Designed for Independence – a new model of (self)-care in medicines management among older people

英国(和全球)不坚持用药的问题--人们没有服用处方药物--对卫生和社会保健构成了重大挑战，导致健康状况不佳、药品浪费，并给本已不堪重负的卫生和社会保健系统带来压力。50%的长期健康状况处方药没有按预期服用(NHS，2018)。打击不遵守行为的一个公认的方法是药品优化(MO)--即了解有关药物影响的个性化数据，以便人们在正确的时间获得正确的药物。这包括增强和使人们能够自我护理--更容易报告副作用并转向对他们有效的药物。目前，在社会护理领域还没有一种可行的以MO为中心的服务模式。这个项目旨在解决这个问题。我们为期16个月的项目是由技术专家互联健康系统有限公司(CHS)和牛津郡议会(OCC)领导的商业项目，以满足医疗和社会护理中MO服务的提供不足。CHS将使用他们成熟的技术--一种在家里使用的辅助技术，它可以识别是否服用了药物，何时服用，以及服用了多少数量的药物。这些信息进入一个智能平台Loop，该平台提供关于服务用户照顾者遵守情况的数据。该系统旨在为城市和农村地区的弱势人群提供服务。该项目将这项技术与OCC的修复服务相结合，创建了一种新的自我护理模式。Reablement支持服务用户独立生活。然而，为了确保遵守，他们目前每天对老年人之家进行面对面的药物访问，限制了服务用户的自我护理能力。拟议的项目将通过远程监测药物依从性来减少这种情况，使Reablement能够进行有针对性的面对面而不是常规的访问。40-50名服务用户将积极参与迭代(调整)这一新模式的设计，使用服务的版本，并反馈给我们的牛津AHSN评估合作伙伴，使他们能够有效地自我管理他们的药物，并就药物副作用或其他可能影响他们服药的原因进行沟通。所有这些新知识将被反馈到新的服务模式设计中，导致开发一种新的护理服务模式，该模式在牛津郡共同设计和提供，目的是在英国扩大规模和推广。

The UK (and global) issue of medication non-adherence -- people not taking their prescribed medicines -- poses a major challenge to health and social care, leading to poor health outcomes, medicines wastage, and a strain on already burdened health and social care systems. 50% of medicines prescribed for long-term health conditions are not taken as intended (NHS, 2018).An acknowledged approach to combatting non-adherence is Medicines Optimisation (MO) -- where individualised data on the impact of medication is known, so people receive the right medicines, at the right time. This includes empowering and enabling people to self-care -- more easily report side-effects and move to medicines that _work_ _for them_. Currently, there is no workable MO focused service model in social care. This project aims to address this.Our 16-month project is business-led by technology specialists Connected Health Systems Ltd (CHS) and demand-led by Oxfordshire County Council (OCC) to meet the under-provision of an MO service within health and social care.CHS will use their proven technology -- an assistive technology used at home which identifies _if, when and what_ quantity of medicines have been taken. This information goes into an intelligent platform, LOOP, which provides data on adherence to the service user's carer. This system has been designed to be accessible by vulnerable populations in urban and rural areas.This project combines this technology with OCC's Reablement Service to create a new model of self-care. Reablement supports service users to live independently. However, to ensure adherence they currently conduct daily face-to-face medication visits to older people's homes, limiting a service user's ability to self-care. The proposed project will reduce these through remote monitoring of medicines adherence, enabling targeted face-to-face, rather than routine, visits from Reablement.To get this right, person-centred design is key. 40-50 service users will be actively part of iterating (adapting) the design of this new model by using versions of the service and feeding back to our Oxford AHSN evaluation partners on how effectively it allows them to self-manage their medicines and communicate back to Reablement about e.g., medicine side effects or other reasons that might impact on taking their medicines.All this new knowledge will be fed into the new service model design, leading to the development of a new service model of care, co-designed and delivered in Oxfordshire with the aim of scaling-up and rolling out across the UK.