SHAPES of things to come- medicine control and optimisation

Background: The Smart & Healthy Ageing through People Engaging in Supportive Systems (SHAPES) Innovation Action comprised 36 partners across 14 countries to build, deploy and pilot an EU-standardised open platform integrating a range of technological, organisational, clinical, educational and societal Digital Solutions to support healthy and independent living of older adults at home. Aim: SHAPES explored 7 themes including ‘Medicine control and optimisation’ represented by this pilot, which aimed to improve deficiencies in adherence to medicines and treatments of older adults living at home with chronic illnesses. Method: The pilot was developed in stages: design, preparation, deployment and evaluation. Throughout these stages, feedback was sought from service users, healthcare professionals and researchers which informed continual co-design. The final versions of the SHAPES Platform and Digital Solutions were then piloted with service users. Pilot participants were over 60 years old and lived at home with multiple chronic conditions, specifically heart failure, hypertension, diabetes and chronic obstructive pulmonary disease. Four use cases, each deploying and evaluating different Digital Solutions were used in this pilot. Participants were asked to access the SHAPES App daily, to use medical and wellbeing devices daily and answer brief symptom and medication adherence questionnaires periodically. Results: This pilot demonstrated the use of 9 SHAPES Digital Solutions; including user-facing apps, analytic software and a browser-based dashboard. Seventy three people participated for 12 weeks; UK (n=4), Spain (n=9), Czech Republic (n=50) and Cyprus (n=10). Recruitment and retention key performance indicators (KPIs) were achieved in Spain, Czech Republic and Cyprus. User engagement and acceptance was mixed, depending on the combination of Digital Solutions used. Collection of questionnaire data was lower than anticipated and there was a reduction in emergency healthcare resources used during the intervention in Spain. Qualitative findings indicated that participants felt they could self-monitor their conditions. There was a high level of trust for collecting health data and willingness to share it with healthcare teams. Most participants were interested in continuing to use the Digital Solutions. Lessons learned: Consider the usability of the medical and wellbeing devices in addition to usability of the SHAPES Digital Solutions. Smart tablets and/or Wi-Fi should be provided alongside Digital Solutions to maximise recruitment and accessibility. Healthcare professional support was key to ensuring recruitment and clinical oversight. The frequency of use of the Digital Solutions should be adapted to the participant’s unique health status and willingness for empowerment. Correspondingly, algorithm data requirements should be adapted. Conclusion: SHAPES Digital Solutions were successfully co-designed with older adults living in the community and piloted in a real world environment. Data exchange flowed as designed, allowing data analytics to be performed. Participants were able and interested to use Digital Solutions as a method of self-management. In future, it would be advantageous to pursue conformity assessment and medical device classification of the SHAPES Digital Solutions and further testing in larger populations over longer time periods. Digital Solutions have the potential to facilitate integrated care and empower service users to be more involved in their decision-making.