PRE2015 4 Groep3

Members of this group:

• Maurits Ambags - 0771400
• Wesly Chu - 088994
• Arthur Geel - 0907552
• Jasper Sparla - 0844019
• Twan Weernink - 0851703

Project Description

The aim of this project is to design and build a secure medication dispensing system that helps seniors manage their medication regimens. It can be used for seniors who:

• Take multiple medications or has complex medication regimens
• May have been hospitalized for misuse of medication
• May have cognitive impairment
• Require assistance with medication today

Title goes here

Historic Log

Individual work log (https://drive.google.com/open?id=14Ykl9HAKBMtJr3HRHOROLrNeHBLKUgkcpnDh3Kak1tQ)

Introduction

Fig 1.: Description goes here with some explanation as to what this is

In present day, people are using more medicine than ever. Patients are expected to take the right amount of their medicine at the right time, often multiple different ones per day. Each of these activities is a process that can easily go wrong, which has the potential to do some serious damage. As we get older, we generally use multiple medicines at the same time, yet our memory becomes worse. The budget cuts in health care result in doctors and pharmacists having less time for each patient, which means they might not understand exactly what they are taking. With the rush of internet and communication sciences, a lot of the patients files are being converted to digital files, yet not everyone is using a standardized format, which means communication can be an issue.

A report that the dutch government has released in 2013, entitled ‘polyfarmacie bij kwetsbare ouderen’ [citation needed], states that over one million people aged 65 and over take five different types of medication every single day. When we expand our view to those aged 75 and over, we see that 20 percent of those take nine different types of medication every day. When you combine that with the fact that up to 40 percent of the elderly receive insufficient information about their medication, an over- or underconsumption of medicine is the frightening result. Often, the medicine old people take are quite potent, leading to hazardous situations when taken incorrectly.

Finally, when we consider the prevalence of dementia amongst the elderly, of which over thirty percent of the people older than 80 years old suffer, it is clear that there is a need for a tool that helps people with their medication, both for when they need to take their medicine, but also as a safeguard to prevent dangerous combinations.

State of the art

Introduction

Medicine boxes are not a novel concept. Medicine has been around ever since the ancient ages, and medicine boxes are a logical extension of medication, required to keep things organised. Modern pharmacies often have the medication distributed in individually sealed boxes or bags with the date of when the medicine should be taken on them, and there are also a plethora of physical medicine cases with dates on them to remind the patients of when medicine needs to be taken. Some of the aforementioned medicine cases can be locked to prevent medicine abuse, yet there is no medicine box on the market that functions as a double-check and as an assistant to remind you to take your medication.

Medicine boxes

Medicine boxes or pill organizers are useful tools to both keep your medicine organised, and to help remind the patients of taking them at the right time. Most of the existing medicine boxes have the date and time on them, such as this one-month pill organizer. (http://i.ebayimg.com/00/s/ODM0WDEwMDA=/z/NMcAAOSwHjNWCEgu/$_57.JPG). While a product like this is both useful for organised storage and reminders of when medicine needs to be taken, there are some flaws to it. As the procedure of replenishing the medicine inside has to be done manually, there is a good chance of it going wrong. In most care homes, care givers or house pharmacists are in charge of the replenishing, yet the elderly that still live on their own have to do it themselves. There is no inspection that determines whether medications can be used in addition to eachother, and finally, the medicine can be taken at all times. There is nothing that stops the patients from under- or overconsuming medicine.

Medicine Reminder Applications

Medicine reminder applications are a step up from medicine boxes in terms of relative usefulness. These applications function as a digital notebook that helps you remind when medicine should be taken. In the user interface of these applications you can see a schedule of what medicine should be taken by what time, along with some visual information about how it looks, what it does and the instructions for use.

Source - (http://www.fastcodesign.com/3048368/the-best-pill-reminder-app-ever (accessed on 19-05-2016))

Pill Dispensers

Pill dispensers are more advanced editions of medicine boxes that have the ability to deliver medication at pre-determined times. They can be helpful in regulating medicine intake, for those who either intentionally or unintentionally take more or less medicine than they actually need. With most automatic pill dispensers there is a visual or an audial notification when a pill is dispensed. Pill dispensers can also function as a means of supervision: if a dispensed pill is not taken out of the space, the caregiver or supervisors can be notified, making improper use of medicine very much preventable.

Source - (http://www.prweb.com/releases/2011/11/prweb8973872.htm (accessed on 19-05-2016))

Philips Medicine Dispensing Service

Philips have created a medication dispensing service that has a "98.6% dispensing adherence level among monitored subscribers". The users have to load up the machine with single-dose cups of medication, and Philips takes care of the rest. The schedule is programmed, so when it's time to take the medication, a visual and audial notification is played to remind the users. The user then has to press the button to dispense the medicine. If the aforementioned button is not pressed within 90 minutes, Philips notifies the caregiver to help fix the problem.

Source - (https://www.lifeline.philips.com/health-solutions/health-mdp.html (accessed on 19-05-2016))

Source - (https://www.youtube.com/watch?v=HOeamcwDFbg (accessed on 23-05-2016))

Philips Medido

Source - http://www.kcwz.nl/doc/zorg_en_technologie/Eindrapport_project_Medido_fase_1.pdf

Conclusion

So, what is actually wrong with the current things, and what can we add to make our concept valuable in the market? Well, what we can do is ..., ... and ... . The end.

The current state of the art has limited or no communication with the pharmacy or the doctor's office. These systems can only notify a caretaker that the medication wasn't taken. The dosage is also prepackaged in plastic bags and thus cannot be adjusted an the fly. This forms a problem for patients with a unstable medicine regime whose prescription may change weekly. The date and time for the medicine intake is also fixed which isn't very flexible. The patient may not be able to take its pills at that time or is simply somewhere else where the device isn't available. There must be an ability to change the timetable of the medicine intake. We hope to remedy this shortcomings in flexibility of the medicine intake.

Requirements

This medicine box should be able to dispense medicine into a compartment that the user can access whenever the time is right. To do this, the box should keep track of its schedule and dispense medicine when necessary. When medicine is due, the user should be notified by the box that medicine is ready to be taken. The medicine storage consists of several separate containers, not directly accessible by the user. The box should dispense medicine from these containers into the aforementioned compartment, according to its internal scheduler. It should also remind the patient in what kind of manner it has to use the medicine e.g. on a empty stomach, before sleep etc,etc.

Secondly, the box should be remotely accessible by caretakers and doctors. They should be able to use an application to update the dosage of medicine in the box. This should alleviate some of the confusion for the patient when dosages change, and should prevent over-consumption of medicine, since dosage can be changed without an intermediate appointment with the doctor. It should also be possible for the doctors and caretakers to see the historical medicine intake of the patient and if it is following its prescription.

To refill the box, the user should be able to pick up (parts of) the box, so that it can be taken with them to the doctor and/or pharmacist. We rely on the caretakers' expertise to fill the box and update the data in the application accordingly, so that the user should not have to concern themselves with their medicine intake.

USE Aspects

User

The main benefit of this technology is that we can provide a better structure in the medicine intake of the patient. This should relieve the user of the burden of remembering when to take which medicine, and also notify them to take medicine when the user might otherwise forget. This should provide the user with several benefits:

More controlled medicine intake

Patients nowadays are generally solely responsible for taking their medicine and finishing treatments. This leads to cases where a patient might forget to take medicine, or even take too much medicine. In the first case, this has a direct negative effect on the effectiveness of the treatment. In the latter case this will probably have a negative effect on the well-being of the patient. Especially when medicine treatment is required over longer time period, or when patients should continue taking medicine even if they are no longer sick (think of for instance antibiotics), patients are more likely to slack on their medicine intake. By encouraging the patient to continue taking their required medicine, we hope to see treatments being more effective.

Preventing over-consumption after treatment ends

Since patients so often are required to take several kinds of medication simultaneously, it may be difficult for the patient to keep track of when to stop taking which medicine. This may result in patients continuing to take medicine even after the intended end of the treatment. Pharmacies nowadays already attempt to prevent over-consumption by only giving exactly as much medicine as is required, though this is not always the case. Also, considering the above, if a patient forgets to take their medicine several times, they assume that they have to finish all of their medicine anyway, resulting in them taking medicine after the end of intended treatment.

More importantly, especially in the case of elderly, some medicine may be given on a recurring schedule until further notice from a doctor and/or caretaker. In these cases, the patient should meet with the doctor once more, at which point the doctor may decide whether to continue using the medicine or not. However in reality, patients may continue taking medicine just because they are in the habit of doing so. This is especially a problem for the elderly, where long-lasting or even continuous treatments are not uncommon. This technology should serve as some kind of threshold for the doctor to consider repeating a prescription, and hopefully cancelling it when possible to prevent unnecessary medicine intake.

Minimising medicine resistance

Over-consumption of medicine also leads to future risks in the form of medicine resistance. In some cases, the patient's body may regard the incoming medicine as being hostile (especially for antibiotics) and the immune system may try to combat the medicine. On the long term, this results in the immune system effectively dispatching of the medicine, and therefore making the patient immune to the medicine's effect. Needless to say, over-consumption of medicine will only speed up this process, and preventing medicine resistance may be beneficial to the patient in the future.

Society

The medicine box should remind people to finish their prescription and not simply stop when their are feeling better. When they complete their prescription they prevent unnecessary bacteria resistance against the medicine. A caretaker has also less work since he/she doesn't have remind the patient to take his/her pills, This lowers medical expenses for society or frees more money for more critical care activities.

Enterprise

Standardising the way people take medicine should allow pharmacists and doctors to more effectively prescribe and dispatch medicine to patients. This in turn should allow both parties to be more time-efficient.

It is worth noting that over-consumption of medicine is beneficial to pharmacists and pharmaceutical companies, since it increases their sales. While this technology does not in any way hinder their intended sales, there may be a decrease in sales from these enterprises as a result of less redundant medicine intake.

Stakeholders

The primary stakeholders for the medicine box are elderly people who can still live on their own or with assistance. The patient must be able to take the pills on their own in the correct way since the box can only encourage medicine usage and cannot enforce it. The patient doesn't have to worry about their pill intake anymore and wonder whether they have taken their pills and if they have taken the right pills. Since pills are stored in a central place the risk of accidents will be smaller. Small children will be less at risk of finding medicine randomly scattered in a home and eating them.

The secondary stakeholders are the pharmacists who will fill the box and the doctors who will set the schedule for the machine. The pharmacist already is able to see which treatment the patient is on. He will need to have a way to accurately restock the machine with the correct medicine in the right compartment. The doctor must have the ability to see the historical medicine usage of the patient and whether the patient adheres to the treatment. If he sees an anomaly in the usage he can discuss this with the patient. The doctor also must be able to change the prescription and dose remotely.

Tertiary stakeholders will be the companies that will produce and install these machines in peoples homes.

Scenario/functionalities

It's 1 o' clock, its time to take your medication.The smart medicine dispenser turns on it's alarm and lights start to blink, the brightness and sound volume increase over a period of 5 minutes. The subject has to walk up to the dispenser and touch a button on the screen in order to turn off the alarm. At the time the button is pressed the required medication in the proper dosage is released and the compartment for that medication is unlocked. The subject can also choose to press the button saying he does not want to take the medicine, if this is done a couple of times the responsible physician is notified and can contact the subject. If the alarm is ignored for 5 minutes, the alarm will stop and repeat itself 30 minutes later.

When the medication is released, a pop-up will apear on the display showing the types of medication that are released and suggestions on how to take them individually. There should also be an option where the subject can ask for more information regarding the medication if the subject is interested or worried. There should be a button on this screen where the subject can click agree after which the display is shut off or turned to it's home screen.

Restocking of medication happens at the local pharmacy. The subject should get a warning on the display of the medicine box that for instance that the medication in slot 1 is running low and that this medication should be restocked at the pharmacist. The pharmacist can take out a cartridge kind of structure out of the medicine box and is able to scan a chip in the box that lets the pharmacist know what type of medication to put in which slot.

• • Scenerio from the perspective of the Pharmacists

• • Scenerio from the perspective of the Doctors

Planning

Week 1 ✓
Field research

Week 2 ✓
Clarify our project goals
Define USE aspects
Literature research
Field research

Week 3 ✓
Design sketches
Start up qualitative questionnaires
Start up quantitative questionnaires

Week 4 ✓
Develop UI for app
Start prototyping the final design
Questionnaire Data processing

Week 5
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Week 6
User-test medicine box

Week 7
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Week 8
Review wiki and update if necessary
Buffer week

Week 9
Prepare final presentation

Used Literature

Below is an example of how we should reference to the literature we have used, also known as APA style referencing.

• Author, A.A.. (Year of Publication). Title of work. Publisher City , State: Publisher.
• Author, A.A.. (Year, Month Date of Publication). Article title. Retrieved from URL