Creating a medicine delivery service for socially distanced patients under the pandemic through Design Thinking
According to the statistics published by the Census and Statistics Department, over 70% of senior citizens, or around 1.4 million people, in Hong Kong are suffering from chronic illnesses and 60% of them need long-term medication. And over 280,000 people have to take more than five types of medications chronically. However, as social distancing and staying home become the new norms under the pandemic, general medical and dispensing services are disrupted, and these elders may not get the medicines they need in timely manner.
As such, Hong Kong Pharmaceutical Care Foundation founded by a group of pharmacists in 2007 tried to figure out a solution to ensure the continuity of medicine supply and meet the needs of these elderly patients. The Foundation then launched the Community Interim Medication Refill Scheme (CIMRS) and Medication Collection and Delivery Service (MCDS). The unprecedented combination of technology and collective strength has eased the problems faced by the patients during the pandemic.
Diagnosing the problems faced by patients before launching a service
Design thinking encourages people to think around a problem from the perspectives of stakeholders and understand its root cause before developing any solution. In this case, the Foundation decided to identify the problems by interviewing private doctors first. “They told us that many chronic patients were unable to visit public clinics or get the medication they needed, so their conditions deteriorated,” said Ms S.C. Chiang, Director of the Foundation.
As solving this problem involved many considerations and resources, the Foundation decided to work together with other industry professionals and explore the solution at the community level. “We invited a group of enthusiastic medical professionals, including doctors, community pharmacists and medical administrators, to cooperate with other social welfare and medical NGOs. With the help and generous financial support from the public and various organisations, it only took us 10 days to conceive and launch the CIMRS project to offer free dispensing service,” she explained.
The scheme covers chronic patients with scheduled visits to public hospitals in the coming month as long as they have registered with the Government’s eHealth Record (electronic health record) service. “Voluntary doctors will first check the patients’ prescription records in the eHR system before arranging them to visit a private clinic for consultation. If their conditions are stable, the doctors will prescribe the medications they need for one to four weeks according to the records, and the community pharmacists will dispense and deliver the medications to the designated collection locations for free within three days.” Ms Chiang compared this trial run to producing a prototype in the product design process, where many areas of improvement were identified. “For example, some prescription drugs can only be bought at HA pharmacies rather than community pharmacies. Also, the scheme is unable to cover patients who do not have eHR accounts.”
Improving the service through cold chain and IoT applications
As HA has been allowing patients in stable conditions to refill their medications without consultation since May 2020, the Foundation tried to improve its interim medication refill service and introduced the Medication Collection and Delivery Service. Ms Chiang noted, “With the authorisation from the patients, our volunteers will collect the medications from hospitals on their behalf and deliver them to their homes. The patients do not have to see the doctors and collect their medications from the community pharmacies, and thus have a lower risk of being infected. It can also solve the problem we mentioned earlier.”
However, to turn the idea into reality, the Foundation not only needed the help from volunteers, but also had to make sure that the medications were correct and remained in good condition during the delivery process. Therefore, the Foundation joined hands with logistics and technology companies to introduce the innovative IoT and cold chain technologies. “First of all, a voluntary pharmacist will collect the medications for a patient, check them and put them into a special smart medicine bag connected to a mobile app. When the patient code is entered, the light on the bag will be on to make sure that the pharmacist takes the correct medications.” Ms Chiang also explained that all medications will be delivered in a customised vehicle equipped with real-time temperature sensors and a special freezer for storing drugs that need to be kept in low temperature. If the storage temperature is too high, the mobile app will alert the volunteer immediately.
This enhanced scheme was officially launched with the sponsorship from the COVID-19 Emergency Fund by Hong Kong Jockey Club in May. With this launch, Ms Chiang said the team also noticed other needs of the patients. “We found that many elders do not know their medications well and may store them in the wrong way. They may also forget the correct dosage or even when to take the medicines. If they have to take pills for hypertension, the diuretic effect will cause frequent urination and accelerate the loss of potassium. So, doctors will usually prescribe the potassium pills too. However, many elders think they only need to take the one for hypertension, and then fear that they may have diabetes as they have to go to the toilet frequently,” she explained.
Introducing medication consultation service to meet other needs
In fact, according to a survey conducted by the Society for Community Organisation in early 2020, 40% of elders had difficulty in managing their medications while 70%, 50% and 40% of them failed to take medicines as prescribed, took the wrong dosage and experienced discomfort after taking the medicine respectively in the past five years. As such, when the Foundation’s voluntary pharmacists deliver the medications to the elders, they will take the initiative to explain the medications in detail and provide free medication consultation service through video or phone calls. “We then took a step further and introduced the Community Outreach Program on Medication Management as an independent programme to enhance the effectiveness.” Under the new service, pharmacists will make home visits to help patients register for the eHealth system. After reviewing the patients’ medications, they will make a simple medication instruction list with the image, usage, frequency and dosage of each medication, and sort and place the medications into a special pill case for easy use. “The pharmacists will also teach patients how to take the medications, highlight the precautions and encourage them to cultivate the habit of medication management.”
The three services presented by the Foundation during the pandemic rightly demonstrate that the Design Thinking principles of continuous exploration and seeking continuous improvement, where they started with understanding patients’ needs, exploring other unsolved problems, followed by modifying the services and finally proposing new solutions. “The trials and practices allowed us to discover other problems, and eventually identify the root cause of the problems as well. If we can improve patients’ drug compliance and help them follow doctors’ instructions, we can alleviate the healthcare burden of the society in the long run. And that is the driving force behind our innovation,” Ms Chiang said.