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

英国（和全球）药物不依从性问题-人们不服用处方药-对卫生和社会保健构成了重大挑战，导致健康状况不佳，药物浪费，并对已经负担沉重的卫生和社会保健系统造成压力。50%的长期健康状况处方药未按预期服用（NHS，2018）。一种公认的打击不依从性的方法是药物优化（MO）-了解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。这包括赋予人们自我保健的能力，使他们能够更容易地报告副作用，并转向对他们有效的药物。目前，在社会护理方面还没有可行的以MO为中心的服务模式。这个项目旨在解决这个问题。我们的16个月项目是由技术专家连接健康系统有限公司（CHS）和牛津郡理事会（OCC）的需求为主导的业务，以满足医疗和社会护理中MO服务的不足。CHS将使用他们成熟的技术-一种在家里使用的辅助技术，可以识别是否，何时和服用了多少药物。这些信息进入一个智能平台LOOP，该平台提供有关服务用户护理人员依从性的数据。该系统旨在为城市和农村地区的弱势群体提供服务，该项目将该技术与OCC的重新安置服务相结合，创造了一种新的自我护理模式。Reablement支持服务用户独立生活。然而，为了确保坚持，他们目前每天都要到老年人的家中进行面对面的药物访问，限制了服务用户自我护理的能力。拟议的项目将通过远程监测药物依从性来减少这些问题，从而实现Reablement有针对性的面对面访问，而不是常规访问。要做到这一点，以人为本的设计是关键。40 - 50名服务用户将通过使用服务版本积极参与迭代（适应）这一新模式的设计，并向我们的Oxford AHSN评估合作伙伴反馈其如何有效地使他们能够自我管理其药物并与Reablement沟通，例如，所有这些新知识将被纳入新的服务模式设计中，从而开发出一种新的护理服务模式，在牛津郡共同设计和提供，旨在扩大规模并在英国推广。

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.