Patent Application
20120081225
This invention relates to a medication delivery and compliance system, method and apparatus. If a patient needs to take multiple medications, there is a risk of complications arising from failure to comply with the prescribed course of treatment. Records kept by emergency wards and long term care facilities show that among seniors, the incidence of non-compliance is particularly high. Studies show that more than 40% of seniors regularly take at least 5 or more medications for various ailments and approximately two thirds of all elderly patients cannot properly manage their medications, accounting for almost 25% of hospital emergency visits.
Medication delivery units are known in which pills are stored in dedicated compartments with indications at the delivery units for a patient as to what pills are to be taken at what times.
According to one aspect of the invention, there is provided a medication delivery system comprising:
The medication delivery system can further comprising a delivery mechanism for delivering said one medication element from the medication delivery apparatus at an exit zone thereof. The delivery mechanism can be operable automatically to deliver said one medication element upon receiving a valid output from the validation means. Alternatively, the delivery mechanism can be operable to deliver said one medication element upon patient actuation of the delivery mechanism following issue of the alert.
The validation means can have a valid output based on a selected one or more validation criteria including:
Preferably the medication elements are stored at the medication delivery apparatus in respective containers, the indicia applied to the containers. The containers can be linked together in the order of the prescribed course of treatment, the containers configured as a cartridge. A preferred cartridge comprises a roll of the containers configured to be unwound progressively to reveal, and enable access to, successive containers, the delivery mechanism operable to unroll the cartridge roll and to feed a free end of the roll to the exit zone. For such a cartridge, the delivery mechanism can include a drive wheel and an idler wheel for gripping therebetween a free end portion of the cartridge roll. The delivery mechanism can also comprise a separation mechanism for separating a leading container from a next-adjacent container of the cartridge.
The medication delivery apparatus is preferably configured with an exit aperture at the exit zone, the delivery mechanism operable to present a leading one of the containers at the exit aperture for the container to be gripped by a user, and a formation at the exit aperture constraining the user to grip the container at a position encouraging a clean separation of the container from an adjacent container. The apparatus can further comprise a collection unit positioned to receive and stack containers separated from a remaining part of the cartridge and presented at the exit zone. The apparatus can further comprise storage unit having a housing, the housing having a base part and a hinged part, the hinged part movable from a closed position in which the cartridge is enclosed in the housing, and an open position to permit loading and unloading of the cartridge. The delivery mechanism can include a drive wheel and an idler wheel for gripping therebetween a free end portion of the cartridge roll, one of the wheels mounted on the hinged part, the wheels brought into a relative positions to grip said free end portion by the act of moving the hinged part to the closed position.
A medication delivery system including apparatus as previously described can include a video conferencing functionality for providing video conferencing between the medication delivery and other nodes on a communication network. A node on the communication network remote from the medication delivery apparatus can accommodate a compliance agent for monitoring compliance information issued to the network on one of a scheduled and an on-demand basis. The medication delivery apparatus can further comprise a patient input functionality for summoning assistance from the network, and a patient output functionality to enable a remote agent on the network to summon the patient.
A least a part of control hardware and software for controlling operation of the medication delivery apparatus can be located at a node on the network remote from the medication delivery apparatus. The stored data can either be stored on the communication network at a location remote from the medication delivery apparatus or can be stored locally at the medication delivery apparatus: for example, on the cartridge.
According to another aspect of the invention, there is provided A method of delivering medication comprising:
Said one medication element can be delivered automatically in response to receiving a valid output from the comparing or can be delivered upon patient actuation of the delivery mechanism following issue of the alert.
The valid output can be based on a selected one or more validation criteria including:
The method preferably further includes establishing at least one of audio and audiovideo communication between the medication delivery apparatus node and the remote node in response to a failure to send to the node said indication whether the one medication element has been consumed by the patient. A node on the communication network remote from the medication delivery apparatus preferably accommodates a compliance agent for monitoring compliance information issued to the network on one of a scheduled and an on-demand basis.
For simplicity and clarity of illustration, elements illustrated in the following figures are not drawn to common scale. For example, the dimensions of some of the elements are exaggerated relative to other elements for clarity. Advantages, features and characteristics of the present invention, as well as methods, operation and functions of related elements of structure, and the combinations of parts and economies of manufacture, will become apparent upon consideration of the following description and claims with reference to the accompanying drawings, all of which form a part of the specification, wherein like reference numerals designate corresponding parts in the various figures, and wherein:
If a patient has many ailments, he or she may be prescribed a complex of drugs. Not only may the drugs differ from one another, but it may be required that they are taken at different times of the day, at variable doses, and with different periods between consumption, etc. This can place complex demands on the patient which are especially burdensome if the patient has difficulty in looking after him- or herself. If the patient cannot fully comprehend complex instructions, there is a danger the patient may either take the wrong drug, or may take the right drug but at the wrong time.
The apparatus, system and method of the invention offer a solution to the need for effective medication delivery and compliance, particularly for use in the home, but also for work sites, group homes, assisted living quarters, etc. The apparatus includes, in its simplest aspect, a patient unit and a medication cartridge, but has a more complex system aspect insofar as the patient unit forms a node on a communication network, one example of which is shown schematically in
The medication cartridge corresponds to a prescribed course of treatment for a patient at home or at another care facility. It is prepared at a pharmacy in compliance with a prescription issued by a physician and then either picked up from the pharmacy or shipped to the patient in readiness for use. A series of containers in the cartridge has an access order corresponding to an order in which the medication elements are to be taken in compliance with the prescribed course of treatment.
The patient unit is kept at the patient's home or other care facility, such as a work site, group home, assisted living quarters, etc. The unit has a housing in which the medication cartridge is stored and a medication delivery arrangement for delivering validated medication elements from the cartridge to the patient in the order and at the times that the medication elements are scheduled to be consumed by the patient. The patient unit 29 is connected into the communication network to ensure accuracy of delivery and to ensure compliance by the patient or assisting care giver with the prescribed course of treatment.
As shown in
The roll of containers is configured to be unwound progressively to reveal and enable patient access to successive containers. As shown in
Various alternative designs of cartridge are possible. In one alternative embodiment as shown in
A further alternative type of cartridge is constructed with a view to its constituent elements being fully discarded once the medication elements have been used up. In the embodiment illustrated in
Containers used in all of the previously described embodiments of cartridge can contain pills, lozenges, liquid or other implementations of medication. The invention is valuable for liquid delivery because accurate delivery of small amounts of liquid medication is notoriously difficult. In the present case, the volume of the liquid dose is accurately metered at the pharmacy centre and provided there is no spillage upon subsequently opening of the container, an accurate volume is received by the patient.
As previously mentioned, the delivery of medication from the different styles of cartridge 10 is effected using a patient unit 29 having a medication delivery mechanism matched to the particular cartridge design. A patient unit for the
The patient unit 29 has a feed mechanism which engages with the free end 26 of the cartridge roll. The free end 26 is located with its edge adjacent a drive wheel 38. When the roll is to be driven to eject a container for the scheduled administering of a prescribed drug, an over-centre spring lever 40 is actuated to drive an idler wheel 42 against the drive wheel and to pinch the edge of the cartridge roll free end between the wheels 38 and 42. Drive to the drive wheel is initiated from a motor 43 to drive the free end of the cartridge roll through a delivery slot 44. Drive to the wheel is halted when a sensor including an LED source 46 and a detector 48 show that the container immediately behind the ejected container has reached a predetermined position at which the separation zone 20, weakened by the perforation line 22, is under a grip bar. The grip bar is moved down onto the separation at a trailing part of the separation zone to grip the container material just behind the perforation line 22 to grip the roll against the ramp 36. This enables the patient or care giver to grip the ejected container which is suspended outside the delivery slot 44 and to tear the container away from the next adjacent container without further pulling the free end 26 through the slot.
An alternative form of exit slot 44 is shown in
In separating the leading container from the rest of the cartridge roll, it is necessary first to clamp the free end of the roll at a position just behind the container to be separated, to effect separation, and then to remove the separated container from the patient unit. The separation and pulling can be separate movements or can be a common movement. Referring, to
With the guillotine arrangement, if the patient is not present to effect separation of a scheduled container from the rest of the cartridge, the container may be ejected from the exit slot. For accommodating more than one container being ejected where a patient must consume medication elements from a series of containers at a single session, the ejected containers are collected in a collection unit such as a bucket or tray (not shown). The collection unit can be shaped and oriented to received, multiple containers 12 as a stack ready for the series of medication elements to be taken at some later time.
In an alternative embodiment of drive mechanism (not shown), one or both of the drive wheel and the idler wheel are configured as rollers to span the full width of the container material. If both rollers are long, the containers are gripped across their whole width although the gripping pressure must be limited to avoid damage to the contained medication elements. In an alternative, one roller is of full width so as to frictionally encourage the free end of the roll forward without however gripping it.
In the normal operation of the patient unit, when the leading container of the roll is to be delivered to the patient, the drive wheel 38 is actuated to drive the free end 26 forwardly to eject the foremost container through the exit or delivery slot 44. The engagement pressure between the rollers is set low enough not to damage the gripped container or its contents but high enough, firstly, that the engagement drives the cartridge roll forwardly and, secondly, to enable the foremost container to be torn away from the rest of the roll without further unwinding the roll. By appropriate control mechanisms, the pressure between the drive and driven rollers can be varied during the medication delivery procedure so as to optimize the pressure to the particular phase of the procedure.
Mounted in the upper wall of the housing 33 is a light source 55 to illuminate a barcode or other indicia 16 on the container 12 next in line to be delivered through the delivery slot 44. Also mounted in the housing is a reader or camera 54 to detect the bar code 16 or to scan an image of it and to feed corresponding bar code data or image data to an interpretation unit for deciphering the barcode or other indicia. The information decoded from the barcode or derived from the image is used to determine characterizing data such as the nature of the medication element contained in the container and its scheduled time for consumption. The housing 33 has a lid 56 which is hinged relative to a base 57 to enable opening of the patient unit to reveal the interior of the housing 33 into which a cartridge 10 is to be loaded or from which such a cartridge is to be unloaded and replaced. The camera/barcode reader 54 and the associated light source 55 are mounted in the hinged lid 56.
In a medication delivery operation, the drive wheel 38 grips one of the seamed edge zones 18 of the free end 26 of the cartridge roll against the idler wheel 42. The idler wheel is mounted at the end of the spring lever 40 which can be moved to an unengaged position to allow manual threading of the free end of the roll cartridge into a delivery bay immediately behind the exit slot 44. Once the roll free end is threaded, the lever arm 40 is moved to a bias position at which the wheels 38, 42 grip the free end 26 of the roll with the spring maintaining the idler wheel against the drive wheel pending manual release of the spring lever for subsequent cartridge replacement.
In use, if the roll cartridge 10 has not yet been opened and installed in the patient unit, it is opened and a free end 26 of the cartridge roll empty of medication is pulled off the roll. The housing 33 is opened by lifting the lid 56 and the cartridge 10 is dropped into the storage bay. The lid 56 is then lowered to close the unit.
A container containing a medication element may advanced to a staging position for inspection by the camera/barcode reader as part of a two movement process to deliver the container to the exit slot. Alternatively, the lead container may be advanced to the exit slot in the same movement that brings the next adjacent container to the inspection zone. The indicia on the staged container is inspected and characterizing data, such as the nature and scheduled time for consumption of the contained medication element, is determined. The determined characterizing data is validated against stored data corresponding to the patient's course of treatment and, in particular, against corresponding stored characterizing data for the next item scheduled to be consumed. If a match is found between the determined data and the stored data, the staged container is viewed as valid and, at the scheduled time for the patient to consume that medication element, he or she is alerted that his or her medication element is ready to be consumed. The match can be a combination of any of several elements of characterizing data viewed as suitable for establishing that an inspected container is valid and that the patient should be alerted that he or she should consume the presented medication element. Such characterizing data may include, for example, (a) data characterizing the nature of the medication element, (b) data characterizing a time of consumption, or period for consumption, of the medication element, (c) a confirmation that the current time of day is before an expiry data recorded in stored data for the medication element next scheduled to be consumed, (d) confirmation that the medication element is not the subject of any recall recorded in the stored data, etc.
If a valid output results from comparing the data determined by the inspection and the stored data, an alert is issued informing the patient that it is time to consume an available medication element. If no valid output is results, an appropriate warning alert is issued to the patient as a sound and/or light alarm and a corresponding signal is sent onto the communication network to inform a compliance agent at a remote node.
In one embodiment of the invention, the alert is advisory only: that is, the patient (or user, if the patient is being assisted at the patient unit) is informed of a valid or invalid output but notwithstanding the meaning of the alert message, the patient is free to consume the validated medication or not as he or she wishes. In another embodiment of the invention, if there is no match between the characterizing data on the medication container and the stored data for the medication next scheduled to be delivered, the patient unit delivers no further medication containers until the reason for the lack of validation has been investigated. As will be evident, the validation of product and the execution of a compliance function can be orientated very much towards patient control (and/or control by other human agents on the network such as a remote compliance agent). Alternatively, control of the validation and compliance functions can be effected largely as automated process steps with the patient having little control over each process step and little freedom in the process outcomes.
To illustrate operation of the patient unit,
In a normal sequence, where the patient has received the alert that the medication element has been validated and so should be consumed, and the patient wishes to take the scheduled medication, he or she presses a designated key 58 to initiate the scheduled delivery procedure. This causes the spring lever 40 to pivot to bring the idler wheel 42 hard against the drive wheel 38 to grip the roll edge between the two wheels. A gate 59 at the delivery slot 44 is opened, and the drive wheel 38 is actuated to drive the free end 26 of the roll forwards so as to direct the previously validated container through the delivery slot 44. The roll is advanced one container length so that the next adjacent container is illuminated by the light source in the housing 33. The barcode 16 on the next adjacent container 12 is read by the barcode reader. The information signified by the bar code is compared with the stored data corresponding to the prescribed courses of treatment to ensure that the medication which is next to be delivered is consistent with the pharmacy record of the prescribed medication treatment and any other central records as necessary and appropriate. Meanwhile, the patient pulls the leading container 12 away from the delivery slot 44 and in so doing, tears it away from the next adjacent container 12. To prevent the patient's action from pulling more than the presented container from the roll at the scheduled medication delivery time, the gate 59 is mounted so that in its closed position, its bottom edge is lodged against the floor of the housing near the top of the ramp 36. As the roll is pulled, the contact between the roll and the gate 59 tends to drive the gate edge hard against the floor of the housing 33 and to lock the roll against further movement past the drive and idler rollers. In normal circumstances, the patient consumes the prescribed medication within a period set for consuming it as recommended by the pharmacist. Once consumed, the patient or care giver again presses the key 58 (or another dedicated compliance key) to indicate that the presented medication element has been consumed.
Timing of the opening and closing of the gate 59 and of the other elements of the feed mechanism is controlled by control logic, inputs to which include an input from an optical sensor having an emitter/detector combination 46/48. As the leading edge 26 of the roll is advanced towards the delivery slot 44, the sensor light passes through two layers of the container material together with an intermediate air gap in which the medication element 14 is located as it passes through the contents area of a container. Subsequently, as the roll material is advanced, the sensor light passes solely through the separation zone 20 where two layers of polyethylene have been heat sealed together. At the heat seal, light transmission is considerably higher than at the air gap region of the container, and the transition between the adjacent low and high light transmission areas is detected and used to govern operation of the feed mechanism and to determine the final position of the leading end of the cartridge roll.
An alternative form of patient unit is shown in side sectional views in
The patient unit 29 incorporates an audio or audiovideo conferencing means including a microphone 65 and a camera 66 respectively for receiving the patient's or a care giver's speech and image and conveying them to a remote node on the communication network. The audiovideo conferencing means also includes a speaker 67 and screen 68 to enable a patient or care giver at the site of the patient unit to listen and watch a person at the remote node who may be a relative, a pharmacist, a doctor, a technician or other user. The particular expertise may be connect directly to the patient unit or initial communication may be between the patient unit and a call centre with call centre operators deciding on the particular expertise to assist the patient, The patient unit 29 includes other system elements as required for implementing the videoconference call. The patient unit screen 68 alternatively incorporates programmable touch keys and can be mounted either with a fixed orientation or so as to enable tilting to provide comfort to a patient or care giver who may be sitting or standing at the patent unit. The patient unit includes adjustment capability for enabling the patient to adjust the volume of speaker 67 and to alter the brightness/contrast of the screen 68.
When the patient is scheduled to take a dose of medicine, an audible and visible indicator at the patient unit 29 is triggered to apprise the patient. There may also be a text message displayed at the screen 68 or an audio message projected from the speaker 67, which message may be personalized to the patient to apprise him or her of the medication delivery event. In normal operation, the patient acknowledges that he or she wishes to proceed with the scheduled procedure, such as by pressing one of a number of keys whereupon the leading container, if previously validated, is separated from the remaining cartridge roll and exits the patient unit 29 at the delivery slot 44. The patient then removes and consumes the prescribed medication and acknowledges doing so by pressing a further one of keys 69. If no acknowledgement is provided by the patient within a certain period from the scheduled time scheduled time of consumption of the associated medication element, an alert is automatically sent from the patient site to family members, care providers, or anyone so designated to receive these alerts, and a further reminder as text or audio is presented at the patient unit 29 for the benefit of the patient, to be repeated periodically until the patient gives a required acknowledgement. The nature of the alert, its timing, the recipient of the alert signal on the communication network, and the response can all vary depending on the situation. The patient unit includes a capability for the patient or care giver to update any of the contact settings for any alert generated that is to be issued from the patient unit or to be transmitted from the network to the patient unit. A record of the settings may be stored locally at the patient unit or at any other node on the network accessible to the patient unit.
To minimize the chance of proper medication element verification and compliance being interrupted by loss of mains power, a backup battery is used to power light/sound indication alert apprise the patient that the patient unit may not be functioning sufficiently to give future reminders or present medication pouches to the patient.
The patient unit also offers a comfort link through the video link capability. For example, if the patient believes he or she is having a reaction from the medication, he or she can contact the call centre where an operator establishes dialog with the patient or care giver, makes a preliminary assessment of the patient's concern and may forward the call from the patient to an appropriate medical professional; for example, a pharmacist or doctor who may be the patient's regular professional if available or an alternative on-call professional if the patient's regular pharmacist or doctor is not available. In recognition of the cost, there may be an escalation of professionals depending on the emerging seriousness of the patient's situation. In addition, the expertise offered in the interface can be free or can be associated with a pay service, the network including a pay provision whereby the patient or care giver is informed of the cost of obtaining a desired consultation and expertise in order for the patient to decide whether he or she wants to accept the charge and proceed with the remote consultation.
The patient units can be built in various sizes depending on their required functionality. For example, the cartridges 10 can be relatively small to provide medication delivery for a short period of time of the order of a week, or can be larger to provide medication delivery of a complex mix of drugs requiring a larger number of containers per day or to provide medication delivery of a regular course of drugs for a longer period, of the order of a month. The housing can be any of a range of sizes to accommodate the different sizes of cartridge. In addition, a wider housing is used to mount two or more cartridges if medication delivery is to take place to more than one patient. In a further alternative embodiment, the patient unit is adapted to accommodate cartridges having differently sized containers that may originate, for example, from different manufacturers or from pharmacies with different standards. Such variably sized containers can be accommodated at a single patient unit by having bias means to operate on one or both of the cartridge, when loading, and on leading ones of the containers in the free end 26 when delivering containers to the delivery slot. The bias means can, for example, drive the cartridge to a register position at which the edge of the containers will be gripped when the drive and idler wheels are driven together. A further bias means such as one or more motor-driven or spring biased drive plates (not shown) may be used to drive individual containers 12 so as to supplement the cartridge registration.
Patient units of the type described above are located on a communication network together with other patient units and other nodes. At the other nodes are sited any or all of the functionalities illustrated in
In a further embodiment of the invention, the patient unit 29 has a network connection to an automated dispensing apparatus 78 of the sort described in copending U.S. Published Patent Application 20100198401 and U.S. Published Patent Application 20100268380. The automated dispensing apparatus 78 is itself connected on the network to a pharmacy 79 where a pharmacist has full purview and control of operations at the automated dispensing apparatus 78 and can authorize and enable dispensing of medication to a patient presenting a prescription at the dispensing apparatus. In a further embodiment of the invention, an automated dispensing apparatus of this type configured to dispense and package medication elements as a cartridge suitable for use in a patient unit. The cartridge corresponds to an ordered course of treatment. The patient's scheduled course of treatment is recorded on the network and/or can be recorded on the cartridge 10 at the time that the medication is being packaged. Subsequently, the cartridge is taken to the patient unit 29 and inserted into a storage bay serviced by a delivery unit to enable scheduled delivery of medication elements to a patient. The bay may be of any of the types described previously to accommodate a corresponding form of cartridge prepared at the automated dispensing apparatus 78 or the arrangement may use a design of cartridge which better lends to being prepared in an automated dispensing apparatus where space not given over to medication storage is limited and must be efficiently used.
An advantage of the patient unit 29 is that it is relatively portable and can be taken with the patient if the patient is to be away from his or her residence for an extended period. Set up at a new site is relatively easy requiring merely an Ethernet, USB, land line, cellular or wireless connection at the new site for establishing Internet connection to provide access to the compliance monitoring function and to enable access to records which may be stored at any of a number of nodes on the network.
The alternative cartridge designs have corresponding patient units configured for the particular form of cartridge. For the zigzag concertina style cartridge of
For each of the different patient unit designs, the patient is required to press an indicator button or key 58 to report that medicine has been delivered and that he or she has consumed it. As an alternative to push button/keys, the patient unit screen 66 can have touch sensitive, programmable keys.
If no acknowledgement has been given by the patient or care giver within a certain period from the scheduled time for the medication to be taken, an alert is sent from the patient site and a further reminder as text or audio is presented to the patient at the patient unit, this being repeated periodically until the patient gives the required acknowledgement or until the situation must be escalated based on a preset assessment of risk. The nature of the alert, its timing, the recipient(s) of the alert signal on the network and the response can all vary depending on the situation. One important distinction in handling an alert is patient risk classification which depends, for example, on the seriousness of the patient missing a scheduled medication or the expected rate of deterioration of the patient's condition resulting from a failure to take the prescribed medication. In the case of a low risk patient, a failure to take scheduled medication may not be a serious matter and so apart from periodic reminders to the patient and a cautionary email automatically generated to a care giver nothing more is done until perhaps the third scheduled medication event in a row has been missed. At this point, an escalation takes place and the doctor is informed of the situation. This can prompt the doctor to initiate an audio or video link to the patient unit or between the doctor and care giver to identify why there have been several misses. If establishing a video link is not possible or the outcome is unsatisfactory, then a further escalation takes place with care giver or paramedic going to the patient site to ascertain the problem. In the case of a high risk patient, an alert may be sent within a short period of time of the omission to the care giver and the patient's doctor. At the same time, a call centre may seek to make contact regularly over a period of time after which paramedics are dispatched to the patient site.
Fundamental to the use of the patient unit as a network node is the idea of individuals, local or remote, who can act as compliance agents to monitor a patient's compliance with a prescribed course of treatment. Compliance information is accumulated and stored so as to be accessible by any of a number of authorized individuals in their capacity as compliance agent or in following up a situation identified by a compliance agent as problematic. At the first level is a care giver who may not be resident with the patient but who has responsibility for the patient. The care giver periodically accesses the website to get information about the compliance failure. The care giver's review of the situation may be triggered by a real time alert that there is a failure or the alert may be logged within the system ready for the next time the caretaker signs. The communication network includes the capability for the care giver to place an audiovideo call to the patient unit to follow up a compliance failure. Other levels of access can be provided to the patient's physician and pharmacist. Alerts signaling a patient's non-compliance are sent on a hierarchical basis, for example, if both the patient and primary care giver appear to have allowed a scheduled medication to pass without corrective action being taken within a prescribed time interval. Alerts signaling a patient's compliance may also be sent to authorized individuals as specified by the patient.
As shown in
By means of the camera 66 at the patient unit 29, the server can provide remote monitoring of the patient in the manner of closed circuit TV to assess the patient's condition if something in the patient's handling of medications suggests that monitoring the patient's appearance or behaviour is warranted. The patient can, for example, be monitored by a nurse who periodically assesses the patient situation or assesses the patient situation in an event driven way such as when a medication is to be taken or when the patient acknowledges that he or she has taken medication.
The audio video link can also be used to download data and video related to the patient's activity. For example, if the prescribed course of treatment includes the patient starting to take an asthma medicine to be administered by an inhaler, the video link can be activated to apprise the patient by text, audio or video that it is known that the patient is to begin using an inhaler, and to enquire of the patient or care giver whether the patient would like to receive information and instruction related to the nature and operation of the inhaler. If the patient responds with an expression of interest, the information and instruction is made available, for example, as a text message or audio or video download.
In one embodiment of the invention, connection to the network is provided through the patient's or care giver's residential Internet connection. Control to the patient unit is provided with a system on a chip device such as a RM7, RM9, Freescale IMX 2, these devices having communications means to access wireless and wired Internet, control USB traffic, etc, and means to control serial devices such as cameras and displays.
The patient unit is managed from a remote monitoring call centre, the elements of the control including any or all of:
The system response to a particular situation can have automatic elements to avoid demands on professional time that may not be needed in the circumstances but to involve the active participation of professionals when required. To minimize costs, there can also be an escalation of professional involvement at appropriate occurrences, the escalation typically moving through care giver, pharmacy technician, pharmacist and physician. Profiles are stored on the network for each patient to connect situations and corresponding responses for the patient. The profiles may include appropriate escalation and may govern what is done automatically, when someone is to become directly involved in the situation, and who that person or persons should be. Clearly the time frame both for response and escalation is made much shorter for a high risk classified patient than a low risk classified patient.
A primary source of value of the medication delivery apparatus described arises from its presence as a node on a communication network. As previously described, connection from the medication delivery apparatus to another node or nodes on the network may be used in the course of verifying that medication about to be delivered to a patient or care giver at the delivery apparatus is the right medication in terms of implementing a prescribed course of treatment. In addition, connection to another node or nodes may be used in the course of the notification being issued that a medication scheduled as part of a course of treatment has in fact been consumed by the patient for which it is prescribed.
As previously described the medication delivery apparatus has video conferencing functionality and this may be used to allow a patient interaction to be extended beyond the verification and notification functions described. For example, the video conferencing facility can be used to establish calls with pharmacists, doctors, nurses and care-givers. Some of this may involve charge billing activity.
The access to the network means also that records associated with the verification and compliance methods described can be posted to the network and stored at another node. This might for example be part of a store of the patient's medication and health record or can be part of statistical records. Similarly, the patient is able to access data from remote nodes that may be germane to verification and compliance in the course of a patient following a course of medication, or may be for a different purpose entirely. While access to the network in the course of the verification and compliance methods described will normally be at specific times related to a patient's scheduled and actual consumption of medication, functionalities and expertise on the network can be made available to the medication delivery apparatus at any time.
It will be appreciated that the verification and compliance method and apparatus of the invention is of particular value for patients who may have poor memory and/or who may have attention difficulties in terms of following a complicated pill consumption that may be relatively complex in terms of both the nature of medication elements to be taken in compliance with a course of treatment and the scheduled times for such consumption. As previously indicated, the schedule for a prescribed course is stored either locally or at a remote location on the network and is used in the course of establishing verification and compliance. If the schedule data is stored locally, it can, for example, be applied to the cartridge at the time the cartridge is prepared. The schedule can be made available at any time on the patient unit screen at the request of the patient or in the context of the patient communication with other on the network so that the patient can check scheduled consumption times and the medication to be consumed at such times.
The network access capability of the patient unit can also be used to browse through a directory of care providers and health professionals as a prelude to initiating audio-video communications with them with a view to setting up a service relationship.
In addition to the patient unit being a network node for data, alert and video access to and from patient, pharmacist, care giver, doctor, etc., the patient unit in a further embodiment, as illustrated in
Wide distribution of the patient unit of the invention to large groups of patients presents significant added value in terms of gathering and integrating medication and health records. Hospital records are generally focused on relatively severe, short term situations. The records that can be gathered and mined using networked patient units 29 of the type described, once a high level of market penetration has been reached, are somewhat different. Thus, they can present over the long term statistical data gathered from a large community and related to such issues as compliance, condition deterioration and improvement dynamics, responsiveness to specific drugs, etc. As shown in
A central container packing and distribution facility such as a pharmacy 79 has access to the prescribed course of drugs being taken by a patient and an alert is sent over the network to the pharmacy when the cartridge is nearing exhaustion. At this point a replacement cartridge is packed at the pharmacy and, at the time that the replacement cartridge is sent out to the patient, a signal is sent to the patient or the patient's care giver informing them that a replacement cartridge is in transit to them. Re-fill of medication is relatively straightforward. The replacement cartridge is prepacked at the pharmacy or at another site according to the required prescription and schedule and is then sealed for transport to the patient unit site. Upon receipt, the patient or local care giver opens the patient unit housing, extracts the spent cartridge, unseals the new cartridge, mounts the new cartridge in the housing with any required engagement with the feed mechanism, and returns the spent cartridge to the pharmacy for restocking.
For the packing of a cartridge of the sort illustrated in
The stored data related to the prescribed course of treatment to be delivered together with the record of drugs that have been successfully administered is maintained at the pharmacy centre and, as well as being used for medication verification, may be made available to other nodes on the network such as to a doctor or hospital site so as to present, over time, a complete patient medication history. The stored data may also be applied to the cartridge itself to enable inspection of the scheduled course of treatment locally at the patient unit 29.
As shown in
It is recognized, for example, that the incidence of medication treatment non-compliance for type 2 diabetes is relatively high. For assessing compliance with a diabetes medication course of treatment, a blood glucose meter is connected to the medication delivery storage and delivery unit. At each alert informing the patient that it is time to take the scheduled medication element, and immediately before the medication element is taken, the patient is requested to undergo a test to measure blood sugar level. In one example, a diabetes sufferer should, pursuant to a prescribed course of treatment, take a diabetes medication such as metformin a half hour before each meal to control blood sugar level after eating. With regard to the patient's mid-day meal, the patient may be required by the schedule to take the metformin medication at 11:30 a.m. The patient as part of the 11:30 a.m. process has blood glucose level measured at a measurement unit coupled to the medication delivery apparatus with a result, for example, that the blood glucose level is found to be in a normal range. The patient consumes the scheduled dosage of metformin and consumes his or her midday meal. Some time after the meal, between 2 to 2:30 pm, the patient's blood glucose is again measured at the measurement unit, with a measurement of 9 mmol being detected. This elevated blood glucose level is normal after a meal. However, had the patient missed the 11:30 a.m. dosage of metformin, s/he may have a measured blood glucose level of 14 mmol, for example, which would strongly suggest that the 11:30 am metformin consumption was missed.
In another example, over several days, a patient's blood glucose measured trend may indicate a blood sugar level that decreases to a normal range indicating that the patient's diabetes medication regimen is working. Data related both to medication compliance and the patient's blood glucose is transmitted onto the network and considered by a medical professional for the latter's evaluation as to whether taking a course the medication is proving to be effective for the patient, and, if not, whether the nature or strength of the prescribed medication needs to be changed.
A further example relates to a patient suffering from high blood pressure who is required periodically to take a vasodilator such as amlodipine besylate, The patient takes the amlodipine besylate at noon every day after measures his/her blood pressure reading at a blood pressure measuring unit coupled to the medication delivery apparatus. The patient's goal may be to manage systolic over diastolic readings to be below 130 over 80, so that 140 over 100 would be indicative of hypertension. If the patient misses consumption on day 1, the patient's day 2 reading might typically show slight elevation (125 over 85). If the patient also misses consumption on day 2, the elevation can be expected to be more pronounced on day 3; for example, 128 over 90. This will suggest to the person on the network responsible for monitoring the patient's compliance that the patient is not taking the anti-hypertensive medication.
A final example relates to alleviating chronic pain. At the time of an alert indicating to the patient that medication should be taken, the patient is requested to complete a pain score survey on a device having an interface to the patient unit. For example, the patient may report a “7” (where 0 is no pain and 10 is a highest level of pain) and then consumes the presented medication element and confirms consumption at the compliance unit. Some period of time later, either prior to or at next consumption reminder, the patient again completes the survey and, at this time, may report, for example, a pain level of “5”. A medically trained professional considers the patient's pain sensation data in conjunction with the compliance report to evaluate whether the medication is proving to be effective and whether the prescribed strength requires adjustment. It will be appreciated that this test is a subjective test as opposed to the objective tests of the prior examples.
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These preferably include non-invasive diagnostic elements. For measuring blood pressure, such apparatus can include, for example, Doppler blood-pressure monitoring devices or automated oscillometric monitoring devices. For measuring temperature, such apparatus can include, for example, non-contact, infra red reading thermometers. For measuring weight, such apparatus can include a load-cell scale incorporated in a mat on which the patient will stand. Such apparatus can further include finger pulse oximeters for measuring blood oxygen levels and electronic stethoscopes for monitoring respiratory condition. Such apparatus can include breath sampling and breath analyzer units particularly for evaluating outgas products such as alcohols or ketones. Such apparatus can further include pupil retina scanning devices for generating basic information related to possible stress, fatigue and brain functions. In each case, the monitoring or measuring units generate electrical outputs which are input to the patient unit and converted to signals indicative of patient condition. The patient vital statistics data is then transmitted onto the network for access by a service centre, the patient's doctor or nurse, or by his or her care giver. It will be understood that in addition to generally commercially available diagnostic elements, the particular devices, or a combination of them, can be tailored to the particular health concerns of a patient. It will be understood too that part at least of the monitoring and measuring apparatus, such as transducers and electronic processing hardware may be housed in the patient unit.
An alternative embodiment of the primary care test unit is used where a patient has a condition which varies in severity over time and where, in response, more or less of maintenance medication should be taken. A special cartridge is used for this condition, the cartridge having sub-elements of a required drug in adjacent containers. If the patient's condition improves such that a lower amount of the prescribed drug is needed, some of the sub-elements are sent to a discard station instead of being delivered, or the patient is signaled that he or she should not consume the medication in the next container to be dispensed. If, on the other hand, the patient's condition worsens and a higher amount of the medication is once again required, the patient is informed that medication contained in all of the delivered containers should be consumed.
The patient unit may also have an associated set of diagnostic functionalities with the communications link being used to effect either or both of prompting the patient to undergo a test such as for example, measurement of blood pressure or sugar level, and providing the results of the diagnostic procedure to a doctor or other medical expert or resource on the network. The diagnostic functionalities are either mounted within the patent unit or are mounted in a standalone unit which is networked with the patient unit to permit data to be made available to other nodes on the network.
It will be seen that the use of the cartridge and the patient unit provide patient safety in two respects. Firstly, if the medication delivery procedure is not followed within a required period of time, an alert is triggered and corrective action is initiated. Secondly, access to stored medication other than a dose scheduled for use is discouraged. In this respect, the cartridge does not lend itself to wrongful dose consumption since only the scheduled dose is presented at the exit slot and the cartridge itself is rolled up and mounted in the housing with later doses confined within the cartridge roll. This latter safety aspect can be supplemented by having the housing locked once the cartridge is loaded. Ideally, the consumption of the drug is made as simple as possible with the minimum amount of involvement of the patient in the selection of the drug to be taken.
It will be appreciated that while a cartridge of physically linked medication containers is a particularly convenient way of ordering medication elements for subsequent delivery to the patient, neither the cartridge form nor the physical linking of the medication containers is essential. Thus, for example, the individual containers are stored in a random way within a storage bay of the patient unit, with each container marked with a barcode signifying at least the scheduled time of consumption of the medication element contained in the respective container. At a treatment session, a corresponding delivery mechanism reads the codes on the containers to find the container next scheduled for delivery and brings that container to the inspection station. As in the previously described embodiment, information derived from the code on that next scheduled container is compared to the stored data to verify that the container contains the right medication element, that there has been no recall, that the medication element expiry date has not passed, etc.
Other variations and modifications will be apparent to those skilled in the art. The embodiments of the invention described and illustrated are not intended to be limiting. The principles of the invention contemplate many alternatives having advantages and properties evident in the exemplary embodiments.
This patent application is claiming priority under 35 USC §119 to a provisionally filed patent application entitled “Method and Apparatus for Monitoring Medication Dispensing and Compliance”, having a provisional filing date of Apr. 5, 2010, and a provisional Ser. No. 61/320,772.
| Number | Date | Country | |
|---|---|---|---|
| 61320772 | Apr 2010 | US |
