Case Studies

Case Studies

People on high medication who fail to take prescribed drugs at the right time and right dosage risk jeopardising their health and independence.  They can end up being re-admitted to hospital or placed in residential care for their own safety. This has huge cost implications for the NHS and social services.  Research shows 3-4 per cent of UK hospital admissions are a result of avoidable medicine-related illness, and between 11 and 30 per cent of these result from patients not using their medicines properly. The costs of admissions resulting from patients not taking prescribed medicines is estimated to be between £36m and £197m in 2006-07.  Home care visits and telecare services, such as telephone prompts are some of the ways used to ensure medication is taken. Devices such as dosset boxes, calendar clocks, blister packs and talking labels are also common. But the West Midlands Telehealthcare Network found the most successful solution cited by customers and carers was the PivoTell automated pill dispenser.*

The device is programmed to dispense pills up to 28 times a day. At the pre-programmed times, the internal pill cassette rotates, the alarm sounds and the correct dosage comes into view through the opening in the lid. Once the alarm has sounded the pills are released by tilting the dispenser allowing them to fall into the hand or a suitable container. It can be used as a stand alone device or linked to a control centre. The latest version of the device can also transmit text messages and e-mails to notify designated contacts (typically family members) if medication has not been dispensed from the device at the medication time. This enables appropriate action to be taken to check on the wellbeing of the individual before a potentially adverse event occurs which might otherwise require a paramedic or ambulance call–out.*

*Case Studies 1-10 from The Automated Pill Dispenser Project. The right pills at the right time delivering the right outcomes
End Project Evaluation Report, March 2012 





Case Study 1.

John, from Staffordshire, is 25 and recently left home to live independently. He struggled with managing his medication which helped control his epilepsy and reduce the risk of tonic clonic seizures. As a result he relied heavily on both Community Nursing support and Social Care staff. He was frequently visited by paramedics and hated the ambulance trips to hospital. He acknowledges that he didn’t like so much attention which, although necessary, impinged on his lifestyle. His lifestyle also suffered because he was experiencing absent periods following a seizure, mainly in the mornings. This, coupled with unsettled nights, affected his ability to function and manage everyday living. His home was in a poor state and his landlord was threatening to ask him to move. His family was worried for him and his friends were visiting less, worried by his seizures. He was reluctant to engage in voluntary work in case he had a seizure.

In June 2010 John started using the pill dispenser and within a week his medication compliance improved which meant his medication started to help manage his epilepsy and his seizures reduced significantly. His sleep improved and he had more energy to live his life. He started to tidy up his home and his friends started visiting again reassured by his improved health. He was able to rely less on his Community Nurse and after two months they now only visit on a planned basis to monitor. His care team visits have also reduced so John has regained control of his life to the delight of himself, his family and friends. His confidence has grown and now he has achieved his goal of working with a community agency greeting visitors to a local leisure centre. John has said using the pill dispenser was been the turning point for him in getting on with his life.

Case Study 2. 

Mrs J suffers from Asthma and Chronic Obstructive Pulmonary Disorder (COPD) and was struggling with her medication. She was also responsible for making sure that her husband was taking the correct amount of medication at the right time: he had lots of health problems and was constantly getting his medication mixed up. Due to health problems, Mrs J was not able to go out unaided and when she was taken out she got very anxious in case she could not get back to Mr J in time to give him his medication. To help him regulate his medication Mrs J bought a weekly pill box from the pharmacist that she filled but this caused problems as Mr J was still taking the doses at the wrong times. A case manager for health could see the distress it was causing Mrs J and the detriment it was having on her health so she referred Mr & Mrs J to the pill dispenser project.
The first week on the project Mrs J and the case manager were shown how to use the pill dispenser followed by a visit the next week to show Mrs J how to change the inserts in the dispenser. Mrs J was happy with changing the inserts herself and did not have to rely on the case manager to do it. Mr J was later introduced to the pill dispenser and was able to take the correct medication at the correct time and change the carousel over on a weekly basis.
Both Mr and Mrs J’s health improved and Mrs J is much more confident about medication. She is now able to go out without worrying about getting back.

Case Study 3.

Mrs R was assessed after a referral from her social worker. She had received a brain injury a few years earlier which had left her with memory loss and epilepsy. Her quality of life had declined because her husband had to work away, which meant she was forgetting to take doses of her medication and had to rely on her children to remind her to take her tablets. Because she was forgetting her medication she was suffering more epileptic seizures which made her feel very self-conscious and not wanting to go out  unaccompanied.
After using the pill dispenser for a couple of weeks later, she was very happy with it and she was taking her medication much more reliably. This meant her seizures were now improving, giving her much more self-confidence, improving her quality of life and giving her husband much more peace of mind whilst working away.

Case Study 4.

Mrs M was becoming forgetful and missing medication doses and even when the carers called to remind her to take her tablet, she wasn’t always taking it. She was referred to the project and the pharmacist felt that an automated pill dispenser would be suitable. Before being referred to the project, Mrs M was taking one tablet once a day. She now has a multiple dose regime and has not missed a single dose in over two years. She feels happier and more confident since she has had the dispenser.

Case Study 5.

Due to a visual impairment, Mrs W was unable to distinguish the sections on her dosette box, resulting in her taking tablets on the wrong day or at the wrong time. She has been using the pill dispenser for nearly two years and has not missed a single dose. She finds the dispenser a great help.

Case Study 6.

There is a supported living scheme that provides 24 hour support to the tenants with a learning disability. Staff within the scheme until recently would have administered the tenants’ medication. Mr C is aged 60 years and had been previously living in a residential care home since 1972. In February 2007 the care home closed and he was asked if he would like to live more independently. He was very reluctant to move into supported living. Professionals also expressed concerns regarding his capabilities to live independently. However since this time he has embraced the changes within his life and achieved many personal goals in all aspects of his life and continues to be a positive role model to others. 

In March 2011 he joined the pill dispenser project and embraced this change. He had never been able to administer his own medication as staff held the view that he was not capable of doing so. He was given a tipper along with the dispenser and now manages his own medication. This has made a dramatic change to Mr C’s life. It has increased his self-confidence and motivation in a positive way. Staff now only need to monitor and will ask him if he has taken his medication.
Family have also noticed what a positive impact the pill dispenser has had on him. Mr C’s is very proud of his achievement and has recently become an ambassador for
independent living and is looking to ‘champion’ the use of assisted technology to other people within Wolverhampton.

Case Study 7. 

Mr and Mrs K are an elderly married couple who live together in a privately owned house and prior to recent medical problems both were very independent and required no assistance from formal services.
In December 2010, Mr K had a stroke resulting in memory problems and was discharged home with the support of a re-ablement service who were visiting 4 times daily to assist with meals and prompt medication. He was keen to regain his independence and manage his medication independently. After a few weeks, visits were reduced to twice daily but Mr K was regularly forgetting to take his medication.

In April 2010, Mrs K was diagnosed with mild cognitive impairment and adjustment disorder with mixed anxiety and depression, and prescribed medication.
She admits she was double dosing at times as she could not remember if she had taken her medication.
Family was concerned and consequently arranged for private carers to visit and prompt them both with medication. Both were not keen having carers coming into the house and wanted to regain independence around medication compliance. Mr and Mrs K were referred by a social worker for a pill dispenser and were visited in April this year with their son present. Mr K was assessed first and deemed a suitable candidate for the pill dispenser trial. Mrs K was assessed a few weeks later, she was keen to try the pill dispenser as she was familiar with her husband’s and felt it would be beneficial for her.

Mrs K was also recommended for the trial; a tipper was required as Mrs K had difficulty handling the dispenser and containing the medication in her hand.
Both have now had the dispenser for several months and carers no longer visit to prompt with medication. The devices are clearly labelled, have different alarm alerts and are kept in separate places so they do not get mixed up.
The dispenser works very well for them and Mrs K advised it has stopped her making dangerous mistakes with her medication. Both are very happy with the dispenser and relieved that they no longer have to rely on others to prompt them with their medication.

Case Study 8.

Mrs C was admitted to hospital with breathing problems which appeared to be as a result of her forgetting to take her medication. She was provided with a PivoTell but declined any other support.
Mrs C’s daughter says the PivoTell is 'brilliant' and a 'life saver'. She said it has very much helped as her mother requires steroids to help her eczema. As she was taking these regularly the eczema has got much better and the dosage is being decreased slowly. She also said that she showed her mother’s GP who was impressed with the device.

Case Study 9.

Mr F was admitted to hospital with a general health problem, when he was discharged he had so much medication that he did not know what to take and was taken back into hospital a day later with an accidental overdose. He spent a long time in hospital and initially did not want to leave. He moved into sheltered accommodate and was provided with a PivoTell and orientation clock. Mr F states that the PivoTell is going well for him. He says he takes his medication when the box tells him to when it alarms. He has had no problems with it at all. Spoke to his advocate to see how he thinks things are going with the clock and PivoTell. He advised that it is all working very well. He said that Mr F 'looks ten years younger' as his medication is now being taken regularly and helping him health-wise. He said that Mr F is on minimum support from his supported housing accommodation as he has managed to become largely independent again due to his, now correct, medication management. Advocate said he 'could not speak any more highly of the service provided'.

Case Study 10.

Mr J suffered a brain haemorrhage last year which also caused a stroke. The stroke led to left sided weakness. He is an insulin dependent diabetic, has asthma and thyroid problems. Mrs J, wife, said that they both her and her husband think the PivoTell is 'brilliant, a godsend'.
There have been no problems. She thinks it is 'amazing and I don’t know how we managed without it before'. She said it has taken the pressure off her as she doesn’t need to prompt him with his tablets. She does however still need to prompt with insulin at times.

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