Mary Sorber, founder of NightingaleRx, will provide a caregiver’s view of methods and technologies currently employed for what doctors call the polypharmacy problem and non-professionals often experience as a “big bag of pills”. The presentation will review the scope of the polypharmacy problem specifically focusing on chronic conditions in the elderly. We’ll review 6 solution and their impact, differences in clinical and home settings, and user interface implication. Presented to IEEE Medical Device SIG on October 1st, 2013 in Santa Clara, CA NightingaleRx (www.nightingalerx.com) provides tools for patients and their caregivers to simplify management of multiple medications and offers User Experience (UX) design consulting on home health medical devices for medication management. Mary has a background in user experience and information architecture. She is now applying those skills in the area of health information and technology.

1. Matching Polypharmacy Solutions
to Personas
Presentation to IEEE-CNSV
Oct 1st, 2013

2. polypharmacy
• 5 or more medications taken
simultaneously
• more medications taken than are
clinically warranted
2

3. 3
Older adults receiving home healthcare
take an average of eight medications
daily and nearly 40% of them use nine or
more drugs.

4. 4
As the number of
prescription and non-
prescription medications
increases…
…so does the potential
for problems caused by
drug interactions or drug-
disease contraindications

5. Polypharmacy Challenge
Several broad problems lead to poor medical
outcomes (ER visits, hospital admits, etc):
① Underdose
② Overdose
③ Interaction (with other meds, with over-the-
counter, with food)
④ Specific impact of medications / side effects
(weight, dizzyness)
5

6. For every $1 Medicare
spends on nursing home
medications…
…it spends $1.33
addressing medication
induced problems
6

7. 7
Adverse drug reactions account for as
many as 12% of hospital admissions in
older patients.

8. 8
• Assessment in 2000 estimated cost of
medication related problems of $85
billion and 106,000 lives.
• A 2009 study estimated the cost of
drug-related morbidity (illness) to be as
much as $289 billion annually, about
13% of total health care expenditures.

9. Polypharmacy Challenge
Several broad problems lead to poor medical
outcomes (ER visits, hospital admits, etc):
① Underdose
② Overdose
③ Interaction (with other meds, with over-the-
counter, with food)
④ Specific impact of medications / side effects
(weight, dizzyness)
9

10. 10
Acute conditions are
well-managed.
Gap existing for chronic
conditions in the home.

11. • Professional Nurses
• Professionally
coordinated
• Structured
• Technology infrastructure
• Compliance
• Caregivers and individuals
with wide range of skills
and abilities
• Self managed
• Unstructured
• Potentially no technology
infrastructure
• Habit Formation
11

12. Medication Management Solutions for
under- and overdose
1. DIY Bag of
Pill Bottles
2. Blinking Caps
3. Pill Boxes &
Dispensers
4. Reminders 5. Personalized Packaging
6. Professional Nursing
12

13. 13
persona
• fictional characters created to
represent the different user
types within a targeted
demographic that might use a
product in a similar way.

14. 14
Josh
Relatively healthy man in his 40s
Medication regime is 2 drugs in
morning:
Low dose aspirin
Blood pressure
Not current in a polypharmacy
situation, but many solutions
available for him
Appropriateness
- +

15. 15
Mike
Adult Diabetic in his 50s
High blood pressure
Concerned about his eyesight
Tech-savvy guy
Medication Regime:
• Rx: blood
pressure, statin, diabetes
• OTC: ocular and multi vitamins
• Monitors blood sugar daily
Appropriateness
- +

16. 16
Adele
Elderly widow in her 80’s
Living alone at home
Declining cognitive ability
Eyesight failing
Arthritis
Medication Regime:
• 8 daily prescriptions taken at 4
different times a day
• Supported by 3 Drs, any of
whom could change regime
• 2 purchased mail-order
Appropriateness
- +

17. 17
Jen
Adele’s Daughter in her 50’s
• “Sandwiched” raising her own
kids and taking care of her
mother
• Not early adopter, but willing to
learn technology if it helps
• Working outside the home
Medication Regime:
• Adele’s regime unchanged
Appropriateness
- +

18. More than a technology problem
18
Complexity of
regime
Living alone
Medications
change
Cognitive
impairments
No
Technology
Infrastructure
Multiple
Doctors
Motor
Impairments
Patients’
understanding
of disease
Forgetfulness
Cultural and
belief systems
Ability to
navigate
healthcare
system
Multiple
Pharmacies
Discontinued
due to lack of
symptoms
Vision
impairments
Multiple
Conditions

19. About NightingaleRx
• We offer UX research and design consulting on
home health medical devices for medication
management for use by elderly and their
caregivers.
• We provide an eBook Getting Started with
Medication Management with practical tips for
caregivers on medication management.
www.NightingaleRx.com
mary@NightingaleRx.com
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20. I Need Your Help
• Still gathering info on polypharmacy situation
– Let me know if you have a story or some promising
ideas
• Building awareness
– If you’d like me to come to senior facility or health fair
please contact me
• Revising eBook
– Have copies in exchange for feedback and suggestions
if you can get into the hands of a caregiver
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21. Thank You
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