Sure - Increasing safety in medication care through patient empowerment

Abstract

The design process of the Zeker app is a graduation project of the TU Delft faculty of Industrial Design Engineering in collaboration with Capgemini Invent. Capgemini Invent is evoked by the increased safety measure in the pharmaceutical supply chain. The European legislation: The Falsified Medicine Directive, ensures additional serialisation of medication packaging with QR-codes. This raised the question which stakeholders can be involved in user-centred opportunities these QR-codes have when brought in to the home of patients. With this project, these user-centred opportunities and who and how current and future stakeholders are involved in medication safety and e-Health interventions are explored.

This report describes the user-centred design process that explores opportunities on how patients, taking medication, can be helped in their day to day lives. The research revealed bottlenecks in the medication care process that cause unsafe medication care. Unsafe medication care can cause (preventable) hospitalisation. Research focuses on patients that are most likely to encounter problems due to medication. These are patients with polypharmacy and multi-morbidity, taking medication that influences the cardiovascular system.

Patient group
Five in-depth, semi-structured interviews are done with patients to set up a Patient Journey. This journey illustrated pain points in the patient’s live to do with their medication and care. These were taken on as a design challenge to resolve, namely:
To empower patients in searching for a regimen in which living with medication is not restrictive and to take away strong negative emotion around adjustments to the medication regimen.

The interviews also showed a gap between norms for safe pharmaceutical care, to relieve bottlenecks, and patient’s experience. This project aims to resolve these problems areas from the patient side through patient empowerment. With the four aspects of patient empowerment the following design vision was made: 1) Patients will better understand their responsibilities in keeping and transferring their medication overview. 2) Patients will gain knowledge to engage in a consult conversation about their medication treatment. 3)Patients experience that their home and the consult environment is facilitated for safer medication treatment. 4)Patient experience their healthcare skills regarding their medication treatment are anticipated.

The Zeker App
Trends in the pharmaceutical and healthcare market shows opportunities in using e-Health as a significant part of the solution. The Zeker app embodies e-Health for improved accessibility, effectiveness, efficiency, safety and quality, of medication care for patients. The Zeker app is designed using brainstorming, wireframing and digital user interface mock-ups. For patients with polypharmacy, the Zeker app gives reliable personalised answers in finding a medication regimen. When medication is restrictive it will reduce negative emotion by taking patients seriously and helping in the search as to why and what are alternatives for patients. Knowledge and giving overview empowers patients in increasing medication safety together with their caregivers:

“Together Sure about your medication.”

Stakeholders
The Zeker app operates in the complex pharmaceutical health care network. For concept validation and further research into the future stakeholders in medication safety and e-Health interventions stakeholder interviews are conducted. Representatives of KNMP, NVZ, VIG, BOGIN and the Patient Federation with expertise in this field, were questioned about their opinion of the mock-ups. As well as their organisation’s and other stakeholder’s roles in these kinds of developments.

It was made clear collaboration with many different stakeholders required to get this concept of the ground. Both on an organisational level, like involving branch organisations. As well for utilising existing databases and content as building blocks for the app. This project distinguishes three types of data to consider for collaborative development: static data, resilient data and timely data.

The research puts forth the need for nationally arranged (big) data analysis of medication side-effects. This can be used in pharmaceutical development as well as in improvement and personalisation of medication treatment. It is believed the existing side-effect registration centre Lareb can fulfil this role. By digitising Lareb can expand its data collection and increasingly offer analytics as a service.

The government should increase its efforts towards e-Health acceptance and adoption for both patients and caregivers. Current numbers on use of e-Health show patients are still slow to adopt. Besides, patients are unwilling to pay for e-Health. Therefore, it is expected e-Health will increasingly be reimbursed by health insurance companies.

Viabilty
For the Zeker app, this implies that it should be developed with or by a GP information system provider. Initial data exchange can be set up swiftly. The GP has an overview of all medication which the specialist has not. The GP has the ability to change the prescription, which the pharmacist has not. Reimbursement for e-Health by the GP is already arranged under patient self-monitoring.

With the collaborative development of PGOs and the changes in the financial model towards Value-Based Healthcare it is likely e-Health will soon be reimbursed as a separate type of care transcending individual caregivers.

The last iteration of the Zeker design is based on user-research. Thirteen in scope participants indicated that they understood the app and its four main functions. If it would help or whether they would use it frequently depended on whether they experienced problems with their medication before and if they had not already fixed the problems in another way. These patients also, indicated that they would not pay for such an application unless it needs little effort. When they are clearly shown the benefit as opposed to their current ways of working. The iteration improved the clarity of- and simplified the Zeker app design. Besides this, it was decided to make a clearer distinction between self-measurement and side-effects by adding a menu function.