2019-01-16

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MEDICATION ADHERENCE AIDS FOR USE BY SENIORS

Dr. Tejal Patel School of Pharmacy

University of Waterloo

BACKGROUND• Older adults take 2 - 9 medications per day with complicated medication regimens• Adherence is the extent to which individuals follow prescription recommendations• Non-adherence can result in adverse consequences

2(H a jjar, e t A l., 2 0 0 7 )

FACTORS AFFECTING MEDICATION TAKING

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Physical Ability: Vision,

Hearing, Dexterity

Cognitive Capacity

Caregiver Support

Medication Complexity

and Packaging

Procurement

2019-01-16

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BACKGROUND • 80 different types of electronic medication aids available for purchase in Canada

•Do not know how effective these products are in improving medication taking by a senior•There are no criteria for a frontline clinician to use to recommend an adherence product

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RESEARCH AIMS1. How user-friendly are some of the medication aids available on the market to seniors?2. How can we enable a clinician to determine which medication aid is best to recommend to a senior who is having trouble managing medications?

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WHAT DID WE DO?1. We developed and tested a tool to enable clinicians to determine

where the problem with medication management is arising from2. We designed a study to test how user-friendly some of the medication

aids are.3. We purchased and tested 22 different products by inviting 39

individuals to test how usable the products were4. We classified the products we found5. We developed a guide

§ User-friendliness§ Workload§ Efficiency§ How completely one was able to complete the tasks

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THE DSL-MMC (DOMAIN SPECIFIC LIMITATION IN MEDICATION MANAGEMENT CAPACITY)

•Specific questions/activities that a person may answer or do that allows a pharmacist or physician to determine if there are any problems with managing medications independently• Started with 42 questions; removed 7 and modified 8 after testing

• More testing, actual use with seniors, is being planned

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Limitations to Medication Management Capacity

Physical Abilities

Visi

on

Dex

terit

y

Hea

ring

Cognition

Com

preh

ensio

n

Mem

ory

Exec

utiv

e Fu

nctio

ning

Medication Regimen

Complexity

Dos

ing

Regi

men

Non

-Ora

l Adm

inist

ratio

n

Poly

phar

mac

y

Access and Caregiver

Pres

crip

tion

Refil

l

New

Pre

scrip

tion

Car

egiv

er

PRODUCTS WE TESTEDGMS Med-e-lert Automatic Pill Dispenser

LiveFine Automatic Pill Dispenser and Reminder

MedReady 1700 Automated Medication Dispenser

E-pill Accutab Weekly Pill Dispenser

MedSmart Med-Reminder and Dispensing System*

E-pill MedTime Station Automatic Pill Dispenser with

Tipper*

TimerCap Travel Size

TimerCap Universal Size*

Jones Medication Adherence System*

Reizen Vibrating Pill Box

VitaCarry Advanced Pill Case

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Nishiki Round Pill Box with Alarm

MedGlider System 1 with Talking Reminder*

Patterson Medical TabTime Super 8

MedQ Smart PillBox

E-pill MedGlider Home Medication Management System*

MedCentre System

eNNOVEA Weekly Planner with Advanced Auto

Reminder*

E-pill Multi-Alarm Pocket XL*

6 Grid Pill Storage Case with Alarm

Itzbeen Pocket Doctor*

SOME OF PRODUCTS WE TESTED

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CLASSIFICATION OF PRODUCTS

TEJA L PA TEL , PH A RM D

WHO DID WE TEST THE PRODUCTS WITH?

• 39 individuals• 11 pharmacists and occupational therapists• 5 persons who assist seniors with taking their

medications• 23 seniors

• Older adults • Male/Female: 47/53%­ Mean age: 75­ Mean number of medications: 7.5­ Use of medication aids: 70%

­ Pillbox, phone alarms/Fitbit, message board, daily lists, blister package

­ 21% reported they seek help with medications from family members

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•Healthcare professionals­ Male/Female: 18/82%

­ Occupation: RPh: 82%; OT: 18%

­ Mean years of practice: 8.63 (0 – 37 years)

­ Assisted older adults with medication taking: 82%

•Caregivers­ Male/Female: 20/80%

­ Caregiver reported use of medication aid by person cared for: 100%

USER

FRIE

NDLI

NESS

OF T

HE

PROD

UCTS

TEST

ED

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WHAT WE FOUND: USABILITY SCORES

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

RA-0

02

PBA-00

1

PBA-00

2

PBA-00

3

PBA-00

4

PBA-00

5

PBA-00

6

PBA-00

7

PBA-00

8

PBA-01

0

PBA-01

1

PBA-01

2

PBA-01

3

Mean PB

A

EPB-O

O2

CC-001

APD-0

01

APD-0

02

APD-0

03

APD-0

04

APD-0

05

APD-0

06

Mean AP

D

SUS

Scor

es

Medication Adherence Products

MEAN SUS SCORES

TEJA L PA TEL , PH A RM D

Acceptable

Marginally

acceptable

Not

acceptable

WHAT WE FOUND

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Unassisted Task Completion

Efficiency (min) SUS(Usability)

NASA-RAW(Workload)

EMAP ScoreDevice Name

GMS Med-e-lert Automatic Pill Dispenser 81% 6% 40.8 67.08 ◑LiveFine Automatic Pill Dispenser and Reminder 70% 5% 46.5 65.21 ◑

MedReady 1700 Automated Medication Dispenser 86% 4% 28.6 72.92 ◔MedSmart Med-Reminder and Dispensing System 67% 5% 41.4 59.63 ◑

e-pill MedTime Station Automatic Pill Dispenser with Tipper 66% 4% 35.1 71.77 ◔TimerCap Travel Size 100% 21% 78.7 29.35 ◕

TimerCap Universal Size 100% 21% 52.9 43.54 ◑Jones Medication Adherence System 80% 6% 50.6 48.63 ◑

Reizen Vibrating Pill Box 78% 7% 50.7 50.28 ◔VitaCarry Advanced Pill Case 88% 8% 52.8 46.11 ◑

Nishiki Round Pill Box with Alarm 82% 7% 46.9 56.48 ◔MedGlider System 1 with Talking Reminder 95% 7% 57.2 45.75 ◑

Patterson Medical TabTime Super 8 81% 10% 57.9 35.65 ◕100-Hour Pill Reminder 96% 12% 55.8 49.35 ◕

MedQ Smart PillBox 85% 9% 64.6 42.17 ◑e-pill MedGlider Home Medication Management System 90% 12% 71.7 28.43 ●

MedCentre System 72% 6% 56.6 52.19 ◑eNNOVEA Weekly Planner with Advanced Auto Reminder 88% 8% 78.1 28.65 ◕

e-pill Multi-Alarm Pocket XL 78% 11% 51.6 45.65 ◑6 Grid Pill Storage Case with Alarm 79% 7% 34.8 65.1 ◔

Itzbeen Pocket Doctor 68% 6% 35 68.33 ◑*e-pill Accutab Weekly Pill Dispenser 82% 20% 63.2 41.02 ◕

QUESTIONS FOR DISCUSSION1. What problems, if any, do you face with

taking your medications?2. How have you solved these problems?3. What are your thoughts about the research

we are doing?4. Do you have any suggestions?

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INTERESTED IN PARTICIPATING?

Contact:Tejal Patel, PharmDAssistant Clinical ProfessorUniversity of Waterloo School of PharmacyEmail: t5patel@uwaterloo.caPhone: 519-888-4567 x 21337

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EMAPS TEAM

Jessica Ivo Aidan McDougall Sadaf Faisal Jillian Bauer

Sarah Pritchard Feng Cheng Maheen Farooqi

TEJA L PA TEL , PH A RM D

FUNDERS

RBC Research Fellowship

TEJA L PA TEL , PH A RM D