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Managing Hard-to-Manage Patients

Managing Hard-to-Manage Patients. Sharon Stancliff, MD Medical Consultant New York State Department of Health AIDS Institute New York, NY. Drug Users. IDU directly accounts for 44% of AIDS case reported by June 2000

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Managing Hard-to-Manage Patients

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  1. Managing Hard-to-Manage Patients Sharon Stancliff, MD Medical Consultant New York State Department of Health AIDS Institute New York, NY

  2. Drug Users • IDU directly accounts for 44% ofAIDS case reported by June 2000 • Ongoing drug users often perceivedof as hard to engage, poorly adherent, and difficult • Education can help to bridge the gap

  3. Syringe Access • Pharmacy access: those over 18may purchase up to 10 syringes at registered pharmacies • Clinic access: article 28 facilities may register to sell or furnishup to 10 syringes • Syringe exchange programs: 13 in NYS

  4. Goals • Public health: primary and secondary prevention • Health promotion: open the door for honesty and education • Sanitation: promote proper disposal

  5. Drug Treatment • “Do you want to stop or reduce use?” • Treatment alternatives and limitations • Few treatments have solid track records • We know little about how people stop abusing drugs • Users know this on some level

  6. Weekly Cocaine Use Before Treatment and at Month 12 Follow-Up Pre 80 Post 60 40 Patients (%) 20 0 LTR STR ODF MMTP LTR: long-term resident. ODF: outpatient, drug-free. MMTP: methadone maintenance treatment program. STI: short-term inpatient. Adapted from Hubbard: Overview of 1-year follow-up outcomes in the (DATOS).g

  7. Methadone Maintenance • Given a high enough dose, the majority will stop heroin use1 • At lower doses, risky behavior is reduced with significantly lower risk of seroconversion to HIV positive2 1Ball 1991, Leavitt 2000. 2 Drucker 1998.

  8. MMTPs • Require frequent attendance • Concerns about diversion create an atmosphere of mistrust • Education about true risks and benefits is often lacking

  9. Disclaimer In the rapidly changing field of HIV care the information in these could become out of date quickly. The user is encouraged to compare the date of this slide set with the date of the most recent guidelines. These slides were offered for distribution by the speakers and the conference organizers. It is intended that these slides be used, as prepared, without changes in either content or attribution. Users are asked to honor this intent. Please give appropriate credit to the authors when using the slides. -AETC NRC

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