The eDosette study – Optimizing medication use and safety in community dwelling seniors

Key Findings:

• The eDosette capture data of enough quality to generate unique medication administration records for each of ten participants
• The eDosette showed that how a person’s subjective rating of medication adherence can differ from their objective medication adherence as observed by the eDosette
• The eDosette was deemed acceptable by participants and the technology could be feasibly installed in participant homes for long-term use.

Why was this study was needed?

Complex medication regimes are common among older adults living with frailty because of increased comorbidity; therefore, this population is at high risk for increased adverse drug events, poorer health outcomes, increased hospitalization and emergency department visits and mortality.  The eDosette provides primary care clinicians with objective information on how older adults living with frailty take their medications in order to help primary care make more informed prescribing decisions thereby reducing medication regimen complexity, and potentially mitigating the negative health and economic sequelae of polypharmacy.  By having medication administration information in real time, primary care clinicians can intervene with an older adult sooner, and make the recommendations regarding medications that may support the older adult with frailty in being more independent in managing their medications.

Suggestions on how administrators or policy makers could use the findings:

• Community pharmacists would be able to better counsel and make the best therapeutic choices together with the patient during MedsCheck encounters if objective medication administration information was available
• By integrating the eDosette medication administration records with existing prescribing functions in primary care EMRs, primary care clinicians could be better informed as they prescribe and renew medications for older adults living with frailty
• Public funders could use this objective medication adherence data to evaluate the cost-effectiveness of covering the cost of different medications

Brief comment on type of study in lay terms:

• The objective of the study was to develop and test the eDosette in 10 homes of older adults living with frailty in Hamilton, Ontario
• The eDosette was installed in the home of each participant for 2 weeks
• During these two weeks, the participant stored their blister pack or dosette in the eDosette, and the information captured by the eDosette was converted to the medication administration record for the family doctor and their team
• Primarily, the investigating team was interested in determining whether the eDosette would be able to accurately capture and transmit the information needed to create unique medication administration records for each older adult
• Secondarily, the investigating team was interested to observe how practical, acceptable and easy it was to install the eDosette into the homes of older adults living with frailty
• Each participant’s feedback was gathered and examined to help improve the design of the eDosette throughout the study

Key Findings:

• The eDosette allowed family doctors know how an older adult living with frailty takes their medications
• The eDosette revealed that how an older adult living with frailty believes they take their medications, and how they truly take their medications do not always match
• Older adults living with frailty approved of the eDosette device and found the eDosette easy to use in their homes

Why was this study needed?

Studies have shown that the more medications a person takes, the higher the chance for drug side effects and other bad outcomes including being admitted to hospital, falls or even death.  Seeing how someone takes their medications, especially the older adult living with frailty who takes many pills throughout the day, can help the family doctor and their team make better decisions about the medicines they prescribe. The eDosette allows the family doctor and their team to act sooner and make the changes required to prescribed medications that allow the older adult living with frailty to more easily manage their own medications.

Brief overview of the methodology:

• The objective of the study was to develop and test the eDosette in 10 homes of older adults living with frailty in Hamilton, Ontario
• The eDosette was installed in the home of each participant for 2 weeks
• During these 2 weeks, the participant stored their blister pack or dosette in the eDosette, and the information captured by the eDosette was converted to a medication administration record for the family doctor and their team
• Primarily, the investigating team was interested in determining whether the eDosette was able to accurately capture and transmit the information needed to create unique medication administration records for each participant
• Secondarily, the investigating team was interested to observe how practical, acceptable and easy it was to install the eDosette into the homes of these 10 participants
• Lastly, each participant’s feedback was gathered and examined to help improve the design of the eDosette throughout the study

Potential impact of findings on clinical practice/patient care and how this impact might be measured:

• The information captured by the eDosette may lead to reduced numbers of medications and dosage times, which would make it easier for an older adult living with frailty to manage medications on their own
• Because the information captured by the eDosette device is sent to the family doctor and their team, the eDosette encourages the older adult living with frailty to be involved in the decision making around which medications and how the medications are prescribed.