Key result
Only 44% of service users on high-dose methadone had received an ECG prior to the audit, with non-adherence largely due to poor communication between primary and secondary care.
Why the study?
Does ECG monitoring detect QTc prolongation in service users on high-dose methadone substitution therapy?
Observational (n=25)
Yes
Does ECG monitoring detect QTc prolongation in service users on high-dose methadone substitution therapy?
An audit of high-dose methadone users found low initial adherence to ECG monitoring guidelines, which improved with better primary-secondary care communication, and revealed a low prevalence of QTc prolongation.
Answers are grounded in this paper and cite their sources.
Low ECG adherence in high-dose methadone users reflects care fragmentation; leaves open whether routine QTc screening improves outcomes.
Aims and method To explore the extent to which 2007 Department of Health guidelines on monitoring of high-dose (⩾100 mg) methadone were followed, the reasons for non-adherence to these and the prevalence of QTc prolongation. We developed a simple tool for collecting data from case notes. Results Out of 25 service users, 11 had had an electrocardiogram (ECG) and 7 had evidence of requests sent to general practitioners. After implementation of our recommendations, ten more service users had ECGs within 1 month. All but one ECG was normal. Methadone prescribing in favour of lower doses has been observed. QTc interval prolongation was not common. Clinical implications Effective communication between primary and secondary care services is important in identifying cases and arranging ECGs.
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Ghosh et al. (2010) conducted an observational in Opioid dependence on high-dose methadone (n=25). High-dose methadone substitution therapy was evaluated on Proportion of service users who had an ECG. Only 44% of service users on high-dose methadone had received an ECG prior to the audit, with non-adherence largely due to poor communication between primary and secondary care.
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