Spenser

Spenser is an affordable medication dispenser that combines portability with automation, handles complex medication regimens, and interfaces with an app.

Chronic illnesses are highly pervasive in society, and the burden of these diseases does not fall only on adults and geriatric patients. 40% of children and adolescents have chronic diseases,[1] and due to complex drug regimens, medical non-adherence affects 50% to 75% of them[2]. This means that, in the United States, nearly 15 million children are missing prescribed medication doses, and forgetting even small fractions of medications can have dire consequences in some scenarios. For example, if a child with leukemia misses 10% of their doses of mercaptopurine, a common leukemia drug, this triples their risk of relapse[3]. 1 in 4 children missed at least 10% of their doses of mercaptopurine, illustrating the significance of this problem[3]. Medical non-adherence results in reduced efficacy of treatments, worse clinical outcomes, and increased healthcare costs. Complex medication regimens are the primary cause of non-adherence, but the current medication management devices that could improve adherence have shortcomings such as high price and lack of portability.

Electronic medication organizers and dispensers can ease the burden of complex treatment regimens by reminding patients to take medications, grouping pills by dose time, or automatically dispensing the proper doses.4 Electronic medication management devices that are on the market are targeted towards geriatric populations or have the purpose of preventing addiction and over-medicating. Adolescent and young adult (AYA) populations have been largely overlooked in medication management technology. Promoting self-management of treatment for AYA patients can improve adherence and long-term health outcomes.5 Portable medication organizers, which can promote independence in AYA populations, are time-consuming to fill, but automated dispensers, which reduce the time component, are large and bulky and currently only exist for home-use purposes. There is also a need to make these devices more affordable for patients already burdened by high healthcare costs, as they tend to be expensive and complementary features come with monthly payment plans.

Overall, we are trying to solve the problem of medication non-adherence in AYA populations. This issue has been studied in geriatric populations, but AYA populations with chronic illnesses that require complex drug regimens have been somewhat overlooked.

We seek to design an affordable medication dispenser that combines portability with automation and ease-of-use and is capable of handling a complex medication regimen. Our device will be controlled through a mobile app that can remind the patient of doses and store information about their treatment regimen. 

References

[1]National Survey of Children’s Health. NSCH 2018 19: Number of Current or Lifelong Health Conditions, Nationwide, Age in 3 Groups website. childhealthdata.org.

[2] Rapoff M. (2010). Adherence to Pediatric Medical Regimens. 2nd ed. Issues in Clinical Child Psychology. New York, NY: Springer Science+Business Media.

[3] Bhatia, S. et al. (2014). 6MP adherence in a multiracial cohort of children with acute lymphoblastic leukemia: a Children’s Oncology Group study. Blood, 124(15):2345-53. https://doi.org/10.1182/blood-2014-01-552166

Spenser consists of six medication tubes arranged around an axel. The dispensing and refill actions are triggered by user interaction with a mobile app. 

Dispensing Mechanism: After the user prompts the device to dispense medication and the proper medication tube is aligned with the linear actuator: (1) The linear actuator extends into the medication tube, forcing the pills downward. (2) One pill is released out of the bottom of the medication tube, with resistant flaps opposing the force of the linear actuator to prevent multiple pills from exiting the tube. (3) The beam between an LED and photoresistor is broken by the falling pill, causing (4) the linear actuator to retract, so only one pill is dispensed.

Refilling Mechanism: The medication tubes are on a rotating system so that only the appropriate tube lines up with the linear actuator.  Two servo motors along the center axis of the device spin the medication tubes to align the proper tube with the refilling tube, and the medications are dropped into the open top end of the refilling tube. To prevent medications from falling out of the medication tubes if the device were to be turned over, a cover platform was placed over the tubes. 

App Development: An app was developed with an internal data structure to handle medication management. After a new medication is added, the app can automatically determine the next time to dispense the medication and internally update the data structure after that time has passed. We integrated Bluetooth control into every aspect of the physical device. During dispensing, a control signal is sent, causing the servos to align the appropriate medication tube with the linear actuator. During refill, the control signal causes the servos to rotate such that the appropriate medication tube is aligned with the refill tube.

We anticipate that our design will have both immediate impacts on our end users (adolescents and young adults with a complex drug regimen) and broader social and economic impacts. The main immediate impacts of our device are increased ease and efficiency of managing one’s medications and decreased risk of missing a dose or taking the wrong medication with app reminders and automated dispensing. Another impact is improved management across environments, both where the patient goes in their daily life, due to portability, and in the healthcare space, making it easier to share adherence data with the patient’s physician. On a larger scale, if we are successfully able to improve medication adherence in adolescents and young adults, healthcare costs associated with missing doses will simultaneously fall. Due to its affordability, the device can mitigate socioeconomic disparities that have been observed in medication non-adherence. Though we have primarily considered the domestic market, non-adherence impacts patients globally, thus our device would be able to improve adherence if sold in other countries.

All four of our team members are seniors at the University of Pennsylvania majoring in bioengineering. As bioengineers, we have extensive experience with the physical sciences, biological sciences, and actually engineering solutions to medical and health-related issues in our bioengineering lab classes.

The Spenser team is comprised of young people who are interested in using engineering to innovate medical technology and improve lives. We were inspired to create Spenser to improve the quality of life of other young people.

We worked closely with a clinical mentor who researches medical adherence in youth and adolescents with cancer. We also met with some survivors of childhood cancer to get their input and suggestions on Spenser.

Following the completion of our design improvements, we plan to informally test the device with some of our friends. We will program a “treatment regimen” into the app and give them the device for several days. We will track their adherence to the regimen. Pills will be substituted with either candy or a non-edible substitute (like beads) that just needs to be removed from the device at the appropriate time. We will have a second test group who have to remember to follow the regimen without using Spenser. We also plan to present our device to a group of former AYA cancer patients to solicit their feedback on how they think the device would have helped them and how it could be improved. This will be ongoing throughout the semester.

Our solution is unique because no previously built pill organizer/dispenser has been able to meet all our needs specifications: portability, automatic dispensing, easy filling, capacity for a complex drug regimen, affordability, and app reminders.

We work with the University of Pennsylvania, Penn Engineering, and Penn Bioengineering. We began work on this device for our Bioengineering Senior Design class. So we work closely with Penn Engineering faculty.