Can a “smart” pillbox and regular nursing visits help fragile older adults stay healthier and remain in their own homes longer?
UWM nurse-researcher Karen Marek will be studying that question during the next five years with the help of a just-announced $2.166 million grant from the National Institutes of Health.
The five-year study will involve a total of 500 people, all over age 65, on Medicare and taking multiple medications. Three groups will be compared: A control group will have no nursing services and no requirement to use a pillbox of any sort; a second group will use traditional plastic seven-day pillboxes and have a nurse assess them weekly; the final group will use a “smart,” or computerized, pillbox and will also have a nurse assess them weekly.
This study will build on Marek’s previous research and pilot studies which showed that the MD.2, or “smart” pillbox, helps memory-impaired patients take their medications on time. With many homebound patients on a dozen or more medications, medication management can be a major challenge, says Marek. Often, if the problems aren’t resolved, the elderly end up in nursing homes.
The MD.2 pillbox, which is about the size of a coffee-maker, not only dispenses medications, but also has an audio feature that reminds patients when it’s time to take their medication. If they don’t retrieve the medicine from the dispenser, the machine beeps for 45 minutes, then calls a service center.
The machine is connected to the service center by a phone line, which uploads medication information to a Web site that medical staff can review. The service center notifies the nurse or a neighbor if a medication is missed. For patients with hearing loss, there’s also a flashing light. A text message notes any special instructions.
In a previous pilot study involving 40 people, all but one person (with advanced Alzheimer’s) were able to remember to take their medications with the MD.2.
The machine, which announces the time as well as dispensing medications, also helps homebound elderly with memory problems stay oriented to their surroundings, Marek notes.
However, Marek adds, the study isn’t only about the “smart” pillbox. “This is not just providing technology. We are providing a nurse as well,” she says. “A frail elderly person on 10 medications needs monitoring.”
In fact, she adds, all participants will receive a pharmacy screen before starting in the study to make sure the multiple medications they are on are all appropriate, and not causing harmful interactions.
Marek notes that the pillbox plus nursing services would cost about $300 a month per patient, very inexpensive compared to the $7.2 billion Americans pay annually in avoidable nursing home care attributed to not taking medications properly.
Research shows that about 87,400 older adults a year move from homes to nursing facilities because they aren’t taking medications properly, a number that could skyrocket as baby boomers age.
Aurora Visiting Nurse Association of Wisconsin will recruit the participants, all of whom will have been discharged from home health care services. Marek’s previous research - while as director of the homecare agency at the University of Missouri-Columbia’s Sinclair School of Nursing - compared two groups of frail older adults with similar health problems. She found that those who remained home with a nurse care coordinator were less depressed, more mobile, and retained more memory function than those who were institutionalized.
The NIH grant will allow Marek to take her research to the next level and provide both clinical and cost outcomes.
“We want to be able to find out if we are using the money to get the best possible patient and medical outcomes,” she says. “We’ll be able to see if people are healthier at the end of the study. Did they avoid the ER? Did they avoid nursing home care? If so, it would be logical for Medicare to consider providing smart pillboxes and nursing services as a benefit.”
“Finding ways to help our elderly maintain their independence is critical,” says Wisconsin Sen. Herb Kohl. “This important study will examine new ways that regular nursing visits and technology may help improve their health.”
e-pill Medication Reminders is Boston based medical device company. Since 1999 e-pill timers, alarm watches, pill boxes with alarms and pill dispensers have helped patients around the world remember to take medications on time (improve medication adherence / patient compliance).