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Research

In order to form a concrete view of the non-adherence of the elderly (age > 65) to their prescription medication, research was executed. Topics included, are numbers on the non-adherence, existing assistive technology and acceptance of assistive technology by the elderly. 

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In short, it is shown that medical non-adherence is a serious problem, occurring in several locations. It is decided to tackle this problem in a home scenario, where patients and their potential help will operate the machine. When designing for the elderly it is important to ensure ease of use, privacy protection and suitability in their house. 

Starting-off location

Germany was selected as the initial location for our project due to several compelling reasons. Notably, Germany outshines the Netherlands in terms of both population size and the proportion of older individuals within the population. In the Netherlands, the percentage of people aged 65 years and above stands at 20.1% as of 2023, whereas Germany boasts a higher proportion of 22% as of 2021. This translates to approximately 3.5 million individuals in the Netherlands compared to a significant 18.3 million individuals in Germany.

Moreover, Germany has recently implemented the innovative "E-Rezept" system, which represents a digitized alternative to conventional prescriptions. This development is particularly advantageous as it incorporates a comprehensive pharmacy inventory tracking system. Furthermore, it empowers our users to effortlessly scan their prescriptions and submit their orders without the need to physically present the prescription paper.

Non-adhereance

As defined by the World Health Organization, non-adherence to long-term medication is “the extent to which a person’s behaviour—taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider.”  Examples are taking an incorrect number of medication or at the incorrect time. (Hoffmann et al., 2018)

    The same article states that the average rate of this non-adherence is 50% (study is located in US). Another paper, studying the in-adherence of chronically ill patients in Germany, found the percentage to be around 62,1 %. (Hüther et al., 2013)

    A study that looked into the adherence of elderly people in nursing homes, found that 21.2% of the administrated medication resulted in an error, such as administration and time errors. (van den Bemt et al., 2009)

Medication non-adherence is strongly associated with hospitalisation, while adherence is estimated to reduce the long-term mortality risk by 21%, in comparison to non-adherence. (Walsh et al., 2019)

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This research goes to show that medication in-adherence is a serious problem. Additionally, it showed different settings wherein medication in-adherence occurs:

  • Patients living independently 

  • Patients living independently, but receiving some form of homecare/assistance in medication administration 

  • Patients living in a nursing house

  • Patients residing in a hospital

Depending on the situation, patients take medication themselves or they get assistance in this from either a nurse or a loved one.

Choosing target group

Considering there are three very different use locations with very different end users, it is decided to focus on one of these. As mentioned before, there are three situations that can be sketched:

  • The medical dispenser at the patient's home, the end users being the patient and their (possible) caretaker.

  • The medical dispensers in nursing homes, the end user being the patient and nurses.

  • The medical dispenser in the hospital, the end user mainly being the nurses.  

The choice to continue designing for home usage with possible assistance, is based on necessity and desire for the product-service system. Looking at the previously referenced studies, it is anticipated that there will be a higher need for improvements in the home situation than in the hospital/nursing homes. Additionally, there are existing systems in hospitals and nursing homes that the PSS would interfere with. It is expected that a new system (dispenser + service) would require a lot of changes from these institutions, which is not appealing to a customer.

MDS influence on adherence

But will medical dispensers actually help improve in adherence? Several studies claim that the use of medical dispensers hugely improves adherence, as will be discussed in this paragraph.

It was found that adherence increased from 49 % to 96,8 % for elderly, unintentionally in-adherent patients upon implementing an automated home medication dispenser. (Hoffmann et al., 2018)

 

Almost 100% of participants in a study (Reeder et al., 2013) found that the dispenser helped them manage their medication. 95% said the dispenser gives them peace of mind and 84 % are likely to use it in the future.

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According to Ahmad et al. (2020) a similar conclusion can be drawn, the medical dispenser gave peace of mind as well as helped improve adherence to prescribed medication. An important aspect raised was that to some patients the dispenser was not deemed necessary (yet). They found they could still manage medication themselves, they would only get the machine if it was needed.

Existing Market

There are already existing electronic devices that are designed to help adherence. Click here to see a full overview of existing technology. It is found that these differ mainly based on:

  1. The way the pills are organised and with that, it's way of refilling and dispensing

  2. The amount of storage

  3. The pricing system.

These variations offer solutions to different segments of the market: people with different medication regimens, cognitive capabilities and surrounding aid (think of a caregiver or loved ones). In the target group section, the characteristics of the chosen target group are discussed.

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It is possible to gather some information by looking at the reviews from the existing market solutions:

Looking at the HERO machine, the following points were deemed important to the target group ("Retirement Living," 2023):

  • No clear communication about exact pricing (per month vs once, rent vs buy, shipping vs deposit)

  • Importance of customer support 

  • Battery backup, in case of power outage

  • Options to delay a dose 

 

In reviews from other machines, the importance of an efficient filling process became clear, as well as the option to put reminders for medication that cannot fit in the machine. ("The Senior List," 2023.)

Assistive Technology -  Acceptance by elderly

For the elderly, it might be difficult to adapt to new (assistive) technology. Now, assistive technology and technology are different terms, both of importance for designing the dispenser.

Looking at assistive technology, this being products designed to help specific users, any type of specific users. In this case, elderly people. The following factors are of importance to successful adaptation of AT by elderly: (Yusif et al., 2016)

1. Privacy

2. Trust

3. Functionality/ added value

4. Cost

5. Ease of use

6. Suitability for daily use

7. Perception of no need

8. Stigma

9. Fear of dependence 

10. Lack of training 

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Ones of specific importance to this project are privacy, added value, ease of use and suitability of daily use. These can be accounted for, by for example, making the device easy and intuitive to use daily, and adding extra value through the service.

 

Technology, such as computers, mobile phones and the internet, play an important part in the PSS too. According to Guner en Acartürk (2018), actually using technology is determined by usefulness, but as of equal importance social motives, perceived costs, expected short-term outcomes, self-efficacy and perceived need. 

References

Hoffmann, C., Schweighardt, A., Conn, K. M., Nelson, D., Barbano, R., Marshall, F., & Brown, J. (2018). Enhanced Adherence in Patients Using an Automated Home Medication Dispenser. Journal for Healthcare Quality, 40(4), 194. DOI: 10.1097/JHQ.0000000000000097

 

Jakob Hüther, Alessa von Wolff, Dorit Stange, Martin Härter, Michael Baehr, Dorothee C Dartsch & Levente Kriston (2013) Incomplete medication adherence of chronically ill patients in German primary care, Patient Preference and Adherence, 7:, 237-244, DOI: 10.2147/PPA.S38373

 

van den Bemt, P. M., Idzinga, J. C., Robertz, H., Kormelink, D. G., & Pels, N. (2009). Medication administration errors in nursing homes using an automated medication dispensing system. Journal of the American Medical Informatics Association, 16(4), 486-492.

 

Walsh, C. A., Cahir, C., Tecklenborg, S., Byrne, C., Culbertson, M. A., & Bennett, K. E. (2019). The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. British journal of clinical pharmacology, 85(11), 2464–2478. https://doi.org/10.1111/bcp.14075

 

Reeder, B., Demiris, G., & Marek, K. D. (2013). Older adults' satisfaction with a medication dispensing device in home care. Informatics for health & social care, 38(3), 211–222. https://doi.org/10.3109/17538157.2012.741084

 

Ahmad, A., Chiu, V., & Arain, M. A. (2020). Users' Perceptions of an in-Home Electronic Medication Dispensing System: A Qualitative Study. Medical devices (Auckland, N.Z.), 13, 31–39. https://doi.org/10.2147/MDER.S241062

 

Retirement Living. (2023). Hero Automatic Pill Dispenser [Review of the Hero Automatic Pill Dispenser]. Retirement Living. Retrieved from https://www.retirementliving.com/reviews/hero-automatic-pill-dispenser#customer-reviews

 

The Senior List. (2023.). Pria Medication Dispenser. The Senior List. Retrieved from https://www.theseniorlist.com/medication/dispensers/pria/

 

Yusif, S., Soar, J., & Hafeez-Baig, A. (2016). Older people, assistive technologies, and the barriers to adoption: A systematic review. International Journal of Medical Informatics, 94, 112–116. https://doi.org/10.1016/j.ijmedinf.2016.07.004

 

Guner, H., & Acartürk, C. (2018). The use and acceptance of ICT by senior citizens: a comparison of technology acceptance model (TAM) for elderly and young adults. Universal Access in The Information Society, 19(2), 311–330. https://doi.org/10.1007/s10209-018-0642-4

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