Smart devices to manage medication adherence: An Evaluation, (Vers1)
Research type
Research Study
Full title
Evaluation of the implementation of technology-enabled smart medication devices to manage medication adherence
IRAS ID
346473
Contact name
Carol A Holland
Contact email
Sponsor organisation
Lancaster University
Duration of Study in the UK
1 years, 7 months, 15 days
Research summary
Summary of Research
Lancashire and South Cumbria (LSC) ICB and Lancashire County Council were together awarded funding to implement Smart medication adherence tools into homes of eligible social care recipients in Lancashire. Funding was provided by the Adult Social Care Technology Fund via NHS England. The implementation is not a research project and the device to be selected will be UKCA/CE marked and used within its intended, licenced purpose. It is to be implemented by the ICB/ICS as service improvement and eligible social care recipients will be given it whether they take part in the evaluation study or not. Lancaster University was commissioned by LSC ICB to evaluate the implementation of this device. The evaluation will report on benefits, facilitators and barriers to the ICB, the funder and the ASCTF National evaluator, and may be written up as research to enable further dissemination of findings. This ethics document therefore covers the evaluation, but not the actual implementation of the service. The evaluation will assess impact on medication adherence, and on domiciliary care providers in terms of number of visits and care costs. Data sources will be:
(i) Anonymised data from administrative data sources with an emphasis on outcomes that can be costed to determine any cost savings related to the implementation of the technology.
(ii) in-depth quantitative and qualitative data collected from a sample of social care recipients and controls (people identified as eligible but have not yet received the tool) at the beginning of the provision and approximately 6-12 weeks later.
(iii) qualitative data collection (interviews) with a sample of care providers at the same time periods.
(iv) organisational implementation factors, including stakeholders involved in medication adherence such as adult social care providers, ICB representatives involved in medication management including pharmacists, and local authorities (e.g. domiciliary care commissioners) and regulators (e.g. CQC).Summary of Results
Adult social care providers spend a lot of time supporting those receiving care to take their medicines correctly. This increases costs associated with adult domiciliary care. Thus, a small-scale pilot project was conducted to address this problem exploring whether digital medication devices could help people to take their medicines correctly and independently. We also aimed to explored whether the use of the devices improved people’s quality of life and reduced costs associated with receiving care. The device was to be given to people who were receiving domiciliary care or people who were recently discharged from hospital and individuals who were unintentionally taking their medicines incorrectly due to reasons like forgetfulness. They were to be given the device for 6-12 weeks. After that, other options were suggested to them to manage their medicines, with intended outcome being that they would have become more familiar and independent with their medication regimen However, recruiting people who were receiving care was challenging because care providers were concerned about their reduced earnings due to reduced need for their services and there were limited incentives for them to refer people to use the device. Due to the problems in recruiting people to use the device, the project was closed early. However, the evaluation team at Lancaster University were able to use qualitative methods to generate some recommendations for similar projects in the future.
Two rounds of workshops (6 workshops) were held with care organisation managers, pharmacists, care recipients, informal family carers, and the device providers. These workshops led to the development of recommendations for personalising the interventions for different individuals and situations. Recommendations for individuals who were uncomfortable with technology, people who frequently forgot to take their medicines, people in different circumstances such as those living alone or with family and individuals diagnosed with health problems such as those causing dizziness were generated. Policy and economic reasons that caused difficulties in completing the project were also discussed. The team also conducted a review of 84 studies which examined digital medication devices to help people with long-term illnesses to take their medicines correctly. The review generated additional recommendations which were combined with those generated from the workshops. These were recommendations to improve habits related to medicine intake, supporting correct medication intake for people with hearing or vision problems, supporting individuals with different levels of comfort with technology and addressing societal policy and economic factors that can affect the progress of similar projects.
A theory called the Combined Framework for Implementation Research (CFIR) was used to design and interpret interviews with some of the project team members to assess the factors within teams, organisations and wider society and policy level factors that affected the progress of the project. These factors were: device limitations around medication storage according to individual doses of medicines; changes in demand for care providers’ services; financial problems faced by care organisations; and limited time provided to recruit patients discharged from hospital. Findings also showed that more care recipients could have been recruited if the local authorities (those who commission care services) had supported the use of the device in this project, given that care providers did not want to refer individuals as they were worried about their loss of income.
So, the results of these studies showed that it was important for similar projects to ensure that there are clear incentives or policy for care providers to refer individuals to use similar devices. A policy change to make the use of similar devices mandatory for people needing help with taking their medicines correctly could be considered. Additionally, similar projects need to be flexible and have different alternative plans to adapt to any societal, economic or policy changes. The evaluation also recommended that the formal project start should be set to the time when all prior contracts and processes are completed.REC name
Social Care REC
REC reference
24/IEC08/0037
Date of REC Opinion
29 Jan 2025
REC opinion
Further Information Favourable Opinion