Approached properly, the frail elderly (mean age 80 years) are willing to accept and use a telehealth medication dispenser meant to ensure they receive the right drugs at the right time, according to a new report.
This study was not devised to test a particular brand of dispenser, but rather to test the concept that an automated dispenser, with home-nurse coordination, would be more satisfying and reliable than a compartmented dispenser box, also with nurse coordination.
The trial participants were recently discharged clients of three Medicare-certified home care agencies in Milwaukee. The automated dispenser was a bells-and-whistles device that can deliver up to six cups of medication a day, with each cup capable of holding up to 20 aspirin-sized meds.
When the device’s alert light goes on, and the LCD message screen shows, the patient presses a button and a sealed cup of nurse-filled medication rolls down a little ramp on the front of the device. If the patient will be out of the house at the preprogrammed time, it’s possible to get the next cup dispensed early. The device plugs into a phone line and warns the nurse if doses have been missed or if the unit needs refilling.
At month 9 of the 12-month trial, participants were asked about their experience with the device. Questions dealt with ease of use and reliability. Ninety-one of the 96 participants (95%) gave the device and the drug-management system high marks in these areas. Eighty-one of the 96 (84%) said they would like to use the device beyond the trial period.
I began this column with the words ‘when approached appropriately’ users were happy with the system. What exactly does that mean? Well, originally, 152 individuals were randomized into the device group. Only 137 agreed to participate; the other 15 outright refused to have the unit in their home. One reason given was that it was too big. In fact, the device is only 13 x 12 x 14 inches, but it was shipped in a big box to ensure safe handling. When some participants saw the nurse wheeling up the box, they immediately declined to participate, giving some variation on ‘oh, no, you’re not putting that thing in my house.’
The researchers, recognizing that presentation was important, thereafter unpacked the unit before delivering it. Among other patient concerns were the psychological presence of the device, fear of dependency, and interference with privacy.
Nevertheless, the results “indicate that technology-enhanced medication dispensers can be acceptable tools for older adults to help manage their care in collaboration with home care nurses,” the researchers state. Of course, they add, “the home is not a clinical setting and older adult patients may lack the experience, motivation and problem-solving skills to overcome barriers in the use of a medication dispensing device. To identify and overcome barriers in person-technology fit, older adults should be engaged using participatory design strategies for the creation of new technologies that support their needs.”
And, finally, the team observes, cost is an important factor that future studies must investigate before medication-management systems can go into widespread use.
Reeder B, Demiris G, Marek KD. Older adults’ satisfaction with a medication dispensing device in home care. Inform Health Soc Care 2013; published online ahead of print, January 16, 2013, doi: 10.3109/17538157.2012.741084.
Nice article. Very interesting & not too long. When I was in home health, in the Houston area, I made a visit to a patient who had one of these electronic med dispensers. I had never seen one, so he demonstrated it for me. He was pretty proud of it and said it didn’t take him long to get used to it. He said it was one of the things that kept him able to remain at home. I have a blog that discusses nurses’ issues, challenges, and alternate options – & it’s called http://www.whatmotivatesanurse.com.— L J Acree / May 25th, 2013 at 6:55 pm