Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Two experts were familiar with this technology, of which 1 had used it before.

Level of innovation

Generally, experts agreed that YOURmeds is novel and the first in a new class of procedures, but has uncertain safety and efficacy. All experts agreed that this technology builds on existing technologies, and 1 expert said that it is novel because it combines digital technology with data gathering. Two experts were unaware of any competing technologies in the NHS.

Potential patient impact

The experts noted that the main benefit is improved adherence. Other benefits could include improved health outcomes, greater independence and reduced hospital attendance or admissions.

Experts highlighted several groups that could particularly benefit from this technology, including people:

  • who need social support for medication administration

  • with mental health conditions

  • who need time-sensitive medication for conditions such as Parkinson's disease, chronic pain, stroke, heart failure and diabetes.

One expert estimated that 50% of all people discharged from hospital would be eligible to use this technology. Another expert said that of the 1.5 million people who use monitoring dosage systems, about 30% would be eligible. But this could be higher for specific conditions such as Parkinson's disease, dementia and stroke.

Potential system impact

The experts agreed that YOURmeds could change the current pathway and reduce the pressure on primary care and social services. Two experts noted that it may also reduce hospital attendance or admissions and speed up hospital discharges.

Two experts said that the technology is likely to cost less compared with standard care. One expert noted that this is difficult to know, and that social care visits often include multiple reasons so costs may not be reduced. One expert noted that the resource demand would likely be highest for community pharmacies. Another expert noted that the largest saving would likely come from a reduction in staff time. This includes a reduced number of support staff in the community giving medication, monitoring medication adherence and collecting data.

Two experts said that the technology can be used in most or all district general hospitals. But 1 expert noted that we cannot currently predict this because it will mostly be started in primary care and community pharmacies.

One expert noted that changes to the clinical facilities need to be considered because the technology needs charging and contains communication software. Another expert considered that changes within the pharmacy may be needed. One expert said that no changes are needed to clinical facilities to use the technology.

Two experts agreed that basic training is needed for the patients, carers and pharmacy staff.

General comments

Two experts said that YOURmeds could replace current standard care because it has the potential to change delivery of care and support. One expert expects uptake to be rapid because the COVID‑19 pandemic has placed a significant demand on resources and people may not be getting the support they need. One expert said that this is a significant improvement in social care. Another expert said that the technology would be available in addition to standard care because some people may not feel comfortable using it.

The experts noted that there may be potential risks associated with this technology including technology failure, incorrect pharmacy dispense of medication, and potential risk of overdose. But 1 expert noted that these are low risks or can be mitigated.

One expert highlighted the importance of equal access to the technology. They said that people who are visually impaired or have reduced hearing and possibly those with literacy or linguistic issues may not be able to use it. Also, YOURmeds may not be suitable for people who are unable to nominate multiple supporters.

Only 1 expert raised some issues that could prevent adoption of this technology. These included costs, patient and support service preference and logistics.

Two experts said that further research focusing on adherence, health outcomes and the value of the support network is needed to address the uncertainty in the evidence base. One expert noted that a larger sample of trial patients would be beneficial.

Post publication comments

Comments were received after publication from pharmacy professionals. These are summarised here, together with replies from the company and comments from community pharmacy staff who use YOURmeds.

Post publication NHS comments

NHS pharmacy staff commented that YOURmeds does not align with the Royal Pharmaceutical Society (RPS) multi-compartment compliance aids (MCAs) pharmacy guide. The company replied that YOURmeds does align with the reasonable adjustments in the RPS guideline, especially when patients cannot manage to take their medication in its original packaging. The company added that YOURmeds is more than a computerised MCA, because it allows carers to be notified about non-adherence.

NHS pharmacists commented that they prefer people to take their medication in its original licensed packaging, which helps ensure stability of the medicine. The company agreed but said that some people need further help to take their medication, and that MCAs such as YOURmeds outweigh the added risk to a medicine's stability. Two of the comments received related to the potential issues around medication stability when removed from the original packaging.

NICE medicines optimisation team comments

NHS pharmacists questioned the quantity and quality of evidence for the technology, saying that it was relatively low and that further larger studies with comparator groups were needed. They raised the lack of consistency with recommendations in the RPS MCA pharmacy guide as a possible barrier to using this and similar technologies.

The pharmacists also queried the additional costs that might be incurred by community pharmacists in using the technology, and said that any savings may be offset by increased pharmacy staff time costs.

The pharmacists queried the proportion of eligible users, saying that the assertion that 50% of all people discharged from hospital would be eligible to use this technology appeared very high. They also queried whether uptake in hospital pharmacies was likely. They also raised safety concerns with YOURmeds.

Community pharmacy comments

Two community pharmacists commented on the technology. Both said YOURmeds was easy to use. Both agreed that patients found the technology useful and easy to use. One noted that it gave the patient more independence, as they did not need to be at home for medicines adherence visits.

One community pharmacist said that the virtual training is easy to access and that once set up had been completed for one patient, it was very simple to repeat as needed. They noted that any pharmacy capable of providing a standard MCA service could easily accommodate YOURmeds.

One expert said they felt there was increasing demand for MCAs, notwithstanding RPS guidance, and technologies such as YOURmeds. They said that the technologies give extra information and are an appropriate evolutionary step in developing MCAs. They noted that MCAs with and without internet connection may get used inappropriately, but that YOURMeds having internet connectivity is an advantage.

They noted that the ideal way to dispense medicines is in their original packaging. But they also said that medicines are already subject to packaging changes, and a large number of patients already have MCAs. One community pharmacist noted that the technology is not compatible with liquids, inhalers or injectables, so strategies are needed to supply these alongside YOURmeds.

When considering technology costs, 1 community pharmacist noted that their area does not have consistent reimbursement for MCAs and that there are different criteria for dispensing in MCA. They said that some localities use carers to deliver medicines for patients, and that the carer service may be reimbursed. They added that the adoption decision often falls to local individual pharmacies. Another noted that beyond initial training, any extra time used on YOURmeds is minimal. They said that the small monthly YOURmeds payment per patient per month makes it an attractive business proposition for community pharmacy.