Automated dose dispensing in Danish primary health care - a technology under construction

Main Article Content

Hanne Herborg
Lotte S. Haugbølle
Anne Lee

Keywords

Patient Compliance, Automation, Qualitative Research, Denmark

Abstract

Objectives: The purpose of this study was to conduct a health technology assessment (HTA) of automated dose dispensing in the Danish primary health care sector. The present article answers the sub question of how various groups of actors spoke about and understood the shaping of automated dose dispensing (positioning in discourses).

Methods: The project utilized two methods: 11 qualitative research interviews with selected key actors and a net-based qualitative questionnaire of 97 selected practitioners.

Results: Three main types of discourse were identified with respect to the development of automated dose dispensing, namely ‘optimistic’, ‘sceptical’ and ‘pragmatic’. A wide diversity of opinion about automated dose dispensing was identified among the three discourses and their attendant scenarios. A number of factors are found in all three types of discourse, and are therefore considered to express common recommendations for decision makers and practitioners. These factors are described in the article.

Conclusions: The article argues in favour of HTA, which to a great extent clarifies and initiates the perspectives of various groups of actors about the same technology. Our analyses show that conscious strategies must be employed to make the technology work successfully with the actors involved. The preferences, ideas and proposals for future actions and initiatives identified in the project could be the basis for defining future development strategies.

Abstract 1559 | PDF Downloads 814

References

1. Bekendtgørelse om dosisdispensering af lægemidler. Bekendtgørelse nr. 80 af 05/02/2003 ed. 3 [Executive Order No. 80 of 5 February 2003, ed. 3 on dose dispensing of drugs. In Danish].

2. Bekendtgørelse om medicintilskud til dosisdispenserede lægemidler. Bekendtgørelse nr. 824 af 18/09/2001 ed. 2001 [Executive Order No. 824 of 18 September 2001 on medicine subsidy for dose-dispensed drugs. In Danish].

3. Bekendtgørelse om servicemål for apotekers distributionsopgaver og faglige rådgivning og information. Bekendtgørelse nr. 1235 af 17/12/2002 ed. 2002 [Executive Order No. 1235 of 17 December 2002 on service goals for pharmacists’ distribution tasks, professional advice and information. In Danish].

4. Lov om ændring af lov om lægemidler, lov om apoteksvirksomhed og lov om erstatning for lægemiddelskader. Lovbekendtgørelse nr. 657 af 28/07/1995 (Lov om apoteksvirksomhed) med ændringer i Lovbekendtgørelse nr. 493 af 07/06/2001 [The Act to amend the Medicines Act, the Act on Pharmacy Operation and the Act on Compensation for Injuries caused by Medicines. Consolidation Act No. 657 of 28 July 1995 (Act on Pharmacy Operations) as amended by Consolidation Act No. 493 of 7 June 2001, In Danish].

5. Website (internal). The Danish Pharmaceutical Association. http://medlem.apoteket.dk. (Viewed 31 August 2007).

6. Crome P, Curl B, Boswell M, Corless D, Lewis RR, Assessment of a new calendar pack – the ´C-pack´. Age Ageing.1982;11:275-279.

7. Henry A, Batey RG. Enhancing compliance not a prerequisite for effective eradication of Heliobactor Pylori: the help study. Am J Gastroenterol. 1999; 94:811-818.

8. Murray MD, Birt JA, Manatunga AK, Darnell JC. Medication compliance in elderly outpatients using twice-daily dosing and unit-of-use-packaging. Ann Pharmacother. 1993; 27:616-621.

9. Pereles L, Romonko L, Murzyn T, Hogan D, Silvius J, Stokes E, Long S. Evaluation of a self-medication program. J Am Geriatr Soc 1996;44(2):161-165.

10. Peterson GM, McLean S, Millingen KS. A randomised trial of strategies to improve patient compliance with anticonvulsant therapy. Epilepsia 1984; 25:412-417.

11. Rehder TL; McCoy LK, Blackwell B, Whitehead W, Robinson A. Improving medication compliance by counselling and special prescription container. Am J Hosp Pharm 1980; 37:379-85.

12. Wong BSM, Norman DC. Evaluation of a novel medication aid, the calendar blister pack, and its effect on drug compliance in a geriatric outpatient clinic. J Am Geriatr Soc 1987; 35:21-26.

13. Munk Hansen B. Dosisdispensering – et forsøg i Vejle Amt. Del II. Vurdering af de økonomiske konsekvenser for lægemiddelbrugere, Fredericia kommune og Vejle Amt [Dose dispensing – a pilot in Vejle Regional Authority. Part II. Evaluation of the financial consequences for medication users, Fredericia Local Authority and Vejle Regional Authority. In Danish]. Sygesikringen i Vejle Amt, 1999.

14. Tomsen DV, Søndergaard B, Damsgaard TM, Herborg H. Dosisdispensering – et forsøg i Vejle Amt. Del 1. Evaluering af resultater og konsekvenser for lægemiddelbrugere og deres behandling samt apotekets indsats ved dosisdispensering af medicin [Dose dispensing – a pilot in Vejle Regional Authority. Part I. Evaluation of the results and consequences for medication users and their treatment, as well as the pharmacy’s efforts concerning dose dispensing of drugs. In Danish]. Pharmakon, 1999.

15. International Network for Agencies in Health Technology Assessment. Available at: http//:www.htai.org.

16. Søndergaard B, Rossing C, Haugbølle LS, Lee A. Litteraturstudie af dosisdispensering som medicinsk teknologi. Arbejdsrapport [Literature study of dose dispensing as a health technology. Working report. In Danish]. Danmarks Farmaceutiske Universitet, Pharmakon, Syddansk Universitet [The Danish University of Pharmaceutical Sciences, Danish College of Pharmacy Practice, University of Southern Denmark], 2005.

17. Haugbølle LS, Herborg H, Lee A. Maskinel dosisdispensering: En medicinsk teknologi under konstruktion. Arbejdsrapport [Automated dose dispensing: a health technology under construction. Working report. In Danish]. Danmarks Farmaceutiske Universitet, Pharmakon, Syddansk Universitet [The Danish University of Pharmaceutical Sciences, Danish College of Pharmacy Practice, University of Southern Denmark]. 2005.

18. Lee A, Haugbølle LS, Herborg H. Maskinel dosisdispensering: Fortællinger fra praksis. Arbejdsrapport [Automated dose dispensing: Stories from practice. Working report. In Danish]. Danmarks Farmaceutiske Universitet, Pharmakon, Syddansk Universitet [The Danish University of Pharmaceutical Sciences, Danish College of Pharmacy Practice, University of Southern Denmark], 2004.

19. Gundgaard J, Søndergaard B. Maskinel dosisdispensering i det primære sundhedsvæsen: Analyse af registerdata. Arbejdsrapport [Automated dose dispensing in the primary health care sector: An analysis of register data. Working report. In Danish]. Danmarks Farmaceutiske Universitet, Pharmakon, Syddansk Universitet [The Danish University of Pharmaceutical Sciences, Danish College of Pharmacy Practice, University of Southern Denmark], 2005.

20. Lee A, Gundgaard J, Haugbølle LS, Herborg H, Søndergaard B. Maskinel dosisdispensering – en ny teknologi i den danske sundhedssektor [Automated dose dispensing – a new technology in the Danish health care sector. In Danish]. Månedsskrift for Praktisk Lægegerning 2006;(July):735– 745.

21. Larsen AB, Haugbølle LS.. The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication stockpiles. Res Social Adm Pharm. 2007;3(3):265-284.

22. Mackenzie D, Wajcman J. The Social Shaping of Technology. Milton Keynes and Philadelphia: Open University Press, 1985.

23. Kristensen FB, Hørder M, Poulsen PB (red). Metodehåndbog for Medicinsk Teknologivurdering [Methodology Handbook for Health Technology Assessment. In Danish]. Statens Institut for Medicinsk Teknologivurdering, 2001.

24. Banta HD, Luce BR. Health Care Technology and its Assessment. An International Perspective. Oxford: Oxford University Press 1993; 21.

25. Larsen B, Pedersen KM. Diskursanalyse for tabere og teenagere [Discourse analysis for drop-outs and teenagers. In Danish]. In: Larsen B, Pedersen KM, editors. Diskursanalysen til debat [Discourse analysis up for debate. In Danish]. 2002.

26. Bijker W. Of Bicycles, Bakelites and Bulbs. Toward a Theory of Sociotechnical Change. The MIT Press, 1995.

27. Website for Sociologisk Forum, http://www.sociologiskforum.dk/ordbog, (viewed 15 May 2006)

28. Kvale S. InterView. Copenhagen: Hans Reitzels Forlag, 1997.

29. ten Have H. Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 2004;20(1):71-76.

30. Reuzel RPB. Health technology assessment and interactive evaluation: different perspectives [Thesis]. University of Nijmegen: Nijmegen, 2002.

31. Mowatt G, Bower DJ, Brebner JA et al. When is the ‘right’ time to initiate an assessment of a health technology? Int J Technol Assess Health Care. 1998;14(2):372-386.

32. Hofman B. Is there a technological imperative in health care? Int J Technol Assess Health Care 2002; 18(3):675-689.

33. Department of Health. Assessing the effects of health technologies: Principles, practice, proposals. London: Department of Health, 1992.

34. Ambrosa PJ, Saya FG, Lovett LT, Tan S, Adams DW, Shane R. Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes. Am J Health-Syst Pharm 2002;59:1183-1188.

35. APODOS Rapport fra dispenseringsprojekt i Hamar 1989/1990 [Report from dispensing project in Hamar 1989/1990. In Danish], January 1991.

36. Medicin på kredit och i påse. Apotekets delbetalingssystem och dosdispenseringsverksamhet [Medicine on credit and in bags. The pharmacy’s part- payment system and dose-dispensing activities. In Swedish]. Riksförsäkringsverket. Anser 2001.

37. Bjerke LT, Nordal A. Endoserte legemidler. Kvalitetssikring av legemiddeldistribusjonskjeden [Dose-dispensed drugs. Quality assurance of drug distribution chain. In Norwegian]. Sykepleien Fag. 1995; 83(5):36-39.

38. Edward C. Läkemedelsförsörjning til sjukhem [Drug distribution to nursing homes. In Swedish]. Svensk Farmacevtisk Tidsskrift 1993; 97(4):28-30.

39. Hansen TS, Sørensen EW, Willems P. Dosisdispensering – arbejdsrapport [Dose dispensing – working report. In Danish]. Danmarks farmaceutiske Universitet, 1988.

40. Toft B, Rieper A. Medicin: mindre spild, klare ordinationer og sikker medicingivning [Medicine: less waste, clear prescriptions and safe drug dispensing . In Danish]. Sygeplejersken. 1997; 40:20-31.

41. Bøgh L. Dosisdispensering på Øresunds Apotek. Intern evaluering og kvalitetsstyringssystem [Dose dispensing at Øresund Pharmacy. Internal evaluation and quality assurance system. In Danish]. Pharmakon [Danish College of Pharmacy Practice], September 1996.

42. Devoteam. Fisher og Lorenz. Kortlægning af praksis for medicinhåndtering i den kommunale hjemmepleje. Rapport version1.1. september 2003 tilgængelig (d20/1/04) på [Charting the practice of medicines handling by local authority home care providers. Report version 1.1 September 2003 available 20 January 2004 (in Danish) at:http://e.gov.dk/uploads/media/Medicinering_bilag2_kommunal_hjemmesygepleje.pdf

43. Thorarinson S, Schmücker K. Dosisdispensering – Hvorfor ikke? Studieopholdsprojekt udarbejdet ved Danmarks Farmaceutiske Universitet [Dose dispensing – why not? Study trip project at The Danish University of Pharmaceutical Sciences. In Danish], 2003.

44. Nunney JM, Raynor DKT. How are multi-compartment compliance aids used in primary care? Pharm J. 2001; 267: 784-89.

45. Bjelland E. Maskinelt fylte doseringsesker – bidrag fra apotekerne til kvalitetssikring i hjemmepleien [Automated unit dose medication cassettes – pharmacists’ contribution to quality assurance in home care. In Norwegian]. Norsk Farmaceutisk Tidsskrift 1993;(13):15-19.

46. Ascione FJ, Shimp LA. The effectiveness of four education strategies in the elderly. Drug Intell Clin Pharm. 1984;18:926-931.

47. Aasen KS. Noncompliance ved medikamentell behandling. Doseringen og doseringseskens betydning [Non-compliance in drug treatment. Dosing and the significance of unit dose medication cassettes. In Norwegian]. Norges Apotekerforenings Tidsskrift 1993;2:42-47.

48. Gardner N. Implementing the Boots MDS: a case study. Nursing Residential Care. 2000;2(7):328-331.

49. Danmarks Apotekerforening. Dosisdispensering – rapport over en række forsøg [The Danish Pharmacist Association. Dose dispensing – a report on several studies. In Danish]. 1990.

50. Edward C. Läkemedelshantering – en del af ADL-träningen [Medicines handling – part of ADL training. In Swedish]. Svensk Farmaceutisk tidsskrift 1992;96:38-41.

51. Kazanjian A. Reflections on the social epidemiologic dimension of health technology assessment. Int J Technol Assess Health Care. 2004;20(2):167-73.

52. Nørgaard LS, Morgall JM. The Social Construction of a Drug Interaction Screening Program – Expectations and Changes in Danish Pharmacy Practice. J Soc Admin Pharm 2000; 17 (2):110-118.

53. Campbell D. The Socially Constructed Organization. Karnac Books, London, 2000.