- Aging & Longevity
Automated Medication Dispensers in the Home
Technology in health and medicine continues to improve quality of care and safety for patients. The implementation of an automated medication dispenser in homes of some individuals may increase medication adherence, prevent medication misuse and adverse incidents when compared to utilizing a pill organizer (pillbox), limited medication supplies, and a lockbox. This paper reviews the literature for the usefulness of automated medication dispensing devices in the home to decrease the prevalence of adverse drug reactions, medication non-adherence while improving quality of care and safety for individuals in a community-based setting.
Using Automated Medication Dispensers to Improve Medication Adherence and Safety
Automated medication dispensers may be the key to improved quality of care and enhance safety for individuals who live in the community. An automated medication dispenser is a device that can be filled with routine medication and as needed medications. The automated medication dispenser can be filled by a health care professional, family or caregiver and is programed to alert patients when it is time to take the medication. The patient is alerted by an alarm to take their scheduled medications. The patient is required to press a button that sends a signal to the machine to dispense the medication cup that had been prefilled and loaded into the device. Some of these automated medication dispensers also are able to send text, email and phone messages to family members or health care professionals when the machines is low on medications or if a patient has missed their doses of medication over a 24 hour period.
According to the Agency for Healthcare Research and Quality (AHRQ) part of the United States Department of Health and Human Services (2013) automated medication dispensing devices started appearing in the 1980s (AHRQ, 2013). At times patients do not always adhere to safe medication practices when it comes to taking medications as prescribed. In fact, it is reported that there are approximately 700,000 emergency department visits and 120,000 hospitalizations due to medication related adverse events annually and 100 people die each day in the United States because of prescription drug overdoses (Centers for Disease Control and Prevention, 2013).
Utilizing this type of device in a community based setting has several advantages to enhance patient safety by improving medication adherence while avoiding overdosing by those individuals who have memory impairments or who simply may forget that they have already taken their medications. Automated medication dispensers prevent a person from taking the same medication twice if they have forgotten they already taken the medication. Likewise, it allows for close monitoring of medication adherence. Some these devices have monitoring and alerting system capabilities that can notify a health care professional or family member if a person has missed their medications, if the device is being tampered with and when the machine is getting low on medication. It does this by sending automated messages to a listed phone number via a phone line in the home. Automated medication dispensing technology can also provide a means for dealing with substance abuse issues.
Additionally, substance abuse does not discriminate among social, economical, gender, or ethnicity; it has the possibility to affect every individual in this country. Community-based nurses are witnesses to the increasing prevalence of substance abuse and misuse among patient in the home and the consequences that can happen. A working definition of medication misuse/abuse for the purposes this paper as defined by the Centers for Disease Control and Prevention (2013) is “The use of illicit or prescription or over-the-counter drugs in a manner other than as directed” (Centers for Disease Control and Prevention, 2013).
Culberson & Ziska (2008) cited a 2006 study, which indicated that the most commonly prescribed medication for pain was hydrocodone/acetaminophen and dispensed by pharmacists with 8 different opiate analgesics among the top 200 medications commonly dispensed. “Benzodiazepines were ranked as the seventh most prescribed medication in 2006” (Culberson & Ziska, 2008, p. 23). According to the Centers for Disease Control and Prevention (CDC) in 2010, two-million people reported using prescription pain killers non medically for the first time within the last year which translates to nearly 5,500 people a day (Centers for Disease Control and Prevention, 2013).
Prescription drug abuse is an important health issue for this country because of the devastating affects it can have on people. According to the CDC (2013) every adult American could take a painkiller around the clock for a month on the number of prescription painkillers prescribed in 2010. So the question is how significant of a health issue is prescription drug abuse? One should consider the fact that misuse of medications is such a problem that many companies are now marketing new devices and systems to help decrease the problem. Companies and health care professionals alike are looking for ways to improve safe medication practice and as the epidemic is on the rise it is more critical than ever before.
Comprehensive assessment of the patient, and careful monitoring of medication use can be an effective mechanism for preventing prescription drug abuse and misuse but may not always be the safest choice for patients who have a history of non-adherence with taking medications as physicians ordered them. Some nurses have seen physicians limit the quantities of high-risk drugs such as benzodiazepines and opiates to assist in preventing ongoing drug abuse and misuse. Furthermore, if appropriate, dispensing of only a seven-day supply of medications and requiring them to be placed in a lockbox has been utilized. Health professionals can also order blood work and urine testing to monitor for therapeutic drug levels.
A viable alternative for deterring patients from misusing medication and adhering to the prescribed regimen, and preventing adverse drug events, is through the implementation of an automated medication (pill) dispenser in the home setting. Examination of current literature demonstrates that the use of automated pill dispensing devices in the home can decrease the prevalence of adverse drug reactions and medication non-adherence while improving quality of care and safety for individuals in a community-based setting (Wakefield, et al., 2008).
- 100 people die every day from medication overdose in the U.S.
- Misuse of medication is responsible for 457,000 emergency department visits in 2009
- 12 million people report using medication for non medical purposes in 2010
- Costs of medication errors range from 100 to 300 Billion dollars annually in the United States
Review of Literature
A review of literature found experimental studies and literature reviews pertaining to the use of automated medication dispensers in a community-based setting. These studies compared the use of traditional methods of medication management, which included using a seven-day pill organizer or simply retrieving medications from the pill bottle (Wakefield, et al., 2008). Comparisons were made using automated medication dispenser systems to determine if medication adherence improved in those individuals who used this type of system over those who used traditional methods, such as a pill organizer or no device at all.
A study was conducted by Wakefield, Orris, Holman, and Russell (2008) at a 136-bed tertiary care referral Veterans Affairs Medical Center which included 24 individuals patients and also included the participation of nine clinical professionals made up of three physicians, three registered nurses and three pharmacists. A survey was used during the experimental process.
The researchers of this study concluded from their evidence collected that the medication dispensers had the highest overall ranking. No difference in the perceived likelihood of using one automated medication dispenser over another one was noted. The researchers also noted “clinician perception indicated the opportunity for improvement of the devices” (Wakefield, et al., 2008).
The authors concluded that a medication adherence intervention is multifaceted and should include behavior, cognitive and effective approaches when considering the use of automated medication dispensers as well as the need for improvement in design of such devices because clinicians may be less likely to prescribe such a device if it is perceived to be difficult to use. They also noted that more research is needed on the use of automated medication dispensers and improved medication adherence in those who live in a community-based setting. “Research is also needed to evaluate whether these kinds of devices actually improve patient adherence to medication regimens” (Wakefield et al., 2008).
Naditz (2008) discusses the significance of missing medication doses and the deadly consequences from misuse of medications. The article cites “Unnecessary hospital admissions, doctor visits, and test, and lost productivity cost the healthcare industry $100 billion to $300 billion annually, depending on the report cited” (Naditz, 2008, p. 875). The article reviews research that has been and is currently being conducted on the use of automated medication dispensers.
Furthermore, the author notes that a key element of the modern medication dispenser’s success is the ability to remind the family, caregivers or doctors about the patient’s use of medications because most of the units now have the ability to alert someone by e-mail, phone or text messages. The one major draw back from these medication devices is “they can remind a patient to take medicine, but they can not physically make the person swallow it” (Naditz, 2008, p. 879). This results in a level of trust between the patient and the health care professional.
Winland-Brown and Vallante (2000) found that the lowest number of missed doses of medication was with those who used the automated medication dispenser. It was determined in their study that slightly higher frequency of missed doses of medication were associated with the use of a pill box and that the most missed doses of the three groups were those who continued to administered their medication from the bottle.
The study authors concluded that the most accurate means of medication adherence is with use of an automated medication-dispensing device when compared to traditional medication management interventions in a community-based setting for elderly individuals. Additionally, the researchers of this study made a correlation of less utilization of the medical system when medication adherence was increased and those who did not use the automated system had an increase need for medical interventions. However, they did note that this system might not be appropriate for every individual as an effective approach for medication adherence. “Some elders become agitated and even violent if voices are heard with no one in the room. Other reasons that need to be considered include the monthly cost and lack of portability” (Winland-Brown & Vallante, 2000).
Another randomized trial conducted by Stip, Vincent, Sablier, Guervemont, Zhomitsky and Tranulis (2013) studied a product called DoPill, an electronic pill dispenser, in patients with schizophrenia to determine if this product increased medication adherence and improved antipsychotic adherence ratio (AAR). Their findings concluded that the “DoPill is a valid tool to quantify adherence” (Stip, et al., 2013).
MacLaughlin, Rhael, Treadway, Sterling, Zoller and Bond (2005) conducted a meta analysis on the subject of medication dispensers. The researchers noted that it is estimated that the actual rate of medication adherence is only about 50% and ranges from 26-59% in those 60 years of age or older while one-half of medications filled on a daily basis are taken incorrectly (MacLaughlin et al., 2005). Furthermore the researchers noted that “Hospitalizations, re-hospitalizations, nursing home admissions are recognized as direct sots of medication nonadherence in the elderly” (MacLaughlin, et al., 2005, p. 233).
They further suggest that traditional adherence assessments that continue to be used by healthcare providers often result in unreliable data such as patient and caregiver self-reporting, pill counting, and review of refill records. The use of new technologies to assist with medication adherence can improve adherence rates and provide more reliable data however, only a limited number of trials have been conducted to validate these early findings. While a number of technical patient medication adherence aids are readily available on the market there is remains insufficient and reliable data to validate the findings of improved medication adherence with the devices. Trials comparing these devices with better-established devices such as the MEMS device are needed (McLaughlin et. al., 2005). The researchers concluded that no one method alone can improve medication adherence rates among seniors or other individuals who are deemed at risk for non adherence of medication regimens.
When automated medication dispensers are utilized in the home of patients who had previously struggled with medication adherence or misused medications, research suggests that those individuals have a significant improvement in adherence to medication regimens. Likewise, the use of pillboxes, limited supplies of medication and frequent medication counting by a health care professional has a high occurrence of over estimation of medication adherence in these individuals. Some studies have suggested improved medication adherence of up to 90 to 95% with use of automated medication dispensers when compared to traditional in home medication practices. This noted improvement in medication adherence with such a device translates to decreased physician office visits, hospital admissions or re-admissions and improved symptom management of chronic conditions and diseases in those individuals who have often been unsuccessful with maintaining safe medication practices.
While early studies have shown promising results for improved adherence in medication regimens, these devices also come with some limitations. Manufactures continue to improve on the design of automated dispensers, however, currently some of the most popular devices are not portable and require established “landline phones” in order to send “monitoring alerts” from the device. The development of wireless and mobile device systems such as Bluetooth technologies incorporated into the automated dispensers would provide for increased portability for seniors. Furthermore, these devices do improve medication adherence according to “alerts” and medications noted to be remaining in the device upon next “refill” schedules. Unfortunately, there is no method currently in place to ensure actual ingestion of the medications that a patient retrieves from the device.
The factor of cost should be considered when discussing limitations for implementing an automated medication dispenser in a person’s home. It is highly encouraged that patients, families, and health care professionals conduct research for themselves to determine which company and device will provide the best price and device to meet that individual’s needs. Not all devices must be purchased; some can be rented without contracts for a monthly fee while others require contracts or purchasing of the device.
It is recommended that further research be conducted. Only a limited number of studies have been conducted and published, many with the limitation of small samplings over short periods of time. Larger, long-term studies should be conducted to verify these early findings of improved adherence using automated medication dispensers. Naditz (2008) noted that the University of Wisconsin-Milwaukee obtained funding to conduct large-scale research for a five-year period with five hundred elderly over the age of sixty-five using a type of automated medication dispenser.
In conclusion, close monitoring, establishment of a therapeutic patient-health care professional relationship, and adding automated medication dispensing system as an intervention can improve quality of life and care, safety, and decrease costs over time. Based on current literature review, incorporating this type of intervention into community-based nursing practice can be more effective in promoting positive outcomes for individuals who have previously struggled with medication adherence in their homes. In many instances, counting medications, continuing to use medication organizers such as pillboxes, and limiting medication supplies have been shown to be ineffective approaches though it continues to be widely practiced. Continuing to utilize the standard approach without adding new found technologies such as an automated medication dispenser is likely to produce on going need for frequent interventions by physicians, hospitalizations and poor symptom management resulting in negative outcomes for these patients.
This article was written by James Constanzer, registered nurse and owner of VitalLifeSenior.com an online retail store for senior that provides medical supplies, mobility equipment and more so they can maintain a healthy and independent lifestyle safely.
Automated Medication Dispensing Video
Agency for Healthcare Research and Quality. (2013). Chapter 11: Automated medication dispensing devices. Retrieved from http://www.ahrq.gov/legacy/clinic/ptsafety/chap11.htm.
Centers for Disease Control and Prevention [CDC]. (2013). Drug overdose in the united states: Fact sheet. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.
Centers for Disease Control and Prevention. (2013). Policy impact: Prescription painkiller overdoses. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/rxbrief.
Clark, M.J. (2008). Community health nursing: Advocacy for population health (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. ISBN: 978-0-13-170982-9.
Culberson, J. W., & Ziska, M. (2008). Prescription drug misuse/abuse in the elderly. Geriatrics, 63(9), 22-31.
MacLaughlin, E., Raehl, C., Treadway, A., Sterling, T., Zoller , D., & Bond, C. (2005). Assessing medication adherence in the elderly. Drugs Aging, 22(3), 231-320. doi: 1170-229x/05/0003-0231.
Naditz, A. (2008). Medication compliance-helping patients through technology: Modern "smart" pillboxes keep memory-short patients on their medical regimen. Telemedicine and e-health, 14(9), 875-880. doi: 10.1089/tmj.2008.8476.
Stip, E., Vincent, P., Sablier, J., Guevremont, C., Zhomitsky, S., & Tranulis, C. (2013). A randomized controlled trial with a canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia. Frontiers in Pharmacology, 4, 1-6. doi: 10.3389/fphar.2013.00100.
Wakefield, B., Orris, L., Holman, J., & Russell, C. (2008). User perceptions of in-home medication dispensing devices. Journal of Gerontological Nursing, 34(7), 15-25. Retrieved from http://www.search.proquest.com/docview/204168632?accountid=45760.
Winland-Brown, J., & Vallante, J. (2000). Effectiveness of different medication management approaches on elders' medication adherence. Outcomes Management for Nursing Practice, 4(4), 172-176. Retrieved from http://www-ncbi-nlm-nih-gov.db15.linccweb.org/pubmed/?term=effectivness of different medication management approaches on elders medication adherence