klinik Kesihatan Tunjang and has already been implemented for 1 year. According to Encik Mohd Amin, There is a building in Kampung Cegah used just for this programme to store the BP set, height & weighing scale, blood sugar test equipment, and also some exercise equipment. Health officer from KK Tunjang will have a training session with the volunteers from the society and those volunteers will then be responsible to manage that building. Those volunteers will have to teach the people in their society on the methods of using those equipment.The Health officer will monitor this programme weekly. Under this programme Community NCD, there is also competitions held to help the society in improving their health. For example, BMI competition, aerobic competition etc. There is a plan in year 2012 that each KK will have 1 programme Community NCD.
Early Detection
Society Health Campaign
This society health campaign is held under Unit Promotion in District Kubang Pasu. There is almost 20 campaigns carried out each year . Health Officers and nurses will measure BP, BMI, and Random Blood Sugar in people of that particular Kampung. When there is high BP and RBS , they will refer them to Hospital Jitra. When there is high BMI , advices will be given to prevent hypertension and Diabetes mellitus. This programme is very good because it helps detecting people who are at high risk of developing hypertension and Diabetic Mellitus in kampung.
School Adolescents Programme
This programme is carried out in schools and the targets are those 12,13 and 14 years old students. Their BMI will be measured and counselling will be given to prevent Obesity, hypertension and Diabetes Mellitus among adolescents.
prepared by,
Woon Yee Ling
QUIT SMOKING CLINIC
As we all know, smoking is a risk factor for a lot of non-communicable diseases such as hypertension, lung CA and etc. One of the National Tabacco Control Programme to prevent and solve this problem is by setting up QUIT SMOKING CLINIC. There is only one Quit Smoking Clinic in Kubang Pasu district. Therefore, it has to cover for all patient from whole district.
Objectives:
- to provide knowledge and skills for smokers to quit smoking
- to treat and rehabilitate smokers who intend to quit smoking
- to provide awareness to smokers on the harmful effects of smoking
- to encourage and motivate smokers not to return to smoke and maintain the non smoking status
The staff consists of MA and MO. When the patient reach the clinic, they will need to register themselves. After that, the MA will give counseling to the patient and when they are sure that the patient really wanted to quit smoking only they will be referred to the MO for treatment. There is a test called Fagerstrom test which is to determine the level of addiction to cigarettes. The questionnaire is attached below.
The patient will then be given a TCA date depending on patient's preferences. During the follow up, patient will undergo Carbon Monoxide Test. There are 4 ranges of CO levels are featured on custom LCD.
- Green Light : Indicates non-smoker which ranges from 0-6 ppm
- Amber light : Indicates a light smoker which ranges from 7 to 10 ppm
- Red light : Indicates a smoker which ranges from 11 to 20 ppm
- Red flashing light with audible alarm : Indicates a heavy smoker which is above 20 ppm
Treatment is by Nicotine replacement therapy(NRT). It consists of nicotine gum, nicotine patch and nicotine tablets.
Legislation
Control of Tobacco Product Regulations 2004 :
Control of Tobacco Product Regulations 2004 :
- Part IV : Prohibition on smoking
- Regulation 11
- Sub-regulation 11 (1) - list of at least 19 smoke free locations
- Sub-regulation 11 (2) - Power of the Minister o Health to determine smoking area
- Sub-regulation 11 (3) - Penalty : Fine not exceeding RM 10, 000 or imprisonment not exceeding 2 years
- Regulation 12 - Duty of proprietor etc., of the premises or vehicle
METHADONE CLINIC
There is only one Methadone clinic at whole district Kubang Pasu, which is at KK Air Itam. They started operating in year 2008. The staff consists of MA, MO and a Pharmacy Officer.
Methadone is a synthetic opiate which is used to substitute addiction for heroin and other types of opiates. It blocks the euphoric and sedative effect of opiates, relieves craving for opiates and relieves opiates withdrawal symptoms. Unlike natural opiates, methadone does not cause euphoria and intoxication (in normal dose) and therefore patient under methadone maintainence therapy can participate in normal daily activity as usual. It is taken daily in oral route. It can only be prescribed first by a MO and then subsequently by a Pharmacy Officer.
There are 2 types of patients, one is those referred from AADK(Agensi Anti-Dadah Kesihatan) and another are walk-in patient. The methadone dosage will slowly being taper according to patient's condition. If the patient defaulted treatment for 3 days, their name will be deleted from the list and so they are not eligible for methadone therapy anymore. Random urine test will be done to detect for any drug addiction and compliance of treatment. If the patient was found non-compliant, they will be given counselling and also warning. If they were found that they were still not compliant to the treatment, their name will be removed. The patient will not be given a specific date so that they will come unprepared for the test if at all they are still on drug addiction. According to Encik Amin, so far all the patient from KK Air Itam are compliant to methadone maintainence therapy.
By,
Ooi Shu Huey
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