As described in the previous sections, the goals of the pilot project were to increase access to MOUD, increase medication safety, and decrease the diversion of medication. To meet this goal, UCHD established the Locking Pill Bottle Subcommittee and established the following process objective. Evaluation measures were identified during the creation of the pilot project to monitor the implementation progress.
Process outcomes measured included:
Partner with LLCHC, local pharmacies, other local treatment providers, and the MHRB to develop and implement the program.
Develop training materials and assessment forms to be used in pilot project administration.
Provide technical assistance to the pilot project partner(s).
Monitor implementation progress and program outcomes.
The above measures allowed UCHD and program partners to monitor the implementation progress and determine if process objectives and projected timelines were being met. The process outcomes were monitored regularly by UCHD and all process objectives were achieved.
Outcome evaluation measures included:
How many patients had ever had medication missing from their regular bottle?
How many patients had ever had medication missing from their locking pill bottles?
Prior to using the locking pill bottle, how many patients had mistaken their medication or medication bottle for another?
When using the locking pill bottle how many patients had ever mistaken their medication for another?
How many patients transported their medication?
How safe did patients feel transporting their medication in their regular bottles?
How safe did patients feel transporting their medication in their locked pill bottles?
How many patients locked their medication when they were in a regular bottle?
How easy did patients describe using the bottles?
Would patients like to use the locking pill bottles with other medications?
Did patients use resources to help them remember the code to their bottles?
What did patients like most about the locking pill bottles?
What did patients like least about the locking pill bottles?
Did LLCHC patients receive the bottles?
The outcome evaluation measures above were chosen to help evaluate whether the program was achieving the intended outcomes and to assess the impact of the program on MOUD patients. The outcome evaluation questions were measured through patient surveys that were given 6 months after the initial pilot project implementation. The surveys were then recorded and analyzed to see if any changes needed to be made to the project. When diversion was measured in the survey, 40% of patients reported that they had noticed medication missing from their regular bottles, and after the implementation of the locking pill bottles, no patients reported missing medication. This showed that by using the locking pill bottle medication diversion decreased. Additionally, when patients were asked if they had ever mistaken their bottle or medication for another, 11% of patients reported that they had when they were using the regular bottle. However, no patients reported the mistake after the implementation of the locking pill bottle. The results of the survey also showed that patients felt safe transporting their medication with the locking pill bottles. The surveys recorded a 70% increase in the number of patients who either felt safe or very safe transporting their medication. These findings supported the goal of increasing medication safety and therefore increasing access to MOUD.
Some initial concerns from providers and pharmacies were that patients would not like the locking pill bottle. However, the survey results demonstrated the opposite of these initial concerns. Over 80% of patients reported that it was easy or very easy to use the locking pill bottle, and over 60% reported they would like to use the bottle with other medications. Another concern that pharmacies had was the potential for patients to forget their codes for the bottles. However, 90% of patients did not need any resources to remember their code throughout the pilot project. Finally, the surveys given back indicated that all LLCHC patients that received prescriptions at the three local pharmacies were able to access the bottles.
When asked, patients reported that the security of having their medication stored safely is what they liked most about the locking pill bottles. Based on these findings, UCHD and LLCHC made contact with corporate pharmacies and are working to implement the bottles in those locations as well.