Interviews requirement analysis

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Questions

Elderly

1. How old are you?

2. Where do you live (care home / independent)?

3. How often do you take medication?

4. How mobile are you?

5. Do you have someone to take care of you or can you still do almost everything by yourself?

6. Would you be interested in a medicine delivery service?

7. Would you be open to a robot providing this service?

8. What are things to take into account when designing such a robot? With regard to:

• Usability / understandability
• Safety/privacy
• Opened by app / password / other
• Other

Pharmacists

1. What do you feel is the main problem with distribution of prescriptions for elderly and disabled?

2. During the current COVID-19 outbreak how do people collect their prescriptions? (particularly the elderly or disabled)

3. Does the pharmacy you work at (or previously worked at) offer a medication delivery service to the customer? (answer if applicable)

4. If yes, how does this delivery service work?

5. Do you think that this kind of service is useful? If no why not and if yes, why?

6. If such a service existed using autonomous robots, would you trust such a system to safely deliver the medication?

Scenario: there are a fleet of autonomous robots with multiple (password) locking compartments inside which you, as a pharmacist, would with medication fill per each customer requirements, then lock and send on its delivery to a certain address.

7. How comfortable would you be using this technology and why?

8. What would some useful features be for this technology? for example a connected application where you can gather customer data like prescriptions addresses and passwords, or removable compartments so that you can pack them on a counter instead of leaning down to the robot

Caretakers

1. Where do you work?

2. What are your tasks/responsibilities?

3. How (in)dependent are the people (elderly) you work with?

4. How many people (elderly who take medication) are there?

5. What is the current situation regarding delivery/distribution/intake of medication?

6. Are there problems/issues/points for improvement? With regard to:

• Money
• Time
• Safety
• Other

7. Do you think automation/robots could bring possibilities?

8. What are things to take into account when designing such a robot? With regard to:

• Usability / understandability
• Trust in technology
• Duration
• Other

Transcriptions

Participant 1 (caretaker)

Participant 1 works in a care and nursing home (Veenhagen) in Nootdorp. She has been working in health care for 30 years now. At the moment she works as a team manager, which means she is working with a team of caretakers and is responsible for the quality of care that they offer. She is well-informed about everything that happens and when needed also takes over some nursing tasks.

Compared to some years ago, the differences between residents are getting smaller, since a lot of people stay at home much longer than they used to. However, there are still big differences in how dependent the people are of the caretakers. There are people with dementia, who cannot really do anything for themselves anymore, but some people are in the care home for somatic reasons. This means they are physically somewhat dependent, but are mentally still really healthy. In total, there are 128 residents in Veenhagen at this moment.

Caretakers deliver medicine to all people in the care home at the moment. All people get a rating, which indicates how much control should be there regarding the medicine intake. A 1 means they get to manage their own pill boxes and are responsible for taking them in on time and a 4 means the caretaker should bring in the pills at the exact right time and has to wait until all pills are correctly taken in.

Participant 1 thinks robots could really have potential in parts of the medicine delivery. She thinks especially in home care it could really offer some solutions, since there are a lot of examples she knows in which a caretaker only delivers medicine and does not really need to help with much else. A robot costs less money and she thinks it could also be less privacy-invasive. In the care homes, she also thinks it could be beneficial, in particular for the somatic patients. It is really important that people are still cognitively well, because otherwise it could become dangerous. So she does not think it is usable for every resident.

It really important to keep the robot user-friendly, because elderly need to be able to understand it. New things are difficult for them to get used to, especially “high tech” gadgets like robots. She thinks a human-like robot might be nicer to work with for elderly than a “box-on-wheels”, but also has doubts for how long this stays interesting and if the benefits of a human-like robot outweigh the costs of implementation and functionality.

A very important thing to take into account is the monitoring aspect. Now, participant 1 and her colleagues have to check every medicine separately and really keep up to date with the 1-4 ratings of peoples independency. There needs to be a way to monitor if people take their medicine correctly and, if not, adjust their rating so that they get less responsible themselves and more dependent on the caretakers. Also, the visiting moments are really variable, so a smart way to regulating that with robots is necessary (if every separate robot visit needs to be monitored by someone, it takes less time to just deliver the medicine themselves).

Participant 2 and 3 (elderly)

Participant 2 and 3 are an elderly couple of 71 and 72 years old. They live independently in their own home and are still really active and mobile. They are both not regular medicine users, but find it really interesting to think about a delivery robot (for acquaintances that are a bit older or for themselves in case they are going to need it in a couple of years). Participant 2 has one daily pill he needs to take, but he can easily get that at the pharmacy himself.

As requirements for the robot, they thought a bit about the security of the compartments with the medication. They think that older people might forget a password too easily. They don’t see themselves as that old yet, but even they have trouble remembering passwords quite often. A simple four digit code might be easier to remember, but also easier to accidentally share with the wrong people (Participant 2 shared an example of an older lady that just told him her pin code, even though he didn’t know her).

One solution they’ve come up with, is a simple security question. The robot should be able to ask a simple (personal) question and can check the answer by speech recognition. The question can be something like “what is your oldest grandsons name?”, since people are likely to always remember that.

Another option a something like a card or chip that they can put against a sensor. This is only possible for regular clients of course, so the robot might use a combination of this sensor and a possibility to enter a password for someone that only uses the service once.

They also think a very simple and understandable app might be an option (after I suggested this), but again, maybe a combination is needed. A lot of people have a smartphone and are able to understand easy apps, but some don’t. Thus there needs to be an option for those people as well.

As an extra element to take into account, participant 3 suggested that the robot should deliver on certain, known timeslots. If the robot delivers on the same time every day it comes by, the users know when to expect it. This gives clarity and peace. It can get confusing for elderly if the moment of day keeps changing and it is practical to know when to expect a delivery.

Participant 4 (caretaker / elderly)

Participant 4 is a 67 year old woman that regularly visits a 90 year old woman, who needs help with a lot of daily tasks. Participant 4 takes no medicine herself and lives on her own. The older lady also still lives independently, but does need a lot of medication daily.

Participant 4 thinks a delivery service can be really useful in situations where people have poor mobility. Health care personnel delivers these medicine at the moment, but this costs them a lot of time (and thus money). As long as a robot can do the same as a human (come to the door, ring the doorbell, etc.), it can be really useful. A human deliverer doesn’t do a lot more now anyways. Especially now with COVID-19 it could really offer some solutions to the vulnerable group (not only elderly). In addition, it might be better for the environment.

On the other hand, when a human is in charge of the delivery, he/she might be able to notice some things sooner. For example, he/she gets alarmed sooner if someone suddenly doesn’t open the door (the resident could have fallen and might be in trouble). Although, a robot can also have a function that determines something might be wrong when the door is not opened after a certain amount of time.

One really important aspect is to determine the target group for this robot. People that use a service like this really should still be clear-headed and responsible enough to handle and to take their own medicine. If someone needs more help with other tasks as well, this robot won’t work or will get people in unnecessarily dangerous situations (when they get more responsibility / independency than they can handle).

As long as people belong to the group described here, a robot can be really practical and could replace a lot of human actions. Participant 4’s first reaction is that a lot of older people might not react very positively to a robot in their homes. But she quickly changes her mind and realises that all innovations need some time to adjust to them and she thinks with a robot like this, it will probably be the same. She remembers the time that medication suddenly got delivered in a so-called baxterroll instead of separate boxes and people also reacted negatively to that. But they got used to this after some time and also will with get used to a machine / robot. As long as they are capable of performing the needed actions to interact with it. Thus mentally healthy and physically able to at least open the door, for instance.

With regard to opening the components, a password/app/card are all good options. Some pharmacies also have a machine from which you can receive you medication. So with a machine that delivers your medication at home this should be possible as well. There are always pros and cons of different options (so also for the options of opening this robot). Some are cheaper, some are easier. A lot of people in participant 4’s age group she knows can handle a smart phone quite well and even older people can still to that. She thinks an app is not a lot more difficult to use than a code or card, although a card that you can scan might be a bit easier. She expects an app to cause most problems during the installation. Once it’s working, most people know how to use it (if designed properly).

Participants 4 thinks robots need some time getting used to (for elderly at least, younger people will understand it fast and can use it easily as soon as it actually exists). With regard to the looks of the robot, she thinks a drone might cause a bit more suspicion than driving/walking robots, but that is a matter of habituation as well. As long as the robots are recognizable as belonging to the pharmacy it should be fine.

Participant 5 (caretaker / COVID-19 risk group)

Participant 5 (54) visits her mother (90) 3 to 4 times a week. She mostly helps her with giving her life some structure by looking at her agenda/planning and reminding her of what day it currently is. She does some light housework like cleaning and doing the laundry or the dishes. Especially the social aspect of her visits are really important. In addition to her visits, home care comes by 4 times a day to give mom her medication and physical care and household support visits once a week. Every other week, this person picks up the medication from the pharmacy.

In the past, the medicine was delivered at home. The family, however, didn’t want this anymore. Mom has dementia and the chance is too high that she opens the door for someone who claims to deliver medicine, but is actually a burglar or some other figure that can’t be trusted. It also happened a few times that she did not open the door (because she did not recognize the doorbell), which is somewhat annoying for the person at the door.

When her mother was still clear-headed enough, a robot could have definitely been used to deliver her medication. A robot doesn’t get annoyed when the door doesn’t immediately get opened, it has more patience than people. Besides being caregiver of her mother, participant 5 herself also regularly needs medication. She would really be open to a robot delivery service. They get delivered at home now as well, a robot would not really make a difference (she doesn’t really have a personal connection with the postman now either).

Regarding the functionality of the robot, she really wants some form of legitimation / control (by scanning a card for example), since medicine are expensive and she doesn’t want her neighbour to be able to easily steal her package. Her pharmacy has a 24-hour machine for picking up medication, which uses a combination of a password (sent by email) and date of birth. She prefers a code (for every single delivery) over an app, because your phone could have died just when you need it.

Other things to take into account are that her medicine need to be cooled at all times, so the robot needs a cooled compartment. In addition, users should be mentally healthy enough to handle the responsibility and to understand the device. Also, watch out for pets (make sure people are there to receive the medication, don’t just drop them on the doormat). As for the appearance of the robot, she does not really care. Although a voice would be nice. Every action should be really easy and intuitively. People should not feel dumb when using technology.

Participant 6 (pharmacist)

In the pharmacy where participant 6 currently works, there already is a delivery service. People that use a lot of medicine and are not that mobile anymore use this service and receive their medication in a baxterrol (for example if they cannot keep them apart anymore). Clients that really need more assistance are helped by home care, who give them their medication and help them take it.

With the current COVID-19 situation, a lot more people make use of the delivery service. Although, still a lot of elderly still come to pick their medication up at the pharmacy, because they like their walk outside. Participant 6 thinks it might be wiser to let them be delivered, but she does understand them. But in total, their delivery service is used a lot now (also by younger people).

In this pharmacy, there isn’t a outside locker where people can receive their medicine 24 hours a day. They do have a very old robot that collects the medicine when the staff members enter it in the system. They are planning to purchase a new one, and when they do, they will also get a locker machine. These machines work with repeat recipes. When customers need a new batch, they receive an email and can collect them within a few days.

Participant 6 does not know what she thinks about delivery with robots at first. For her it is still a vague future image. She thinks she might be a bit too old and gets why the younger generation has more imagination when it comes to these subjects, but for her it seems far in the future. Although it is an abstract idea for her, she thinks she would trust the service if it becomes available. Especially when it only travels small distances.

One thing that would be necessary is a sachet or lable which makes it really clear which medicine should be in which compartment and for which customer it is. This is important for the pharmacists as well as the customers. It could be bad when medicine accidentally get swapped. Another thing to take into account with delivery in general is that people need to be at home. A lot of people like to know (and have a say in) what time the delivery will be, although that is sometimes difficult because the route planning can be a challenge.

Participant 7-15 (pharmacists)

What do you feel is the main problem with distribution of prescriptions for the elderly and disabled?

The lack of communication to the patient about their medicine, leads to compliance issues

Geographical spacing

They find it difficult to move around to get their medication and tend to mix up their medication quite often.

Availability and affordability of key chronic medications. The supply chain is a bit strained at the moment so theres erratic drug supply. Furthermore a small proportion of population- 8% on medical insurance so the rest have to pay out of pocket for medications. With a challenging economy and shrinking income it's harder to ensure medication remains affordable to these groups

Inconvenience of patients with respect to coming to collect their medicines

Their access to pharmacies is limited

Some are no longer able to come to the pharmacies to collect their own medication

Medical aid is not sufficient to cover drugs required.

Time required to collect and distance to be traveled

During the current COVID-19 outbreak how do people collect their prescriptions? (particularly the elderly or disabled)

We delivered or they arranged for family and friends to collect on their behalf . Or sadly( we presume) they just went without

We deliver or they send a relative or friend

Usually get a family member or worker to come get their medication otherwise there is an order system where they phone and ask for order and delivery of medication.

Home deliveries for some. Or they send younger relatives to collect medication at the retail pharmacies

Some receive deliveries if they can afford the service, others still come to collect

85% or so collect on their own or ask a caregiver to pick up while the rest get a delivery arranged by the pharmacy

Some pharmacies have started delivering medicines at patients' doorstep. Walk ins are still allowed in most pharmacies with requests to wear masks, sanitize hands and practice social distancing.

Caregivers of family members are sent to collect the medication

They send caregivers or relatives or children to collect for them

Does the pharmacy you work at (or previously worked at) offer a medication delivery service to the customer? (answer if applicable)

Yes, we always have

Yes we do

Yes they do offer a delivery service provided you live within the city

Yes. We have partnered with a delivery company that ensures home deliveries

Yes

Yes

Yes it does

Yes

No we do not

If yes, how does this delivery service work?

The patient phoned for their medicines and asks for them to be delivered. We have a motorbike for delivery

For distances within a 10km radius from the pharmacy deliveries are made with a motorbike

The doctor will call through or drop off the prescription, the client normally phones to confirm their order, pharmacists process it and it is packed in a sealed container that is locked in the delivery box, they have a delivery person who is normally a pharmacist technician to take orders to customers homes with an invoice. He drops off the medication and collects the money.

As mentioned we have partnered with a delivery company that uses motorcycles to deliver.

We pay for service to a third party logistics service provider

Clients request for the service and if repetitive the state the frequency. On the appropriate time the pharmacy confirms the delivery request with the client before dispatching a messenger

Patients leave their prescriptions with the pharmacy and the pharmacy sources and delivers the medicine once monthly until the prescription expires via motorbikes.

Meds are delivered to patients residence using motorcycles

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Do you think that this kind of service is useful? If no, why not? And if yes, why?

Yes very useful. People who are elderly or infirm are not usually very mobile so need their medicines delivered.

Yes it reduces the number of people visiting the pharmacy physically

Yes for elderly patients that cannot make it to the pharmacy and don’t have anyone to go for them, but only for people who are take chronic medication and have been on it for a while, as those who have just got a new prescription or on medication for the first time, we like to counsel them on each and make sure they fully understand how and when to take them

Yes it is and it changes the way in which people can access their medication and conveniently get their medication delivered

To some extent, it gives patients convenience with respect to receiving their meds. But it is currently pricey and out of affordability range for most patients. However, also reduces the patient pharmacist interaction

Yes. It served well those with limited mobility and also decongested the dispensing point

Yes. It decongests the pharmacies, makes planning and stocking easier and is a convenience for the patients.

Yes it is very convenient

Yes , because that will improve customer service and ensure access to especially the elderly and the disabled

If such a service existed using autonomous robots, would you trust such a system to safely deliver the medication?

Yes

I do not think I would fully trust the robot to deliver the medication safely

Yes but if there is a malfunction it could be a massive problem and no ‘dangerous drugs’ or schedule 5 and 6 ( in South Africa) could be delivered using them according to the laws.

Yes as long as the security aspect is addressed and confirmation of delivery can be done on both sides - pharmacy and to the patient. And also ensure that the product is delivered to the correct patient.

Yes I would

Yes

Yes

Yes I would trust it

Yes

How comfortable would you be using this technology?

Quite comfortable, the robot will go where programmed to go

Not so confident

If the passwords are only used by the pharmacist and client I will feel ok using it, however I prefer to deal with clients one to one and rather to their face to ensure all questions are answered and they are happy with the service you are providing before they leave.

Very comfortable. I have seen other systems such as these in other countries and such a method has also worked with Amazon. The compartments are accessible by password which increases the security.

I would. Robotics is the way of the future. It offers the service at a lower cost and wit greater efficiency

Very comfortable

Not entirely comfortable

Very comfortable

Yes , if it is security proof but provide sthe desired output of uninterrupted access and better access too

What would some useful features be for this technology? for example a connected application where you can gather customer data like prescriptions addresses and passwords, or removable compartments so that you can pack them on a counter instead of leaning down to the robot, or anything else that would make this technology easier and more practical to use.

There are strict regulations about how and where medicines can be dispensed to the pharmacist in the normal manner and then put them in the robot compartments.

I would like to be able to offer counselling to my patients somehow

Barcodes prescription and information on medication linked to your phone An app to let people know when to expect delivery dates and times and tracking and other information.

A connected application with password verification. This must be a secure portal to ensure the medication has been collected by the right customer. A connected application is also helpful because customer can provide feedback and also other incentives to use such a delivery system can be created eg notifications and tips

Some medications have to be kept cold, therefore some kind of compartment that is well insulated or refrigerated would be necessary

A system that has the drug compartments that can be filled at the pharmacy that is then picked up by the robot. A system that is seamlessly connected to the prescribers.

Tracker to monitor movement, gather information on who collected medicines and feedback from patients

A secure locking system and an easy to understand application

A connected application such as web based system with access rights and security