Abstracts

Introduction: Implications of medication non-adherence include the decreased effectiveness of treatment, increased hospitalisations, and a growing burden on social care services 1 .Following government initiatives 2 , social care sites are exploring the use of technology in supporting medication management.One type being explored is an electronic Monitored Dosage System (eMDS) called Biodose Con-nect™.The device offers a more enhanced approach in supporting adherence, with embedded remote monitoring and prompting features which have the potential of transforming the care-at-home sector.Considering the paucity of evidence within this sector and a need to understand the drivers in seeking such technology, an exploration into the current challenges being faced in both the assisted-living and domiciliary care sector was necessary.Aim: The purpose of this multi-site case study was to explore the current status of managing medicines within both sectors to help in understanding the drive for implementing eMDS-type technologies.Methods: A mixed qualitative method approach was used across both case studies.The first case study was a UK assisted-living site providing medication support for service users of varying needs within a communal dwelling enclosure.Ten in-depth semi-structured interviews were completed with a range of stakeholders including site managers, team leaders, care workers, and pharmacist.The second case study was a UK domiciliary care service provider, which delivered medication support services to service users in their own homes.Three in-depth semi-structured interviews were completed with the provider service managers, as well as two focus groups with ten care workers who provided medication support to service users.All data were audio-recorded, transcribed verbatim, and thematically analysed.This study has been reviewed and given favourable opinion (ethics ref no: 166-1711).Results: Both sites described the high responsibility placed around managing medicines for service users, as well as its associated risks.Current challenges in managing medicines within both sectors included lack of medicines awareness by service users and the need for care workers to continuously reassure and persuade service users in taking their medication.Within the domiciliary care sector, the issue of responsibility ownership was a key feature especially with service users that required medication-prompting visits only.Participants described the blurred line of taking "medication responsibility" with such service users, where evidence of medication taking was not being recorded however staff were not certain medication was being taken.Medication administration issues were also described notably around administering liquid medication and dealing with end of month shortfalls.Care workers found using MDS-type systems helpful during medication support as shown in the literature 3 , further explaining interest in exploring eMDS type technology.Further, drivers included decreasing risk of medication administration errors, increasing responsibility and awareness of medication in service users as well as the possible financial benefit that could arise from decreasing visits made by care workers. Conclusion:Participants described an array of challenges faced whilst managing medication for service users but remain optimistic in implementing eMDS technologies that could further promote independence in their service users.Further data exploration will use Greenhalgh's framework 4 to explain the challenges in the implementation of health and care technologies within care sites.