"""Medication flow (#37, case scenario «управление приёмом лекарств»). Module-agnostic: every patient with a prescription gets it, whatever the clinical module. system:med_reminder {dose_id, drug, dose} ──▶ «Принял» → dose taken, check-in med_taken = true ──▶ «Пропущу» → dose skipped, med_taken = false ──▶ reason: забыл / побочки (→ side effects) / решил бросить (quit_intent) / другое ──▶ «Есть побочные эффекты» → code buttons (тошнота, бессонница, …) or «Другое» → free text → check-in side_effects (+ dose.side_effects) → «А препарат сегодня приняли?» menu «Вопрос о лекарстве" ──▶ meds.question (free text) ──▶ med_qa (instruction excerpt) or «уточните у врача» rule action med_info (actions.py hook) ──▶ instruction excerpt for the rule topic + fixed notice Everything the patient answers is written to the clinical DB (`doses`, `daily_checkins`) and the step asks the engine to run monitoring (`notify_monitoring`): the rules (lane B, ADR-007) decide alerts and further actions (quit intent → delayed-onset explanation, missed doses → caring contact). Nothing here decides risk. Reminder buttons carry the dose they refer to (#56): "med:taken:", "med:skip:", "med:side_effects:" and the follow-up buttons likewise ("med:se::", "med:skip_reason::", "med:dose:yes:"), matched by prefix triggers. `` is the `doses.id` of the reminder or, when there is no dose row (prescription only known to the МИС), the reminder's ISO date. A button of an earlier day's dose is stale (friendly note, nothing recorded); so are the old payload-less buttons ("med:taken") of earlier releases. Check-in answers without a button (daily.med step, free text) go to today's planned dose, if any. """ from datetime import date, timedelta from functools import lru_cache from pathlib import Path from typing import Any import yaml from pydantic import BaseModel, ConfigDict from sqlalchemy import select from app.config import get_settings from app.core.privacy import scrub from app.core.rules import Action from app.db import repo from app.db.clinical import DailyCheckin, Dose from app.db.clinical import Prescription as PrescriptionRow from app.dialog.actions import register_med_info_handler from app.dialog.contracts import Button, Event, Reply from app.dialog.flows.core import menu_reply from app.dialog.fsm import Ctx, Step, abandonable, get_trigger, handler_for, state, trigger, trigger_payload from app.integrations.base import integrations from app.llm import agent from app.llm.med_qa import DOSE_QUESTION, fallback_text, med_qa QUESTION_STATE = "meds.question" SIDE_EFFECT_TEXT_STATE = "meds.side_effect_text" SIDE_EFFECT_CODES = ("nausea", "insomnia", "headache", "dizziness", "agitation", "other") SKIP_REASONS = ("forgot", "side_effects", "quit", "other") # ------------------------------------------------------------------------------------------- texts class _Strict(BaseModel): model_config = ConfigDict(extra="forbid", frozen=True) class ReminderTexts(_Strict): text: str text_no_drug: str taken: str skip: str side_effects: str class SkipTexts(_Strict): question: str reasons: dict[str, str] ack: dict[str, str] class SideEffectTexts(_Strict): question: str options: dict[str, str] questions: dict[str, str] describe: str ack: str repeat: str ask_dose: str dose_yes: str dose_no: str class CheckinMedTexts(_Strict): question: str question_no_drug: str yes: str no: str later: str class QuestionTexts(_Strict): prompt: str no_prescription: str class MedInfoTopic(_Strict): section: str # med_qa section code (side_effects | onset | alcohol | ...) question: str lead: str = "" fallback: str notice: str = "" class MedsTexts(_Strict): status: str reminder: ReminderTexts taken_ack: str stale: str skip: SkipTexts side_effects: SideEffectTexts checkin: CheckinMedTexts question: QuestionTexts med_info: dict[str, MedInfoTopic] def meds_texts_path() -> Path: return get_settings().config_dir / "texts" / "meds.yaml" @lru_cache def load_meds_texts(path: Path | None = None) -> MedsTexts: path = path or meds_texts_path() return MedsTexts.model_validate(yaml.safe_load(path.read_text(encoding="utf-8"))) # ------------------------------------------------------------------------------------------- data helpers class Rx(BaseModel): """Active prescription as the dialog needs it (drug INN + dose exactly as the doctor wrote them).""" id: int | None drug: str dose: str async def current_prescription(ctx: Ctx) -> Rx | None: """Latest prescription active today: clinical DB first, then the МИС integration (demo: in-memory).""" today = ctx.now.date() rows = await ctx.session.scalars( select(PrescriptionRow).where(PrescriptionRow.token == ctx.token).order_by(PrescriptionRow.id.desc()) ) for row in rows: if (row.start_date is None or row.start_date <= today) and (row.end_date is None or row.end_date >= today): return Rx(id=row.id, drug=row.drug, dose=row.dose) for p in await integrations.prescriptions.get_prescriptions(ctx.token): if (p.start_date is None or p.start_date <= today) and (p.end_date is None or p.end_date >= today): return Rx(id=None, drug=p.drug, dose=p.dose) return None async def checkin_of(ctx: Ctx, day: date) -> DailyCheckin | None: return await ctx.session.scalar( select(DailyCheckin).where(DailyCheckin.token == ctx.token, DailyCheckin.day == day) ) async def save_checkin(ctx: Ctx, **fields: Any) -> DailyCheckin: return await repo.upsert_checkin(ctx.session, token=ctx.token, day=ctx.now.date(), now=ctx.now, **fields) def dose_ref(dose_id: int | None, day: date) -> str: """Button payload naming a dose: its row id, or the reminder day when there is no row.""" return str(dose_id) if dose_id is not None else day.isoformat() async def todays_dose(ctx: Ctx) -> Dose | None: """Latest dose row planned for today (local day of `ctx.now`) — target of answers given without a button.""" rows = await ctx.session.scalars(select(Dose).where(Dose.token == ctx.token).order_by(Dose.id.desc()).limit(20)) today = ctx.now.date() return next((r for r in rows if r.planned_at.astimezone(ctx.now.tzinfo).date() == today), None) async def resolve_ref(ctx: Ctx, ref: str | None) -> tuple[bool, Dose | None]: """(fresh, dose row) for a button payload. Not fresh: missing/foreign/unknown ref or a dose of another day.""" if not ref: return False, None if ref.isdigit(): row = await ctx.session.get(Dose, int(ref)) if row is None or row.token != ctx.token: return False, None return row.planned_at.astimezone(ctx.now.tzinfo).date() == ctx.now.date(), row try: return date.fromisoformat(ref) == ctx.now.date(), None except ValueError: return False, None async def _dose_row(ctx: Ctx, ref: str | None) -> Dose | None: if ref is None: return await todays_dose(ctx) return (await resolve_ref(ctx, ref))[1] async def record_dose(ctx: Ctx, taken: bool, *, status: str | None = None, ref: str | None = None) -> None: """Dose answer → `doses` row (`ref` from the button, else today's) + `daily_checkins.med_taken` (rules read both).""" row = await _dose_row(ctx, ref) if row is not None: row.status = status or ("taken" if taken else "skipped") row.answered_at = ctx.now await save_checkin(ctx, med_taken=taken) async def record_side_effects(ctx: Ctx, codes: list[str], *, ref: str | None = None) -> None: """Merge side-effect codes into today's check-in (rule `side_effect_3d` counts days with any code).""" today = await checkin_of(ctx, ctx.now.date()) merged = list(dict.fromkeys([*(today.side_effects if today and today.side_effects else []), *codes])) await save_checkin(ctx, side_effects=merged) row = await _dose_row(ctx, ref) if row is not None: row.side_effects = ",".join(c for c in dict.fromkeys([*(row.side_effects or "").split(","), *codes]) if c) async def side_effect_reply(ctx: Ctx, codes: list[str]) -> Reply: """Reaction to newly reported side effects. Same effect as yesterday → short support (the instruction was already shown; persistence over 3 days is the rules' business). New effect with a known instruction question → the excerpt of the drug instruction (med_qa, section side_effects) — never generated advice. Otherwise a plain acknowledgement. """ t = load_meds_texts().side_effects yesterday = await checkin_of(ctx, ctx.now.date() - timedelta(days=1)) if yesterday is not None and set(codes) & set(yesterday.side_effects or []): return Reply(text=t.repeat, kind="info") rx = await current_prescription(ctx) for code in codes: if code in t.questions and rx is not None: answer = await med_qa(rx.drug, scrub(t.questions[code]), topic="side_effects") if answer is not None: return Reply(text=answer.text, kind="info") return Reply(text=t.ack, kind="info") async def leave_to_idle(ctx: Ctx, event: Event, data: dict[str, Any] | None = None) -> Step: """Abandon the current sub-flow and let the idle state handle the event (menu button, system event...).""" step = Step(next_state="idle", data=data or {}) idle = handler_for("idle") return step.then(await idle(ctx, event)) if idle is not None else step async def run_trigger_inline(ctx: Ctx, key: str, event: Event) -> Step | None: """Run an idle trigger from inside another flow (e.g. a reminder button pressed during the check-in).""" handler = get_trigger(key) return await handler(ctx, event) if handler is not None else None # ------------------------------------------------------------------------------------------- reminder def _reminder_buttons(ref: str) -> list[list[Button]]: t = load_meds_texts().reminder return [ [Button(label=t.taken, data=f"med:taken:{ref}")], [Button(label=t.skip, data=f"med:skip:{ref}")], [Button(label=t.side_effects, data=f"med:side_effects:{ref}")], ] @trigger("system:med_reminder", replace=True) async def _med_reminder(ctx: Ctx, event: Event) -> Step: t = load_meds_texts().reminder rx = await current_prescription(ctx) drug = str(event.params.get("drug") or (rx.drug if rx else "")) dose = str(event.params.get("dose") or (rx.dose if rx else "")) try: dose_id: int | None = int(event.params["dose_id"]) # type: ignore[call-overload] except (KeyError, TypeError, ValueError): dose_id = None if dose_id is None and rx is not None and rx.id is not None: # No scheduler row (demo console without #13): create the planned dose so the answer has a record. row = Dose(token=ctx.token, prescription_id=rx.id, planned_at=ctx.now, status="pending") ctx.session.add(row) await ctx.session.flush() dose_id = row.id text = t.text.format(drug=drug, dose=dose).replace(" ", " ") if drug else t.text_no_drug reply = Reply(text=text, buttons=_reminder_buttons(dose_ref(dose_id, ctx.now.date())), kind="question") return Step(replies=[reply], data={"med_pending": None}) # key of earlier releases: the button carries it now def _stale_reply() -> Step: return Step(replies=[Reply(text=load_meds_texts().stale)]) async def _legacy(ctx: Ctx, event: Event) -> Step: """Payload-less medication button of an earlier release: the dose is unknown → treat as stale.""" return _stale_reply() def _with_dose(fn: Any) -> Any: """Prefix-trigger handler wrapper: resolve the dose payload, answer stale buttons without recording.""" async def handler(ctx: Ctx, event: Event) -> Step: ref = trigger_payload(event) fresh, _row = await resolve_ref(ctx, ref) if not fresh: return _stale_reply() return await fn(ctx, event, ref) return handler def med_trigger(name: str) -> Any: """Register `button:med::*` (with the dose payload) plus the legacy payload-less key as stale.""" def deco(fn: Any) -> Any: trigger(f"button:med:{name}:*")(_with_dose(fn)) trigger(f"button:med:{name}")(_legacy) return fn return deco @med_trigger("taken") async def _taken(ctx: Ctx, event: Event, ref: str) -> Step: await record_dose(ctx, True, ref=ref) return Step(replies=[Reply(text=load_meds_texts().taken_ack)], notify_monitoring=True) @med_trigger("skip") async def _skip(ctx: Ctx, event: Event, ref: str) -> Step: await record_dose(ctx, False, status="skipped", ref=ref) t = load_meds_texts().skip buttons = [[Button(label=t.reasons[r], data=f"med:skip_reason:{r}:{ref}")] for r in SKIP_REASONS] return Step(replies=[Reply(text=t.question, buttons=buttons, kind="question")], notify_monitoring=True) def _side_effect_question(ref: str) -> Reply: t = load_meds_texts().side_effects buttons = [[Button(label=t.options[c], data=f"med:se:{c}:{ref}")] for c in SIDE_EFFECT_CODES] return Reply(text=t.question, buttons=buttons, kind="question") def _skip_reason(reason: str) -> Any: async def handler(ctx: Ctx, event: Event, ref: str) -> Step: if reason == "side_effects": return Step(replies=[_side_effect_question(ref)]) if reason == "quit": # «Решил бросить» is the same signal as "брошу" in free text: rule `quit_intent` reacts (alert + # delayed-onset explanation through the med_info action). await save_checkin(ctx, quit_intent=True) return Step(replies=[Reply(text=load_meds_texts().skip.ack["quit"])], notify_monitoring=True) return Step(replies=[Reply(text=load_meds_texts().skip.ack[reason])]) return handler for _reason in SKIP_REASONS: med_trigger(f"skip_reason:{_reason}")(_skip_reason(_reason)) @med_trigger("side_effects") async def _side_effects(ctx: Ctx, event: Event, ref: str) -> Step: return Step(replies=[_side_effect_question(ref)]) async def _after_side_effects(ctx: Ctx, codes: list[str], ref: str | None) -> Step: if ref is None: row = await todays_dose(ctx) ref = dose_ref(row.id if row is not None else None, ctx.now.date()) await record_side_effects(ctx, codes, ref=ref) replies = [await side_effect_reply(ctx, codes)] today = await checkin_of(ctx, ctx.now.date()) if (today is None or today.med_taken is None) and await current_prescription(ctx) is not None: t = load_meds_texts().side_effects buttons = [ [Button(label=t.dose_yes, data=f"med:dose:yes:{ref}")], [Button(label=t.dose_no, data=f"med:dose:no:{ref}")], ] replies.append(Reply(text=t.ask_dose, buttons=buttons, kind="question")) return Step(replies=replies, next_state="idle", data={"med_se_ref": None}, notify_monitoring=True) def _side_effect_code(code: str) -> Any: async def handler(ctx: Ctx, event: Event, ref: str) -> Step: if code == "other": return Step( replies=[Reply(text=load_meds_texts().side_effects.describe)], next_state=SIDE_EFFECT_TEXT_STATE, data={"med_se_ref": ref}, ) return await _after_side_effects(ctx, [code], ref) return handler for _code in SIDE_EFFECT_CODES: med_trigger(f"se:{_code}")(_side_effect_code(_code)) @state(SIDE_EFFECT_TEXT_STATE) async def _side_effect_text(ctx: Ctx, event: Event) -> Step: if event.type != "text" or ctx.text is None: return await leave_to_idle(ctx, event, {"med_se_ref": None}) facts = await ctx.gateway.extract_checkin(ctx.text) # Store only normalised codes, never the description itself (it stays in the scrubbed message log). codes = [str(c) for c in facts.side_effects] if facts is not None and facts.side_effects else ["other"] ref = ctx.data.get("med_se_ref") return await _after_side_effects(ctx, codes, str(ref) if ref else None) def _dose_answer(taken: bool) -> Any: async def handler(ctx: Ctx, event: Event, ref: str) -> Step: await record_dose(ctx, taken, status=None if taken else "missed", ref=ref) return Step( replies=[Reply(text=load_meds_texts().taken_ack if taken else load_meds_texts().skip.ack["other"])], notify_monitoring=True, ) return handler med_trigger("dose:yes")(_dose_answer(True)) med_trigger("dose:no")(_dose_answer(False)) # Free-text waiting states of this flow: a long-forgotten question must not swallow tomorrow's message. abandonable("meds") # ------------------------------------------------------------------------------------------- question menu @trigger("button:menu:med_question", replace=True) async def _menu_question(ctx: Ctx, event: Event) -> Step: t = load_meds_texts().question if await current_prescription(ctx) is None: return Step(replies=[menu_reply(ctx, t.no_prescription)]) return Step(replies=[Reply(text=t.prompt)], next_state=QUESTION_STATE) async def answer_question(ctx: Ctx, rx: Rx | None) -> str: """Answer from the instruction excerpt only (SPEC §7 п.5); dose questions and gaps → «уточните у врача».""" if rx is None or ctx.text is None: return load_meds_texts().question.no_prescription if DOSE_QUESTION.search(ctx.text.lower()) is None: # Agent: instruction + ЕМИАС record (other drugs, conditions, intolerances) + guidelines; else excerpt only. smart = await agent.answer_chat(ctx.token, ctx.text) if smart is not None: return agent.render(smart) answer = await med_qa(rx.drug, ctx.text) return answer.text if answer is not None else fallback_text() @state(QUESTION_STATE) async def _question(ctx: Ctx, event: Event) -> Step: if event.type != "text" or ctx.text is None: return await leave_to_idle(ctx, event) text = await answer_question(ctx, await current_prescription(ctx)) return Step(replies=[menu_reply(ctx, text)], next_state="idle") # ------------------------------------------------------------------------------------------- rule actions async def med_info_reply(ctx: Ctx, action: Action) -> Reply | None: """`med_info` action of a rule (quit_intent → onset, alcohol_3d → alcohol): instruction excerpt framed by fixed texts. The rule already decided to say it; this only picks the words. None → engine template.""" spec = load_meds_texts().med_info.get(str(action.params.get("topic"))) if spec is None: return None rx = await current_prescription(ctx) answer = await med_qa(rx.drug, scrub(spec.question), topic=spec.section) if rx is not None else None body = answer.text if answer is not None else spec.fallback return Reply(text="\n\n".join(p for p in (spec.lead, body, spec.notice) if p), kind="info") register_med_info_handler(med_info_reply)