Locking element for dispenser
Abstract
The invention relates to a dispenser (601, 2601, 2802), especially for dispensing solid preparations (225, 227), comprising a housing (603) having a dispensing orifice (606), and a collar member (609) having a receiving opening (604), and a passage member (605) having a receiving chamber (602), wherein the housing (603) and/or the passage member (605) are, preferably jointly, movable relative in respect to the collar member (609) between a first position with the receiving chamber (602) being in receiving communication with the receiving opening (604) of the collar member (609) and a second position with the receiving chamber (602) being in dispensing communication with the dispensing orifice (606) of the housing (603), wherein it is an object to provide a blocking interaction during which it is not possible to unscrew the dispenser from a container provided therewith. This object is achieved by a dispenser which is characterized in that the dispenser (601) comprises a locking element (650) which comprises a sleeve-like member (651) which is to be placed on the top of a container (617) and surrounds the dispensing orifice of the container (617), wherein the locking element (650) comprises two flexible elements (656) which in the attached position of the locking element (650) and the collar member (609) interact with blocking surfaces (658) provided at an inner wall of the collar member (609).

Term
Projected expiry 19 December 2028.
- Priority
- Filed
- Published
- Today
- Projected expiry
15 claims: 8 independent, 7 dependent
- 1Dispenser (601, 2601, 2802), especially for dispensing solid preparations (225, 227), comprising a housing (603) having a dispensing orifice (606), and a collar member (609) having a receiving opening (604), and a passage member (605) having a receiving chamber (602), wherein the housing (603) and/or the passage member (605) are, preferably jointly, movable relative in respect to the collar member (609) between a first position with the receiving chamber (602) being in receiving communication with the receiving opening (604) of the collar member (609) and a second position with the receiving chamber (602) being in dispensing communication with the dispensing orifice (606) of the housing (603), characterized in that the dispenser (601) comprises a locking element (650) which comprises a sleeve-like member (651) which is to be placed on the top of a container (617) and surrounds the dispensing orifice of the container (617), wherein the locking element (650) comprises two flexible elements (656) which in the attached position of the locking element (650) and the collar member (609) interact with blocking surfaces (658) provided at an inner wall of the collar member (609).
- 4Dispenser according to one of the preceding claims, wherein the receiving chamber (602) is dimensioned for accommodating one unit dose of a solid substance or a solid preparation (225, 227) to be dispensed.
- 5Dispenser according to one of the preceding claims, wherein the collar member (609) comprises a circumferential outer fringe (618) at its perimeter providing connecting elements which are suitable for interacting with corresponding connecting elements provided at a, preferably commonly used, container (617), especially at a dispensing opening of a medication bottle, preferably containing solid pills or capsules.
- 6Dispenser according to one of the preceding claims, further comprising a detector (641) for monitoring the dispensing of each substance and/or particle, particularly a solid preparation (225, 227), dispensed.
- 7Dispenser according to one of the preceding claims, further comprising a mechanical or electromechanical blocking mechanism for releasably blocking relative movement between the collar member (609) and the housing (603) and/or between the passage member (605) and the collar member (609) and/or for releasably blocking the closure (654) covering the dispensing orifice (606).
- 8Dispenser according to one of the preceding claims, further comprising an electronic circuit (643, 2500) and an energy supply (645, 2506) for monitoring, controlling, indicating and/or communication.
- 9Dispenser according to one of the preceding claims further comprising a container (617) being in, preferably permanent, dispensing and/or receiving communication therewith and providing a substance and/or solid preparation (225, 227) to be dispensed.
- 10Dispenser according to one of the preceding claims wherein the container (617), especially a medication container, is equipped with an electronic temperature sensor (2538) and/or an electronic humidity sensor (2536) positioned such that the temperature and/or humidity within the container are measured, wherein the container and/or the dispenser is further equipped with an electronic circuit (2500) that receives readings from the electronic temperature sensor (2538) and/or the electronic humidity sensor (2536), and stores and/or transmits said readings to an external device.
- 12Dispenser according to one of claims 8 to 11, wherein the container or the dispenser further comprises a blocking device (2534) that prevents access to the solid preparation, especially medication, stored in the container, and wherein the commands comprise a command to activate the blocking device to prevent access to the solid preparation, especially medication, if the preparation, especially medication, has been stored at a temperature and/or humidity outside of an acceptable temperature and/or humidity range.
- 13Dispenser system comprising a dispenser (601, 2601, 2802) according to one of the claims 1 to 12, wherein the dispenser (601) and/or the container (617) comprises an electronic circuit (643, 2500) and/or an energy supply (645, 2506) for monitoring, controlling, indicating and/or communication, especially data communication, wherein the electronic circuit (2500) comprises:a sensor (643, 2518) configured to detect a dispensing event of a single dose of the medication from the dispenser;a memory (2504) that stores information associated with the dispensing event;and a transceiver (2510) that wirelessly transmits the information associated with the dispensing event to an external device and/or wherein the electronic circuit (2500) comprises a temperature sensor (2538) and/or a humidity sensor (2536) positioned to detect the temperature and/or humidity of medication stored in the dispenser (601) and/or the container (617), wherein the electronic circuit (2500) is further configured to communicate information relating to the temperature and/or humidity to an external device.
- 15Method of monitoring a patient's medication compliance using a dispenser (601, 2601, 2802) according to one of the claims 1 to 12 and/or a dispenser system according to one of the claims 13 or 14, wherein the method comprises:a. providing a dispenser system which dispenser system tracks at least one type of patient medicine compliance data, said dispenser system being connected to a container, b. providing a wave energy transmitter and a power source to drive said transmitter for transmission of said patient's medicine compliance data to a remote location, said transmitter being electronically connected to said dispenser system for said transmission and said data transmitter and power source or supply being connected to said container, c. having either said dispenser system or said computer programmed to store the prescribed medicine dosage and regime of said container, d. having either said device or said computer programmed to calculate compliance requirements for each dosage administration for the prescription period of the medicine and for comparing the actual medicine consumption or container usage with the compliance requirements and/or wherein the method further comprises: e. providing a receiver at said remote location and providing a computer to which said receiver inputs patient compliance data.
Independent claims11
121 paragraphs, as filed
0001The invention relates to a dispenser, especially for dispensing solid preparations, comprising a housing having a dispensing orifice, and a collar member having a receiving opening, and a passage member having a receiving chamber, wherein the housing and/or the passage member are, preferably jointly, movable relative in respect to the collar member between a first position with the receiving chamber being in receiving communication with the receiving opening of the collar member and a second position with the receiving chamber being in dispensing communication with the dispensing orifice of the housing. The invention further relates to a dispenser system comprising such a dispenser, wherein the dispenser and/or the container comprises an electronic circuit and/or an energy supply.
0002Finally, the invention relates to a method of monitoring a patient's medication compliance, using such a dispenser and/or dispenser system.
0003Such kinds of dispensers and dispenser systems are used for dispensing solid preparations stored and contained in a container, which is permanently or which will be brought into a dispensing communication with a dispenser. Solid preparations may be medical or pharmaceutical preparations, nutritional preparations, confectionary preparations and all other kinds of solid materials, which are of a solid configuration. Such preparations may be pills, capsules, tablets, particles, pallets, agglomerations etc. One special field for application of solid preparations is the field of medication. Here solid pharmaceutical preparations are generally prescribed by a physician to the patient; however some pharmaceutical preparations can be obtained without prescription (so-called "over-the-counter medication"). Whether the medication is prescribed by a physician or obtained over-the-counter, best results are generally obtained when the medication is taken at regular intervals so that the effective ingredient in the medication is replenished at regular and precise intervals.
0004Daily or otherwise regular usage is not only important in the normal use of medication so as to have as regular a dosage pattern as possible, but it is even more important in clinical trials. Before any drug is allowed to be prescribed by a physician, the drug must be registered at local agencies, such as the FDA (Food and Drug Administration) in the USA and the European Medicines Agency (EMEA) in Europe. Only after registration may the drugs be put on the market and prescribed and sold for pharmaceutical preparations. To pass the registration procedure, large amounts of data regarding the drug need to be collected and supplied to the authorities. One part of these data is the result of clinical trials. In several phases of the clinical trials, patients are administered a certain dose of the drug. The effects of the drug on the patient are carefully followed, so as to be able not only to determine the effect of the drug but also possible side effects. For the correct determination of the side effects, it is important that the patient strictly follows the prescribed medication regime, or in other words that he/she complies with the regime. When he/she deviates from the regime he/she is considered not to be compliant. The consequence of non-compliant behavior will strongly depend on the kind of drug he/she was taking. With some drugs, the effect may not be serious, while with others, it can lead, for example, to symptoms of poisoning. When a patient who is participating in a clinical trial shows these symptoms of poisoning, the conclusion could, possibly erroneously, be drawn that the symptoms of poisoning and the poisoning itself are adverse effects of the drug itself. Therefore it would be an advantage to the patient, researcher and physician participating in the clinical trials to be able to follow the patient's compliance behavior.
0005Another factor influencing a patient's compliance is posed by new developments in therapeutics, such as the use of cocktails of pharmaceuticals and the use of chrono-therapeutics. Since the recent discovery that combinations of pharmaceuticals are more effective than mono-therapies in treating AIDS, some cancers and infectious diseases, some of these patients need to take considerable numbers of pills each day without missing doses, else resistance to treatment could develop. Chrono-therapeutics are used for illnesses that fluctuate with the biological rhythm of a patient such as for example asthma. Asthma is often more severe at night than during the day. Therefore it is not necessary to administer a steady dose. A preferred treatment should match the medicine levels to the symptoms. This is exactly what can be done with chrono- therapeutics. However it is essential that the patient is very precise in complying with the prescribed (time) scheme.
0006Patients sometimes tend to forget their medication. This forgetfulness is strongly dependent on external factors, such as for example holidays, traveling through different time-zones and stress. So patients that experience these situations more often are at a higher risk for non-compliance. Another group of patients with an increased risk for non-compliance are patients with a chronic disease. The chronic disease causes the character of the medication also to be chronic. As it is easier to obey prescription rules for only 10 days than for 10 years, especially patients with a chronic disease may have difficulties in complying with the medication regime as prescribed by their physician.
0007Again another group of patients with an increased risk of non-compliance are elderly people who suffer from forgetfulness.
0008All the factors mentioned above in addition to the recent developments can make it difficult for a patient to take his medication right in time; that is: to comply with the medication regime prescribed by the physician. This is reflected in the fact that less than 70% of prescribed medication is actually consumed. For chronic diseases, such as for example hypertension and diabetes this is even lower: approximately 50%. When diseases or conditions are treated sub-optimally, symptoms and complications may worsen, leading to increased use of hospital and emergency services, office visits and other medical resources. Increased adherence may generate medical savings that more than offset the associated increases in drugs costs. In addition to the costs, medication that is prescribed but not consumed must be disposed of in a sensible way, giving rise to additional costs. The non-consumed medication can pose a health risk when it is not brought back to the pharmacy or is not disposed of in another sensible way. For example a child can get hold of it and think it is candy and eat it with all the health risks going with it. Or the presence of the medication in some system can generate immunity against the active ingredient in the medication.
0009For the reasons described above, either separately or combined, it would be desirable to have means available to aid a patient, researcher, physician and/or pharmacist to increase the rate of compliance for taking medication and possibly not only increase the rate, but also increase the convenience, that is "the ease" with which compliance can be reached. In addition to the mentioned persons, it could also be advantageous for family and/ or friends and/ or other care takers around the patient.
0010Although the advantages are described above in connection to solid pharmaceutical preparations, the advantages can apply fully, or at least partially, to other fields where solid preparations are supplied to or taken by a person. An example of such another field outside the pharmaceutical field is the nutritional field, or the field of confectionary. The device according to the present invention can equally well be used in these and other fields; it is not limited to the pharmaceutical field. Therefore, the term "dispenser" refers to a device in a very brought sense as well as the term "solid preparation" and they cover all applications and application forms as mentioned before and hereafter.
0011The wording "solid preparation" is meant to encompass each and any form of solid dosage of a certain pre-determined amount and shape. With solid dosage is meant a dosage that during normal use by the user, such as for example a patient, retains its shape. It encompasses a dosage of a liquid or liquid-like substance that is captured within a solid skin. Examples of solid preparations are tablets, dragees, capsules and pills. Examples of solid preparations with a liquid or liquid-like substance captured in a solid skin are dragees with a gel-like substance contained in it. With solid pharmaceutical preparation is meant a solid preparation containing at least one pharmaceutically active compound. With solid nutritional preparation is meant a solid preparation containing at least one nutritionally active compound.
0012A dispenser for medication is known from <patcit id="pcit0001" dnum="US20060283876A"><text>US2006/0283876</text></patcit>. The dispenser according to <patcit id="pcit0002" dnum="US20060283876A"><text>US2006/0283876</text></patcit> comprises elements that can indicate the moment the medicament should be dispensed and it contains means to initiate an alarm at the moment that the medicament should be taken according to a pre-set frequency scheme. This dispenser can therefore help a patient to take the medicament at regular pre-set intervals according to a pre-set frequency.
0013A disadvantage of the dispenser according to <patcit id="pcit0003" dnum="US20060283876A"><text>US2006/0283876</text></patcit> is that it is impossible to analyze the patient's compliance to the pre-set medication regime. Some kinds of medication need to be taken at very strict intervals. Not obeying this regime can cause severe harm to the patient. Therefore the availability of this kind of information would be very helpful to, for example emergency doctors when the patient, due to the non-observance, needs to be brought to the hospital.
0014A dispenser, especially for dispensing solid preparations, comprising a housing having a dispensing orifice, and a collar member having a receiving opening, and a passage member having a receiving chamber, is known from the <patcit id="pcit0004" dnum="US2962190A"><text>US 2,962,190 A</text></patcit>. This document discloses a dispenser wherein a receiving chamber comprising a receiving opening and a dispensing opening is movable arranged within a housing, wherein in a first position the receiving opening of the receiving chamber is in a receiving communication with a housing providing the solid preparations and wherein the receiving chamber is in a second position providing a dispensing communication between its dispensing opening and a dispensing orifice of the housing. It is a disadvantage of this known dispenser that the compartment of the receiving chamber receiving the solid substances or preparations which shall be dispensed may receive more than one of these solid preparations. Thus, it is difficult or nearly impossible to assure that only one single dose will be dispensed.
0015A dispenser and/or a dispenser system comprising an electronic circuit and/or an energy supply for monitoring, controlling and/or communication as well as a method of monitoring a patient's medication compliance using a dispenser is known from <patcit id="pcit0005" dnum="WO2007081947A"><text>WO 2007/081947 A</text></patcit>. This known device and method comprise the use of a relatively complex constructed dispenser which might be improved under convenience aspects.
0016The present invention also relates to a method of monitoring a patient's medication compliance. Such a method involves utilizing an automatic compliance monitoring device, which tracks patient compliance data, along with a wave energy transmitter and power source. A receiver is connected to a computer. The dispenser or the computer is programmed to calculate compliance requirements by for example the number of cap openings. Such a method is known from <patcit id="pcit0006" dnum="EP0526166A1"><text>EP 0 526 166 A1</text></patcit>.
0017A disadvantage of the method described in <patcit id="pcit0007" dnum="EP0526166A1"><text>EP 0 526 166 A1</text></patcit> is that the compliance determination is vulnerable to manipulation, either deliberately or accidentally. For example when a patient opens his medication bottle to see how many pills are still in there and to determine whether he has to ask for a refill, the automatic compliance monitoring device records an opening of the bottle and records, falsely, compliance.
0018Solid pharmaceutical preparations and/ or solid nutritional preparations and/or solid confectionary preparations pose certain requirements on the atmosphere wherein they are contained. When the quality of the atmosphere surrounding the solid pharmaceutical preparations and/or solid nutritional preparations and/or solid confectionary preparations is not sufficient a reasonable shelf life can't be obtained. With a reasonable shelf life is meant a period of usually between six months and three years, typically at least two years. One factor influencing the quality of the atmosphere within the container is the relative humidity. Relative humidity (RH) has here and hereinafter its usual meaning, being the ratio of the actual humidity over the saturated humidity at the same temperature. To reach the reasonable shelf life indicated above, the relative humidity inside the container has generally to be maintained below 50%, preferably less than 40%, more preferably less than 30%.
0019A container for holding solid pharmaceutical preparations is known from <patcit id="pcit0008" dnum="US20070163917A"><text>US2007/0163917</text></patcit>. <patcit id="pcit0009" dnum="US20070163917A"><text>US2007/0163917</text></patcit> describes a package for pharmaceutical dosage forms, wherein the pharmaceuticals inside pose certain requirements on the level of oxygen and moisture present in the package. The pharmaceutical dosages are packed in a bottle. To decrease or at least maintain the oxygen level in the bottle at an acceptable level, a self-activated metal- based oxygen absorber is placed in one sub-container. To decrease or at least maintain the moisture level in the bottle at an acceptable level, a desiccant is placed in another, second, sub- container. The sub- container with the desiccant is covered on both open ends with membranes so as to allow the air in the container to enter the desiccant sub- container. The sub-containers can be separate units or unitary, that means they are fabricated together as separate compartments within a single unit.
0020A disadvantage of the construction chosen in <patcit id="pcit0010" dnum="US20070163917A"><text>US2007/0163917</text></patcit> is that the production process is difficult as first a bottle must be constructed, wherein at least two separate sub-containers must be placed. Additionally the filling of the bottle with the pharmaceutical dosages is difficult as the bottle already contains the sub-containers.
0021It is an object of the present invention to provide a blocking interaction during which it is not possible to unscrew the dispenser from a container provided therewith.
0022It is another object of the invention to provide means for increasing the rate of patient's compliance.
0023It is another object of the invention to control and/or monitor relative humidity and/or temperature in a dispensing system.
0024It is another object of the invention to overcome or at least diminish the above mentioned disadvantages and to provide a solution for proper dispensing a single unit dose of a substance when required.
0025This object is achieved by a dispenser, especially for dispensing solid preparations, comprising a housing having a dispensing orifice, and a collar member having a receiving opening, and a passage member, having a receiving chamber, wherein the housing and the passage member are, preferably jointly, movable relative in respect to the collar member between a first position with the receiving chamber being in receiving communication with the receiving opening of the collar member, and a second position with the receiving chamber being in dispensing communication with the dispensing orifice of the housing, wherein the dispenser comprises a locking element which comprises a sleeve-like member which is placed on the top of a container and surrounds the dispensing orifice of the container, wherein the locking element comprises two flexible elements which in the attached position of the locking element and the collar member interact with blocking surfaces provided at an inner wall of the collar member.
0026This object is also achieved by a dispenser system according to claim 13 comprising a dispenser according to claim 1, wherein the dispenser and/or the container comprises an electronic circuit and/or an energy supply for monitoring, controlling, indicating and/or communication, especially data communication, wherein the electronic circuit comprises: a sensor configured to detect a dispensing event of a single dose of the medication from the dispenser; a memory that stores information associated with the dispensing event; and a transceiver that wirelessly transmits the information associated with the dispensing event to an external device and/or wherein the electronic circuit comprises a temperature sensor and/or a humidity sensor positioned to detect the temperature and/or humidity of medication stored in the dispenser and/or the container, wherein the electronic circuit is further configured to communicate information relating to the temperature and/or humidity to an external device.
0027Finally, this object is achieved by a method of monitoring a patient's medication compliance using a dispenser according to one of the claims 1 to 12 and/or a dispenser system according to one of the claims 13 or 14, wherein the method comprises: <ol id="ol0001" compact="compact"><li>a. providing a dispenser system which dispenser system tracks at least one type of patient medicine compliance data, said dispenser system being connected to a container,</li><li>b. providing a wave energy transmitter and a power source to drive said transmitter for transmission of said patient's medicine compliance data to a remote location, said transmitter being electronically connected to said dispenser system for said transmission and said data transmitter and power source or supply being connected to said container,</li><li>c. having either said dispenser system or said computer programmed to store the prescribed medicine dosage and regime of said container,</li><li>d. having either said device or said computer programmed to calculate compliance requirements for each dosage administration for the prescription period of the medicine and for comparing the actual medicine consumption or container usage with the compliance requirements and/or wherein the method further comprises:</li><li>e. providing a receiver at said remote location and providing a computer to which said receiver inputs patient compliance data.</li></ol>
0028Favourable and advantageous embodiments of the invention are part of the depending claims.
0029The invention provides a dispenser wherein a blocking interaction between the flexible elements of the locking element and the stopping faces provided at an inner wall of the collar member constitute a releasable unscrew-blockade when the locking element and the collar member are attached to one another.
0030The invention further provides a dispenser, which allows the dispensing of a substance, especially a solid preparation, in a unit dose manner. Due to the relative movement of the housing together with the collar member between a first position wherein the receiving opening of the collar member is in receiving communication with the receiving chamber of a passage member and a second position wherein the receiving chamber is in dispensing communication with the dispensing orifice of the housing it is possible to design and form a dispensing channel or dispensing part or way of dispensing which only allows one unit dose or substance to be delivered from the receiving opening of the collar member to the receiving chamber of the passage member and from the receiving chamber of the passage member to the dispensing orifice of the housing - during each dispensing action - to reach and achieve this object it is one possibility that the housing and the passage member are, preferably jointly, movable relative in respect to the collar member. Thus, it is possible to have the collar member positioned, for instance by screwing, on a dispensing orifice of a preferably well known and commonly used container containing the respective solid substance, and then dispense the solid preparation by using the dispenser according to the invention. Such a dispenser device provides a dispenser, which is in permanent receiving and/or dispensing communication with the respective container.
0031It is further possible to provide the dispenser and/or the dispenser device with electronic means for monitoring, controlling and data communication, which additionally enhances therapy compliance. This will provide a dispenser system. Further, it is an advantage of the dispenser and the dispenser system according to the invention that it is easier to produce and easier to fill with the solid preparations, such as for example pharmaceutical preparations, because it is possible to provide a commonly used container, for example medication bottle, with a dispenser according to the invention.
0032A dispenser and/or a dispenser system provided with a docking station is referred to as a "system". Also a dispenser and/or a dispenser system provided with an external data base that stores information sent by a dispenser is referred to as a "system".
0033In order to close the guiding passage and/or the receiving opening of the collar member in case that one unit dose of a substance or one solid preparation has already been delivered to the receiving chamber and/or the guiding passage or in case that it is not desired to use the dispenser for dispensing the invention further proposes a dispenser wherein the passage member, which preferably is centrally arranged in the housing, closes the receiving opening when reaching its second position.
0034For the dispensing of a unit dose it is further of advantage, when the receiving chamber is dimensioned for accommodating one unit dose of a solid substance to be dispensed, as also proposed by the invention.
0035To ensure the delivery and a good guidance of a substance into the direction towards the dispensing opening of the collar member, the collar member may be hopper-like shaped towards the receiving opening and/or may comprise a funnel-like designed part extending from the receiving opening.
0036To support the performing and conducting of the movement of the housing and/or the passage member relative to the collar member between the first position and its second position, it is of advantage to have the support of resilient member. Therefore, a resilient means, especially a coil spring, can be arranged between the housing and the collar member biasing and/or urging them to move the passage member into the first position or the second position.
0037To connect the dispenser with a container it is according to the invention of further advantage to have a dispenser wherein the collar member comprises a circumferential outer fringe at its perimeter providing connecting elements which are suitable for interacting with corresponding connecting elements provided at a, preferably commonly used, container, especially at a dispensing opening of a medication bottle, preferably containing solid pills or capsules.
0038To ensure that a substance contained in the receiving chamber of the passage member and/or already positioned in the guiding passage will not be dispensed out and leave the dispenser accidentally, a closure which releasably closes the dispensing orifice of the housing can be provided. For instance, it is possible to block this closure, which may be a lit or a cap, so that it can only be opened in case that the medicine or substance shall be dispensed.
0039In many cases it is desirable to avoid that moisture or humidity from the outside environment enters the dispenser and/or the container connected therewith. To avoid this, it is further proposed to have a dispenser wherein sealingly interacting parts or elements are arranged between or respectively at the passage member and the collar member and/or between or respectively at the collar member and a container interacting therewith and/or between or respectively at the housing and the collar member and/or between or respectively at the housing and the passage member to provide a moisture tight seal, respectively.
0040To support this measure, at least one of the housing and/or the passage member and/or the collar member can be made at least partly of a desiccant entrained polymer, especially polypropylene or polyethylene. This allows to make the housing, the collar member and the passage member being moisture or humidity absorbing.
0041To provide a guidance for the passage member it is proposed to have a dispenser wherein the collar member provides an inner sleeve surrounding a perimeter of the passage member to accommodate and guide the passage member during its movement from the first to the second position and vice versa.
0042Sometimes it is important to identify whether a solid substance, such as a pill or a capsule, has already been and really been dispensed out of the dispenser. To ensure this, the invention proposes a dispenser further comprising a detector for monitoring the dispensing of each substance and/or particle, particularly a solid preparation, dispensed.
0043To allow only dispensing in cases that it is useful and in cases which are in accordance with the time table for taking medications, the dispenser may further comprise a mechanical or electro-mechanical blocking mechanism for releasably blocking relative movement between the movable collar member and the housing and/or between the passage member and the collar member and/or for releasably blocking the closure covering the dispensing orifice.
0044For controlling, monitoring and communicating all these actions, it is a further feature of the dispenser according to the invention to comprise an electronic circuit and an energy supply for monitoring, controlling, indicating and/or communication.
0045This also allows to additionally provide a dispenser which comprises at least one element indicating that at least one unit dose of the substance should be dispensed.
0046As above mentioned the members and elements of which the dispenser consists may be at least partly be made of a desiccant entrained polymer. But this is also favourable in respect to the dispenser device wherein a container is combined with a dispenser, so that the container is made at least partly of a desiccant entrained polymer, especially polypropylene or polyethylene.
0047The dispenser device comprising a dispenser and a container may comprise a container with an absorber function, suitable for holding solid preparations, wherein the absorber function is obtained by an absorber component and wherein the absorber component is an integral component of the material the container is made from. As the absorber component is an integral component of the material it is much easier to fill containers without the obstruction of a separate sub-container. With integral component is meant a component that is incorporated in the container material or in a part of the container material, but also attached to the container material in a manner it can't become detached by simple movement of the container. An example of the last embodiment is a liner or sleeve in the container, whereby the liner/sleeve is connected to the container by for example chemical means such as an adhesive or mechanical means such as for example a notch preventing the sleeve/liner from separating from the container. It is also possible to provide the absorber component during a coextrusion process or in a two step extrusion or blow moulding process.
0048An additional advantage is that there is no risk of breaking the sub-container. The breakage of the sub- container could release the absorber into the container. A further advantage of the container according to the invention is that there is no risk of falling out of the sub- container. When the sub-container would intentionally or unintentionally be removed, the absorber function is lost and the quality of the solid preparations in the container will quickly decrease, possibly posing health risks when the quality drops below a certain level.
0049The material of the container for use in the invention which has an absorber function and is suitable for holding solid preparations is preferably a polymer as polymers can easily be processed and formed into any desired shape. The technique of preparing a polymer composition suitable for use as container material or part of the container material is known from for example <patcit id="pcit0011" dnum="US5911937A"><text>US 5,911,937 A</text></patcit> or <patcit id="pcit0012" dnum="US6214255A"><text>US 6,214,255 A</text></patcit> which are included by reference. The absorber function in the container is especially suitable for absorbing moisture, gases and/ or odors.
0050The absorbing material in the polymer composition can be chosen from any kind of suitable absorber material. Suitable is meant herein to be suitable for the component to be absorbed. Examples of suitable absorber materials can fall in a number of categories: i) anhydrous salts that tend to absorb water and/ or moisture and form a stable salt, ii) reactive compounds that tend to react with water and/ or moisture upon the formation of a new species, or iii) absorbers that function via physical absorption for example via their fine capillary morphology. Suitable examples of physical absorbers are molecular sieves, silica gels, clays and starches.
0051According to another embodiment of the invention, the dispenser further comprises a container being in, preferably permanent, dispensing and/or receiving communication therewith and providing a substance and/or solid preparation to be dispensed.
0052Another embodiment of the dispenser according to the invention comprises a container, especially a medication container, which is equipped with an electronic temperature sensor and/or an electronic humidity sensor positioned such that the temperature and/or humidity within the container are measured, wherein the container and/or the dispenser is further equipped with electronic circuit that receives readings from the electronic temperature sensor and/or the electronic humidity sensor, and stores and/or transmits said readings to an external device. It is possible that the electronic temperature sensor, and/or the electronic humidity sensor, and/or the electronic circuit are connected to a dispenser disposed in dispensing communication with the container. Further, it is proposed that the circuitry comprises an alarm device, and wherein an alarm is produced when the temperature sensor and/or the humidity sensor indicates that a solid preparation, especially medication contained in the container is being stored at a temperature and/or humidity that is outside of an acceptable temperature and/or humidity range for said preparation.
0053According to the invention, the circuit further may receive information and/or commands from an external source wherein the information comprises an acceptable temperature and/or humidity range for the solid preparation, especially medication, contained in the container and/or an expiration date for the solid preparation, especially medication, in the container calculated based on the temperature and/or humidity readings sent to the external device, wherein it is also possible that the commands comprise a command to alert the user that the temperature and or humidity readings sent to the external device are outside of an acceptable temperature and/or humidity range.
0054Also, the invention proposes that the container or the dispenser further comprises a blocking device that prevents access to the solid preparation, especially medication, stored in the container, and wherein the commands comprise a command to activate the blocking device to prevent access to the solid preparation, especially medication, if the preparation, especially medication, has been stored at a temperature and/or humidity outside of an acceptable temperature and/or humidity range.
0055The dispenser system according to the invention comprises a dispenser and/or a container, which additionally comprises an electronic circuit and/or an energy supply for monitoring, controlling, indicating and/or communication, especially data communication, wherein the electronic circuit comprises: <ul id="ul0001" list-style="none" compact="compact"><li>a sensor configured to detect a dispensing event of a single dose of the medication from the dispenser;</li><li>a memory that stores information associated with the dispensing event; and</li><li>a transceiver that wirelessly transmits the information associated with the dispensing event to an external device and/or wherein a humidity sensor positioned to detect the temperature and/or humidity of medication stored in the dispenser and/or the container, wherein the electronic circuit is further configured to communicate information relating to the temperature and/or humidity to an external device.</li></ul>
0056The electronic circuit may be configured to receive commands from an external device. The commands of the dispenser system may comprise a lock and/or an unlock command that causes the dispenser to lock and/or unlock dispensing of medication.
0057The invention further discloses a dispenser system wherein the dispenser communicates with a second dispenser to coordinate the administration of medication from the dispenser and the second dispenser.
0058The above-mentioned object is also reached or achieved by a method of monitoring a patient's medication compliance using a dispenser according to claim 1 and/or a dispenser system as mentioned in claim 13 and/or 14 wherein the method comprises <ul id="ul0002" list-style="none" compact="compact"><li>a. providing a dispenser system which dispenser system tracks at least one type of patient medicine compliance data, said dispenser system being connected to a container,</li><li>b. providing a wave energy transmitter and a power source to drive said transmitter for transmission of said patient's medicine compliance data to a remote location, said transmitter being electronically connected to said dispenser system for said transmission and said data transmitter and power source or supply being connected to said container,</li><li>c. having either said dispenser system or said computer programmed to store the prescribed medicine dosage and regime of said container,</li><li>d. having either said device or said computer programmed to calculate compliance requirements for each dosage administration for the prescription period of the medicine and for comparing the actual medicine consumption or container usage with the compliance requirements and/or wherein the method further comprises:</li><li>e. providing a receiver at said remote location and providing a computer to which said receiver inputs patient compliance data,</li></ul>
0059In the method according to the invention a dispenser system is used that is connected to a container, generally a medicine container. The container can either be a well-known medicine container or a container with an absorber function as described above. It is preferred to use a container with an absorber function as this type of container makes it possible to use the container for prolonged periods of time without the medicament loosing quality.
0060A method of monitoring a patient's medication compliance can comprise <ul id="ul0003" list-style="none" compact="compact"><li>a. providing a dispenser system which dispenser system tracks at least one type of patient medicine compliance data, said dispenser system being connected to a container,</li><li>b. providing a wave energy transmitter and a power source to drive said transmitter for transmission of said patient's medicine compliance data to a remote location, said transmitter being electronically connected to said dispenser system for said transmission and said data transmitter and power source or supply being connected to said container,</li><li>c. having either said dispenser system or said computer programmed to store the prescribed medicine dosage and regime of said container, and</li><li>d. having either said device or said computer programmed to calculate compliance requirements for each dosage administration for the prescription period of the medicine and for comparing the actual medicine consumption or container usage with the compliance requirements.</li></ul>
0061Additionally, this method may comprise providing a receiver at a remote location and providing a computer to which said receiver inputs patient compliance data.
0062Particular embodiments of the invention will now be described in reference to the accompanying drawings in which: <dl id="dl0001"><dt>Fig. 1</dt><dd>diagrammatically shows in cross section a dispenser according to the invention in combination with a medicine container in an inactive first position;</dd><dt>Fig. 2</dt><dd>diagrammatically shows the dispenser of <figref idref="f0001">Figure 1</figref> moved into a second position;</dd><dt>Fig. 3</dt><dd>diagrammatically show the release of a single pill or tablet after the dispenser of <figref idref="f0001">Figure 1</figref> has returned to the first position;</dd><dt>Fig. 4</dt><dd>diagrammatically shows a perspective view onto the container of the embodiment according to <figref idref="f0001 f0002 f0003">Fig. 1-3</figref> with the collar member removed;</dd><dt>Fig. 5</dt><dd>diagrammatically shows a perspective view onto the inner side of a collar member according to the embodiment of <figref idref="f0001 f0002 f0003">Fig. 1-3</figref>;</dd><dt>Fig. 6</dt><dd>diagrammatically shows a perspective view on the inner side of a closure cap of the embodiment according to <figref idref="f0001 f0002 f0003">Fig. 1-3</figref>;</dd><dt>Fig. 7</dt><dd>diagrammatically shows a block diagram of the electronic monitoring and communication means of a dispenser;</dd><dt>Fig. 8</dt><dd>diagrammatically shows the/a dispenser in association with a docking station for the exchange of monitoring and communication data;</dd><dt>Fig. 9</dt><dd>diagrammatically shows a block diagram of the docking station of <figref idref="f0007">Figure 8</figref>; and</dd><dt>Fig. 10</dt><dd>diagrammatically shows a therapy compliance monitoring and communication system.</dd></dl>
0063An embodiment of the invention is explained in respect to <figref idref="f0001 f0002 f0003">Figures 1-3</figref>. For dispensing again the collar member 609 is moved in respect to the housing 603 and the passage member 605 into a first position with the receiving chamber 602 being in receiving communication with the funnel-like shaped receiving opening 604 of the collar member 609 and into a second position with the receiving chamber 602 being in dispensing communication with the dispensing orifice 606 of the housing 603, where the receiving member 602 is not in receiving communication with the receiving opening 604 anymore. The embodiment further comprises a locking element 650, which interacts with the collar member 609, a separating element 652 connected to the passage member 605 and extending into the receiving opening 604 and a closure cap 654 provided at the bottom of the housing 603.
0064The locking element 650 comprises a sleeve-like member 651, which is placed on the top of a container 617 surrounding the dispensing orifice of the container 617. As can be seen from the <figref idref="f0004">Figures 4 and 5</figref> the locking element 650 comprises two flexible elements 656, which in the attached position of the element 650 and the collar member 609 interact with stopping faces 658 provided at the inner wall of the collar member 609. During this blocking interaction it is not possible to unscrew the dispenser 601 from the container or medicine bottle 617. To open the dispensing orifice of the container 617 the elements 656 have to be pushed to come free from the blocking surfaces 658, so that it is then possible to unscrew the dispenser from the container 617.
0065The separating element 652 comprises bar-like elements 660 provided on its surface, which are helpful for separating solid preparations containing the container 617 so that only one above the other enters the dispensing opening 604. The bar-like element 660 may also be provided with brushes, which improve the separating effect.
0066Another feature is the closure cap 654, which is rotatable for some degrees in circumferential direction mounted outside at the bottom of the housing 603. It can be see from <figref idref="f0005">Figure 6</figref>, that this closure cap 654 is provided with the dispensing orifice 606 of the housing 603. Further the closure cap 654 comprises a resilient member 662, which interacts with the bottom 607 and urges the closure cap 654 at its position attached to the bottom 607 of the housing 603 into a position where the bottom 663 of the cap 654 faces the exit opening 631 of the guiding passage 629, so that a solid preparation 225 can not be dispensed although it is already placed in the guiding passage 629. For dispensing such a solid preparation 225, it is necessary to turn and rotate the closure cap 654 for some degrees against the force of the resilient member 662 until the dispensing orifice 606 comes in an aligned position with the exit opening 631. In this position now the solid preparation 225 will fall out by gravity and be dispensed.
0067Within the housing 603 there are arranged an electronic circuit 643 and a laser detector or detecting sensor 641 and although not shown an energy supply means and other electronic elements to be used for monitoring, controlling, indicating and/or communication with elements outside the dispenser 601 or the dispenser device 610. For arranging the electronic elements, there might be a compartment 666 provided at the bottom side of the passage member 605.
0068Alternatively, in respect to the rotatable arranged closure cap 654 it is also possible to have a sliding or closing flap closing the dispensing orifice 606 of the housing 603 which has to be opened for dispensing a solid preparation 225, 227. The embodiment as disclosed above may comprise humidity and/or moisture and/or temperature detecting sensors, although not mentioned in detail. Especially the container 617 is equipped with an electronic temperature sensor 2538 and/or an electronic humidity sensor 2536 as referred to below.
0069The dispenser 601 is provided with an upstanding wall 635, wherein the dispenser 601 likewise comprises a depending wall 637 and wherein the dispenser is provided with an inner sleeve 609A. This inner sleeve 609A also constitutes a stopper element which stops further relative movement between the collar member 609 and the passage member 605 as soon as the first position of the receiving chamber 602 being in receiving communication with the receiving opening 604 is reached. For this purpose - as can be seen from <figref idref="f0002">Fig. 2</figref> - the inner sleeve 609A abuts upon a rim portion 616 provided at the lower part of the opening of the receiving chamber 602.
0070Also for providing a guiding means the collar member 609 and the housing 603 are provided with guiding means 628, 630, wherein guiding means also extend into the closure cap 654 where it is referenced by reference number 632.
0071The dispensing mechanism of the embodiment according to <figref idref="f0001 f0002 f0003">Fig. 1-3</figref> is as follows: <figref idref="f0001">Figure 1</figref> shows the starting position of the container 617, containing solid preparations 225, 227, which container is provided with a dispenser 601 to build a dispensing device 610. The collar member 609 is mounted on the dispensing orifice of the container 617 with its receiving part extending in the region of the dispensing orifice of the container 617. This receiving part comprises a funnel-like shaped receiving opening 604, which is closed at its bottom side and at its inner side. It is delimited and obstructed by a passage member 605 extending longitudinal within the housing 603 and being fixed with the housing 603. The funnel-like shaped receiving opening 604 is filled with two solid preparations 225, 227. Starting form this position, which is the same as the position as shown in <figref idref="f0003">Figure 3</figref> and which is the second position wherein the housing 603 and the passage member 605 are in a position with the receiving chamber 602 being in dispensing communication with a dispensing orifice 606 of the housing 603, the collar member 609 on one hand and the housing 603 and the passage member 605 on the other hand are moved relatively to each other until the position as shown in <figref idref="f0002">Figure 2</figref> is reached. In this position the receiving chamber 602 is now in receiving communication with the receiving opening 604 so that one single solid preparation 225 enters the receiving chamber 602. Because the receiving chamber 602 has a dimension, which allows to receive and contain only one unit dose of a solid preparation, the remaining solid preparation 227 remains in the receiving opening 604. From this position the collar member 609 and the housing 603 together with the passage member 605 are moved back into the first position as shown by <figref idref="f0003">Figure 3</figref> where now the receiving chamber 602 is in receiving communication with the dispensing orifice 606 via the guiding passage 629, which is formed within the housing 603. Therefore, the solid preparation 225 leaves the housing 603 by gravity, whereas the remaining solid preparation 227 is together with the collar member 609 moved back into the starting position, where the receiving opening 604 is separated from the receiving chamber 602.
0072In <figref idref="f0001 f0002 f0003">Figures 1-3</figref> it can also be seen that the dispenser 601 is provided with the electronic circuit 643 and the detecting sensor 641 for detecting the dispensing of a unit dose of a solid preparation 225. Also it can be seen that a spring 611 is positioned within the housing 603 and partly within the collar member 609 as well as in its tensed position (<figref idref="f0002">Figure 2</figref>) as in its expanded position (<figref idref="f0001">Figures 1</figref> and <figref idref="f0003">3</figref>).
0073The housing 603 has a substantially hollow interior with the passage member 605 extending from the bottom 607 of the housing 603. Surrounding the passage member 605 is the movable collar member 609, which is urged by a resilient means in the form of the coil spring 611 towards a circumferential detent which is arranged at an upper position of the housing 603 and prevents the movable collar member 609 from escaping from the housing 603. The housing 603 and the passage member 605 are connected to each other and are jointly movable relatively in respect to the collar member 609 as well as the collar member 609, which is attached to the container 617, is relatively movable in respect to the housing 603 and the passage member 605. It is possible to move the housing 603 and the passage member 605 and the collar member 609 against the force of the resilient means, i.e. the coil spring 611, to a first position as shown in <figref idref="f0002">Figure 2</figref> wherein a receiving chamber 602 of the passage member 605 is in receiving communication with the receiving opening 604 of the collar member 609. Likewise it is possible to move the housing 603 and the passage member 605 in a second position as shown in <figref idref="f0001">Figure 1</figref> wherein the receiving chamber 602 is in dispensing communication with the dispensing orifice 606 provided in the housing 603. In this embodiment the coil spring 611 drives or urges the housing 603 and the passage member 605 on the one hand and the collar member 609 on the other hand automatically in a self-acting manner into the second position as shown by <figref idref="f0001">Figure 1</figref>. The solid preparations 225 and 227 can be a solid pharmaceutical agent or solid substances in the form of for example a pill or a tablet. As shown in <figref idref="f0001">Figure 1</figref> the dispenser 601 is in its second - and at this stage inactive - position and/or situation.
0074The receiving chamber 602 is dimensioned to only accommodate a single one of the shaped preparations 225, 227 once the movable collar member 609 is in the first position.
0075In the second position of the collar member 609 and the receiving chamber 602 relative to each other the receiving chamber 602 is in dispensing communication with the dispensing orifice 606 of the housing 603. But, the receiving chamber 602 is not in receiving communication with the receiving opening 604 anymore.
0076Suitable examples of relatively soft materials for use in the construction of passage member 605 or movable collar member 609 are materials with a Shore A hardness of maximally 60, preferably less than 50, more preferably less than 35. Suitable materials are for example natural and/ or synthetic rubbers, elastomers, thermoplastic elastomers, vinyl-based polymers and/or plastomers, such as for example TPV, TPO, EP(D)M, SEBS, SBS, PE, copolymers of PP and PE. Other suitable materials are for example nylon, polyurethane and/or Teflon. Foams of materials with a suitable Shore A hardness are also suitable. Also compounds and/ or blends of suitable types of materials are an option. The man skilled in the art can easily determine which material is most suitable for use with a specific solid preparation.
0077Depending on the kind of solid preparation to be dispensed, it can be advantageous to use only materials that are approved for use in contact with food and/ or pharmaceuticals, such as for example FDA- approved materials.
0078The embodiment of dispenser 601 is provided with therapy compliance means in the form of electronic monitoring and communication means. The monitoring means includes laser detector which detects the passage of a solid preparation through the guiding passage 629 when it exits from the exit opening 631. The laser detector is, advantageously, an LED (light emitting diode) which emits light within the IR-frequency range, so that accidental triggering by ambient light can be prevented. Further the dispenser 601 is provided with an electronic circuit 643 which is in the form of a printed circuit board and includes an antenna for external communication. An energy supply means 645 to supply the necessary energy for the laser detector and the electronic circuit 643 is provided in the form of a battery. It is further advantageous for battery life, when the laser detector and its related circuitry is kept in a sleeping mode until the dispenser is actuated by a user.
0079<figref idref="f0006">FIG. 7</figref> shows a block diagram of an electronic circuit 2500 for use in monitoring and controlling administration of medications and for communication. The dispenser 601 and/or the container 617 comprises the electronic circuit 643, 2500. The electronic circuit 2500 includes a processor 2502, which may, for example, be an 8-bit microcontroller, such as a P89LPC936, developed by Philips and available from NXP Semiconductors Netherlands B.V. Of course, it will be understood that other processors or microcontrollers may also be used in the electronic circuit 2500. In some embodiments, the processor 2502 may be clocked by an external clock or crystal 2503.
0080The processor 2502 may include a memory 2504, for storing programmed instructions for the processor 2502 and/or data used by the electronic circuit 2500. Alternatively, the memory 2504 may include one or more external memory devices (not shown). The memory 2504 may include non-volatile memory, such as flash memory, EEPROM memory, or static memory, and/or volatile memory, such as DRAM.
0081The electronic circuit 2500 is powered by an energy supply 645, 2506 in form of a battery, which may have its electrical characteristics adapted to the needs of the electronic circuit 2500 by a power regulator 2508. The battery 2506 may be a conventional replaceable battery, or a rechargeable battery, which may be recharged, for example, when the device is connected to a docking station (see below). The power regulator 2508 may also include the ability to detect the status of the battery 2506, and provide the status information to the processor 2502. In some embodiments, an additional battery measuring device (not shown) may be used to measure the status of the battery 2506.
0082The processor 2502 communicates with a first transceiver 2510, which communicates wirelessly with other electronic devices via a first antenna 2512. The first transceiver 2510 uses radio frequency (RF)-based communication, such as Near Field Communication (NFC) or other wireless communication technologies suitable for short-range and/or low-power wireless communication, such as other RFID technologies, Bluetooth, or ZigBee. Where power considerations permit longer range communications, other wireless communications technologies, such as Wi-Fi, WiMAX, or various cellular technologies may be employed.
0083In some embodiments, where the device includes an optional display 2514, the processor 2502 may further include a display driver 2516, to operate the display 2514. In some embodiments, the display driver 2516 may be implemented at least in part as driver software. In some embodiments, the display driver 2516 may be a separate device (not shown), rather than being included in the processor 2502.
0084As discussed above, a detecting sensor 641 or optical detector 2518, such as a laser detector, an LED and detector, an infrared LED and detector, or other opto-electronic detection device, is used to determine when a solid preparation 225, 227, such as a pill, has been dispensed by the device. A signal from the optical detector 2518 is provided to the processor 2502 for evaluation. In some embodiments, where there are multiple optical detectors (not shown), such as where there are multiple dispensing paths for pills, in which case one such detector may be present in each such path, signals from each of these the optical detectors are provided to the processor 2502.
0085The electronic circuit 2500 may also include numerous control switches for adjusting the settings of the processor 2502 and/or of the electronic circuit 2500. For example, a first switch 2520 can be used to activate or deactivate the electronic monitoring and communication. A second switch 2522 can be used to detect tampering with the dispenser device by detection its removal from the container. Third and fourth switches 2524 and 2526 may be used, for example, for setting the time in hours (third switch 2524) and minutes (fourth switch 2526). A fifth switch 2528 may be used to select use of an audible alarm, such as a buzzer 2530, which may be sounded when, for example, a patient has forgotten to dispense a medication at the time that he is supposed to take it, or when temperature and/or humidity sensors indicate that the medication is being improperly stored. It will be understood that, depending on the user interface needs of the embodiment, the control switches may be assigned to other functions.
0086The electronic circuit 2500 may also optionally include alarm devices, such as the buzzer 2530 and/or a vibration device 2532. These alarm devices may be activated by the processor 2502 separately or in unison, to alert a user to a variety of conditions. In some embodiments, the buzzer 2530 may be controlled to produce a variety of different sounds to alert a user to various conditions. For example, one sound may be used to warn the user that he should take a dose of a medication, another sound may be used to warn the user that he is attempting to dispense additional medication before it is safe to take another dose, a further sound may be used to warn the user that the medication in the container is running low, another sound may be used to indicate that the battery is low, and still another sound may be used to indicate to the user that temperature and/or humidity sensors are indicating that the medication is not being properly stored. In some embodiments, the buzzer 2530 may be a small speaker, capable of producing sounds including buzzing noises, speech, musical tones, or other sounds, depending on the message to be conveyed to the user.
0087The timing of the sounds or vibrations produced by the buzzer 2530 and/or vibration device 2532 may be controlled by the processor 2502 to convey particular meanings or warnings. For example, the processor 2502 may be programmed to use the buzzer 2530 to produce a warning sound at a predetermined time after the solid preparation should have been dispensed. For example, a short beep could be generated every minute during one hour following the time when the solid preparation should have been dispensed. The processor 2502 may be programmed to cease such warnings when the solid preparation has been dispensed through the dispenser.
0088The processor 2502 may be programmed to use the vibration device 2532 in a similar manner. For example, the vibration device 2532 may be switched on for one second at the time that the solid preparation should be dispensed. This may be repeated, for example, sixty minutes later, if the solid preparation is not dispensed.
0089In some embodiments, the electronic circuit 2500 may optionally be connected to a blocking mechanism 2534. When activated, the blocking mechanism 2534 prevents the dispenser from dispensing a solid preparation. This can be achieved, for example, by sending electrical signals to a motor or solenoid to move a stopper notch between a locked and an unlocked position, as described above. The blocking mechanism 2534 may be used, for example, to prevent a user from dispensing a further dose of a medication during a time period over which a further dose is not needed or could be dangerous, or from dispensing medication which may have been damage by exposure to temperatures or humidity levels outside of an acceptable range.
0090In some embodiments, the electronic circuit 2500 may further include additional sensors, such as an optional humidity sensor 2536 and/or an optional temperature sensor 2538, positioned in such a way that they are able to detect the humidity and/or temperature of the pills, capsules, or other solid preparations stored in the dispenser device 601. The humidity sensor 2536 may, for example, be a capacitive humidity sensor, a resistive humidity sensor, a thermal conductivity humidity sensor, or other suitably small, commercially available electronic humidity detection device. Similarly, the temperature sensor 2538 may be a thermistor or other resistance temperature detector, or any other suitably small, commercially available electronic temperature detector. These sensors should be positioned so that they measure the temperature and/or humidity of the pills, capsules, or other solid preparations stored in the container, bottle, or dispenser.
0091Generally, the electronic circuit 2500 may be configured to fit within a portion of the dispenser mechanism, as described in respect to <figref idref="f0001 f0002 f0003 f0004 f0005">Figures 1-6</figref> above. Individual components of the electronic circuit 2500 may be built into other portions of the dispenser, depending on their function. For example, the humidity detector 2536 and temperature detector 2538 may be positioned so that they measure the humidity and/or temperature in the locations where pills, capsules, or other solid preparations are stored.
0092In addition to the features described above, the dispenser mechanism may include an identity detection device (not shown). Such an identity detection device may be connected to the electronic circuit 2500 to permit the user of the dispenser to be identified. An example of such an identity detection device is a fingerprint reader and identifier. The processor 2502 may be programmed to accept signals from such a fingerprint reader (not shown), and to activate the dispenser only when the fingerprint read by the fingerprint reader matches a stored fingerprint. The stored fingerprint may be stored in the memory 2504, or in a memory associated with the fingerprint reader (not shown). Since fingerprints are unique, the fingerprint of the authorized user of the device may be stored, so that only the authorized user of the device is able to activate the dispenser and to dispense a solid preparation. Other identity detection devices could also be used, including other (preferably small/portable) biometric devices, or security measures such as requiring the user to enter a combination or a personal identification number (PIN).
0093By adding such an identity detection device to the electronic circuit 2500, an identity function may be implemented for the dispenser. This identity function makes it possible that only an authorized or intended user, such as the patient or a caregiver, can activate the dispenser. Using this feature, the solid preparation could not be dispensed, for example, by a child who finds the device. Additionally, the identity function may reduce the risk of taking the wrong medication, for example if there are several such dispensers being used by different people in a single household.
0094Further, the electronic circuit 2500 may be connected to an RFID reader (not shown) in the dispenser. Some medication containers (not shown) may be equipped with RFID chips (not shown) that can contain information on the medication in the container. Such RFID chips may be placed on or built into the container when the container is manufactured, or at a later time, such as when a pharmacist provides the container containing medication to the patient. The RFID chip in such a container may be a standard MIFARE RFID chip, or any other type of RFID chip or tag. A drug manufacturer, physician, and/or pharmacist may store information on the RFID chip. For example, the RFID chip may include the date and time of packing a medication in the container, the content of the container, the drug type and number of pills, the expiration date of the medication, a unique identification number, patient medication intake times, length of the course of treatment, pharmacist license number, prescribing physician license number, proper storage temperature and humidity ranges, and/or other information pertaining to the solid preparation contained in the container.
0095The RFID reader may be used to read this information from the RFID chip attached to the container when the dispenser is attached to the container. The information can then optionally be stored in the memory 2504, and used by the processor 2502 for a variety of purposes. For example, if the dispenser includes a display, such as the display 2514, the information read by the RFID reader may be displayed. This can reduce the risk of taking the wrong medication or medication that has passed its "use by" date. The risk of taking the wrong medication may be especially pronounced when a patient needs to take two or more types of medication. When an RFID reader in the dispenser is used with an RFID chip on the container, the patient is able to read on the display which of his medications is contained in the container. This may be particularly useful when the labelling of the container has faded, for example due to frequent use or contact with water or solvents. The processor 2502 may use the information read from an RFID chip on the container for purposes such as displaying the drug contained in the container, determining when the container is almost empty (based on pill count), automatically programming the times that the solid preparation should be dispensed or accessed so that the processor 2502 may generate alarms at the proper times, producing a warning when a medication has expired or has been stored at an unacceptable temperature and/or humidity level, preventing a user from dispensing or accessing the solid preparation at the wrong times, after it has expired, after a course of treatment has been completed, if improper temperature and/or humidity conditions may have affected the medication, and other uses for such information.
0096Additionally, in some embodiments, the RFID reader may also store information back into the RFID chip on the container. This means that compliance information may be available in the container chip when it is returned to the pharmacist, for example for a refill.
0097Referring now to <figref idref="f0007">FIG. 8</figref>, a system 2600 for communicating with a dispenser 601, 2601 is described. A docking station 2602 is used for electronic data communication and electronic data transfer between the dispenser and a computer (not shown) or other communication device (not shown). Additionally, in some embodiments, the docking station 2602 may be used to recharge a rechargeable battery in the dispenser.
0098In some embodiments, the docking station 2602 may include a wired connection 2604, such as a USB connection or other wired connection for transferring data between the docking station 2602 and a computer or other communication device. In some embodiments, the docking station 2602 may include a wireless communication device (not shown) to allow the docking station 2602 to communicate via a wireless connection, such as through a cellular network, a wireless wide area network, or a wireless local area network. The docking station may be powered using an AC mains adapter 2606, or through power received over the wired connection 2604.
0099The docking station 2602 is also equipped with an electronic reader-writer device (described below), for reading and writing data from the dispenser. In some embodiments, where the dispenser is able to communicate directly with a wide area network or cellular network, or where the communication is handled by a portable reader, such as a mobile phone equipped with an NFC reader, the docking station 2602 may not be needed for the dispenser to communicate its data.
0100<figref idref="f0008">FIG. 9</figref> shows a block diagram of an electronic reader-writer device 2700 suitable for use in the docking station 2602 of <figref idref="f0007">FIG. 8</figref>. The reader-writer device 2700 includes a second transceiver 2702 with a second antenna 2704 for communicating with the first transceiver 2510 in the dispenser, as shown in <figref idref="f0006">FIG. 7</figref>. When used with the reader-writer device 2700 in a docking station, the dispenser may preferably use a low power, short range communication technology, such as Near Field Communication (NFC), Bluetooth, or ZigBee. Other communications technologies suitable for longer range wireless communications may also be used, such as WiFi or other wireless local area network (WLAN) technology. Of course, the communication technology used by the reader-writer should be compatible with the communication technology used by the dispenser. Alternatively, a physical electrical connection between the dispenser and the docking station could be used, assuming that the dispenser includes an appropriate interface. For example, if the dispenser has a USB interface, it may be possible to connect it to the docking station (or directly to a USB-equipped external computer) using the USB interface. A physical interface, such as a USB interface, may also be useful for charging a rechargeable battery in the dispenser.
0101The reader-writer device 2700 also may include a wired connection interface 2706. The wired connection interface 2706 may be, for example, a USB interface through which the reader-writer device connects the docking station to an external computer system. Other types of wired connections, such as a serial connection or a wired Ethernet connection could also be used.
0102The reader-writer device 2700 may be powered from an AC adapter (not shown) through a voltage regulator 2708. Alternatively power may be received from other sources, such as through the wired connection interface 2706.
0103Once the data are transferred from the dispenser to an external computer (through a docking station, such as the docking station 2602, shown in <figref idref="f0007">FIG. 8</figref>, when the dispenser is unable to communicate directly with the external computer), the external computer can transfer the data to a remote computer via a wide area network, such as the Internet. The dispenser may also receive data via a wide area network through an external computer (and, possibly a docking station). Further, programming or instructions for the electronic circuit 2500 of the dispenser, as shown in <figref idref="f0006">FIG. 7</figref>, may be sent from a computer at a remote location, and communicated to the dispenser via the Internet or other wide area network. The remote computer may, for example, be accessible by a physician, pharmacist, or other medical professional who is overseeing the therapy compliance of the patient who is using the dispenser. It will be understood that in some embodiments, where the dispenser includes wide-area networking or cellular communication capabilities, the dispenser may be able to connect to the Internet and/or the remote computer system without using an external computer or docking station to establish the connection. It will also be understood that in some embodiments, a mobile device, such as an NFC-equipped mobile telephone may be used to communicate between the remote computer and the dispenser.
0104Such a system is shown in <figref idref="f0009">FIG. 10</figref>. The system 2800 of <figref idref="f0009">FIG. 10</figref> includes one or more dispensers 2802, which include the electronic circuitry 2500 as shown in <figref idref="f0006">FIG. 7</figref>. For purposes of illustration, these dispensers include NFC communication circuitry, which allows them to transfer data between a dispenser 2802 and an NFC-equipped mobile telephone 2804. The NFC-equipped telephone 2804 can wirelessly communicate via a wide area network 2806, such as a cellular communication network or the Internet with a remote database 2808, which collects and stores information from the dispenser(s) 2802. The remote database 2808 can be accessed (through the wide area network 2806 or a different wide area network) by a remote computer 2810, which may also remotely send instructions to the dispenser(s) 2802 through the wide area network 2806 and the mobile telephone 2804.
0105It will be understood that the communication path may be somewhat different, depending on the technology used. For example, if no NFC-equipped mobile phone is available, the dispenser may use a docking station (not shown) connected to a computer (not shown) to communicate with the remote database 2808 and/or the remote computer 2810. Alternatively, in some embodiments, the dispenser may be able to directly connect to the wide area network, and communicate with the remote database 2808 and/or the remote computer 2810 without using an NFC-equipped mobile telephone or a docking station.
0106As can be seen in <figref idref="f0009">FIG. 10</figref>, the therapy compliance monitoring and communication means provided can be mobile. The dispenser 2802 is arranged for monitoring the therapy compliance of a patient, and for remotely allowing or disabling the dispensing of a solid preparation, to help ensure therapy compliance. Wired and/or wireless communications can be used to report therapy compliance to the remote computer 2810, which may be used by a physician, pharmacist, or other medical caregivers to monitor compliance. Additionally, administration of therapy may be controlled or adjusted from the remote computer 2810, depending on the therapy compliance reporting received. Further, as can be seen, in addition to the Internet, other communication technologies may be used in the remote surveillance and control of therapy compliance, including mobile platforms, such as the mobile telephone 2804, and the like.
0107When a container 617 with a solid preparation is issued by a pharmacist, the dispenser 2802 according to an embodiment of the invention is put in place on the container, such that solid preparations may be taken from the container by pushing a button on the dispenser 2802. The dispenser 2802 has a built-in clock/calendar so that when the button is operated and a solid preparation, such as a pill or tablet is dispensed, the date and time of this event are stored in a memory in the dispenser 2802. Similarly, the times of other events, such as recording of temperature and or humidity readings can be stored. The dispenser 2802 may optionally be programmed so that the solid preparation may only be dispensed at pre-programmed times, depending on the medication prescribed, and the instructions of the physician and/or pharmacist. This may prevent a patient from taking too many doses, since the dispenser 2802 is blocked after a dosage is taken, and will only dispense a further dose when the next dosage should be taken. It should also be noted that this option of programming the dispenser provides the opportunity to register and regulate a combination therapy, whereby more than one type of medication must be taken, as will be described in greater detail below.
0108Next, the date and time stamp at which a dose was dispensed, and/or other information, such as temperature and/or humidity data are transferred over the wide area network, which may be a mobile telephone network, such as GSM or GPRS, to the patient's record in the remote database 2808. As shown in <figref idref="f0009">FIG. 10</figref>, in some embodiments, this transfer may be accomplished by reading the data from the dispenser using a Near Field Communication (NFC) mobile phone 2804, or by using another gateway for conversion of data from NFC or Bluetooth devices into SMS and GPRS data. It will be understood that other communication options, as described above are also possible. In some embodiments, other data collected by the dispenser may also be transferred along with the compliance data. For example, data concerning the temperature and humidity of the stored medication may be transferred. These data may indicate whether the pills, capsules, or other solid preparations are being stored in appropriate conditions. This information may be used to send the patient and/or the pharmacist or physician a warning if the medication is being stored at an inappropriate temperature or humidity. This data could also be used, for example, to dynamically adjust the expiration date of a medication, depending on its storage conditions, or to prevent a patient from taking medications which could become dangerous if stored for a period of time in an inappropriate manner. Other information, such as the battery status may also be transferred. This data may, for example, be used to warn the patient or pharmacist if a non-rechargeable battery in the dispenser device will need to be replaced.
0109The patient record in the database 2808 contains various kinds of patient information, including the therapy compliance records for the patient received from one or more dispensers. This information can be securely accessed by physicians, pharmacists, or other authorized medical caregivers from a remote computer 2810 over a wide area network, such as the Internet. The compliance data may be correlated and analyzed in the remote database 2808 or on the remote computer 2810, and if mal-compliance or non-compliance are detected, the patient can be warned, for example via an SMS service or the like. In some embodiments, when non-compliance or mal-compliance are detected, a call centre, pharmacist, and/or care organization may receive an instruction to call the patient to discuss his mal- or non-compliance.
0110A dispenser according to an embodiment of the invention can also communicate with another dispenser, either directly, through a docking station, or through a network. An advantage of such a dispenser is that it is possible to regulate an order in which two or more medications are taken. For example, in AIDS treatment, a combination of drugs may be prescribed, which need to be taken in a strict order and according to a strict time schedule. For example, the prescription schedule can specify that a first medication should be taken first, followed within one hour by a second medication. If the patient forgets that he has already taken the required dosage of the first medication, he may try to "correct" this by taking another dose of the first medication. Such non-compliance can have serious effects on the health of the patient and on the effectiveness of the treatment.
0111By communicating with each other, the dispensers according to an embodiment of the invention can reduce this problem. Using the above-described example, a first dispenser for a container containing the first medication can block further dispensing of the first medication until it receives a communication indicating that a second dispenser for a container containing the second medication has dispensed a dose of the second medication. Thus, a new dose of the first medication can only be taken after the required dose of the second medication has been taken. The time for taking the second medication can be set by the second dispenser receiving a communication indicating that the first medication has been dispensed by the first dispenser, causing the second dispenser to set a buzzer or other alarm feature to provide a warning one hour later that the second medication should be taken. By use of dispensers that are able to communicate with each other, according to an embodiment of the invention, a strict medication regime can be followed with reduced effort by the patient and with an increased rate of compliance.
0112It should be noted that in accordance with various embodiments of the invention, communication between the dispensers can be achieved directly between the dispensers, or via an indirect method. For example, the dispensers may communicate through a base station, or through a wireless network. Also, the dispensers could communicate indirectly through a database, such as the remote database 2808 shown in <figref idref="f0009">FIG. 10</figref>, or through another computer or communication device that receives and sends communications to dispensers in accordance with various embodiments of the invention.
0113The dispenser according to the invention can be used for dispensing various sizes and shapes of solid preparations. This feature makes it possible to use the dispenser several times for different solid preparations.
0114The dispenser according to the invention can be used in combination with any type of container. With container is here and hereinafter meant a reservoir for the solid preparations to be dispensed through the dispenser. Preferably the container has such dimensions that it can be carried by a patient. The combination of the dispenser with the container will be referred to as a device for dispensing solid preparations, or shortly a dispenser "device". The present invention also relates to the device comprising the dispenser and a container. The combination of the dispenser with included an electronic circuit and energy supply will be referred to as "dispenser system". The combination of dispenser system with a docking station will be referred to as "system".
0115The container that is used in combination with the dispenser according to the invention is not particularly critical and the characteristics will mostly depend on the contents of the container. For example when the contents of the container are susceptible for (day)light, the container can be opaque or made not transparent. The size of the container will generally be determined by the size of the solid preparations and the number of preparations that the container should hold. For pharmaceutical solid preparations generally bottle sizes of 30-250 cc are used.
0116It is advantageous that the dispenser according to the present invention can be combined with a standard medication container, such as, for example, those which are currently in use in the USA by pharmacies and/or pharmaceutical companies to distribute pharmaceutical preparations to patients. For this purpose, the threads are of a standard size to match standard containers. The generally known and widely used containers have a screw cap which can be removed and replaced by the dispenser according to the invention. Therefore it is not necessary to repack the solid preparations from the standard medical container wherein the solid preparations are supplied, to a different container. This reduces the risks in contamination and mistakes during repacking. The dispenser according to the present invention in combination with a standard container supplies to the relevant user the advantages as described above.
0117The dispenser 601 according to the present invention for dispensing solid preparations can include a housing having a bottom, a movable collar or collar member, movable relative to the housing between a first position and a second position, a passage or guiding passage defined in the housing leading to an exit opening or dispensing orifice of the housing, and a passage member adapted to accommodate a solid preparation, which passage member is relatively movable with respect to the movable collar. In this dispenser the movable collar can be biased into the first position by resilient means.
0118The resilient means can be a coil spring. Further the movable collar can include a circumferential generally U-shaped recess around its outer perimeter, wherein the circumferential U-shaped recess is adapted to receive a container for holding solid preparations. Further, sealing means can be positioned between the container and the movable collar or collar member and between the movable collar and the passage member, wherein at least one of the sealing rings can be an O-ring.
0119Further, the movable collar can be provided with an inner sleeve that surrounds a perimeter of the passage member. The exit opening or dispensing orifice can be positioned in the bottom of the housing. The passage member is an extension of the passage or guiding passage and fixed to the housing, wherein the passage preferably has a restricted portion. There may be an upstanding wall which extends from the bottom, parallel to the restricted portion and spaced there from at a predefined distance. Also the movable collar may have a depending wall, which is adapted to slide along the upstanding wall. Furthermore, the dispenser can include a detector for monitoring the dispensing of each solid preparation, especially of each unit dose thereof, dispensed.
0120The detector can be a laser detector. Further, a dispenser system can comprise a dispenser including an electronic circuit and an energy supply for monitoring, controlling and/or communication. In such an embodiment the energy supply includes a battery and the electronic circuit includes a microcontroller, wherein the electronic circuit preferably includes a first transceiver. Such an embodiment may further comprise an alarm signal generator, wherein the alarm signal generator can be selectable to generate an audible signal by means of a buzzer. The alarm signal generator can include a vibrator. Further, a dispenser system can further comprise an electromechanical blocking mechanism for blocking relative movement between the movable collar or collar member and the housing and/or between the passage member and the movable collar or collar member. The dispenser system can further include an LCD display for transferring messages. Further, the system can comprise the dispenser system as mentioned before and a docking station. In this case, the docking station has a communication link for the exchange of data with an auxiliary data communication device. Further, the docking station is arranged for data communication with an auxiliary device in the form of a mobile platform, such as a mobile phone. The system comprising an electronic circuit and a first transceiver may comprise a docking station which includes a second transceiver, wherein the first and second transceiver use Near Field Communication technology. Additionally, the docking station can also include an USB interface, wherein the communication link includes an USB-connection. A container and a dispenser may cooperate as a dispenser device and also a container and a dispenser system may cooperate as a dispenser device or a dispenser system. The container as mentioned above can be a container with an absorber function obtained by an absorber component. Also it is possible that the absorber component is an integral component of the material the container is made from. The method of monitoring a patient's medication compliance can comprise <ul id="ul0004" list-style="none" compact="compact"><li>a. providing a dispenser system which dispenser system tracks at least one type of patient medicine compliance data, said dispenser system being connected to a container,</li><li>b. providing a wave energy transmitter and a power source to drive said transmitter for transmission of said patient's medicine compliance data to a remote location, said transmitter being electronically connected to said dispenser system for said transmission and said data transmitter and power source being connected to said container,</li><li>c. providing a receiver at said remote location and providing a computer to which said receiver inputs patient compliance data,</li><li>d. having either said dispenser system or said computer programmed to store the prescribed medicine dosage and regime of said container,</li><li>e. having either said device or said computer programmed to calculate compliance requirements for each dosage administration for the prescription period of the medicine and for comparing the actual medicine consumption or container usage with the compliance requirements.</li></ul>
0121Preferably a dispenser system as described above is used for carrying out the invention. For this purpose further especially a container is used with an absorber function obtained by an absorber component.
10 sheets
Sheet 1 Sheet 2 Sheet 3 Sheet 4 Sheet 5 Sheet 6 Sheet 7 Sheet 8 Sheet 9 Sheet 10
Every citation, both ways
| Document | Relation | Office | Cited during |
|---|---|---|---|
| US9975688B2 | Cited by | United States of America | Search report |
| US2016207691A1 | Cited by | United States of America | Pre-grant |
| CN109843246A | Cited by | China | Search report |
| EP0526166A2 | Cites | European Patent Office (EPO) | Applicant |
| WO2005004786A1 | Cites | World Intellectual Property Organization (WIPO) | Search report |
| US2006283876A1 | Cites | United States of America | Applicant |
| WO2007081947A2 | Cites | World Intellectual Property Organization (WIPO) | Applicant |
| US2007163917A1 | Cites | United States of America | Applicant |
| GB2108086A | Cites | United Kingdom | Search report |
| FR2642729A1 | Cites | France | Search report |
| US2962190A | Cites | United States of America | Applicant |
| US4653668A | Cites | United States of America | Search report |
| US5911937A | Cites | United States of America | Applicant |
| US6214255B1 | Cites | United States of America | Applicant |
17 members in 4 offices
Priority claims7
| Document | Office | Kind | Date |
|---|---|---|---|
| 07024898 | European Patent Office (EPO) | – | |
| 07024898 | European Patent Office (EPO) | A | |
| 08100672 | European Patent Office (EPO) | – | |
| 08100672 | European Patent Office (EPO) | A | |
| 08171578 | European Patent Office (EPO) | – | |
| 08171578 | European Patent Office (EPO) | A | |
| 08864731 | European Patent Office (EPO) | A |
Members17
| Document | Office | Kind | |
|---|---|---|---|
| WO2009080309A2 | World Intellectual Property Organization (WIPO) | A2 | |
| WO2009080309A3 | World Intellectual Property Organization (WIPO) | A3 | |
| WO2009080309A4 | World Intellectual Property Organization (WIPO) | A4 | |
| WO2010066456A1 | World Intellectual Property Organization (WIPO) | A1 | |
| WO2010066904A1 | World Intellectual Property Organization (WIPO) | A1 | |
| EP2201925A1 | European Patent Office (EPO) | A1 | |
| EP2231098A2 | European Patent Office (EPO) | A2 | |
| EP2289480A2This record | European Patent Office (EPO) | A2 | |
| US2011060457A1 | United States of America | A1 | |
| EP2355768A1 | European Patent Office (EPO) | A1 | |
| EP2355769A1 | European Patent Office (EPO) | A1 | |
| EP2289480A3 | European Patent Office (EPO) | A3 | |
| CN102245151A | China | A | |
| US2012003928A1 | United States of America | A1 | |
| US2012006700A1 | United States of America | A1 | |
| US8622241B2 | United States of America | B2 | |
| CN102245151B | China | B |
13 legal events, as the office reported them to INPADOC
Over the term
Point at a mark for the eventEvents
| Event | Code | |
|---|---|---|
| Application deemed to be withdrawnWithdrawn18D | 18D | |
| Information on the status of an ep patent application or granted ep patentGrantedSTATUS: THE APPLICATION IS DEEMED TO BE WITHDRAWNSTAA | STAA | |
| First examination report despatched17Q | 17Q | |
| Designated contracting statesAK | AK | |
| Information provided on ipc code assigned before grantRIC1 | RIC1 | |
| Information provided on ipc code assigned before grantRIC1 | RIC1 | |
| Information provided on ipc code assigned before grantRIC1 | RIC1 | |
| Information provided on ipc code assigned before grantRIC1 | RIC1 | |
| Search report despatchedORIGINAL CODE: 0009013PUAL | PUAL | |
| Request for examination filed17P | 17P | |
| Divisional application: reference to earlier applicationAC | AC | |
| Designated contracting statesAK | AK | |
| Public reference made under article 153(3) epc to a published international application that has entered the european phaseORIGINAL CODE: 0009012PUAI | PUAI |
Numbers
- Publication
- 2289480
- Application
- 101951663
Titles3
- German
- Verschlusselement für Tablettenspender
- English
- Locking element for dispenser
- French
- Fermeture pour distributeur
Classification
- CPC, 10
- A61J7/0076
- A61J1/03
- A61J2200/30
- B65D83/0409
- B65D2583/0477
- A61J2205/60
- A61J7/0418
- A61J7/0436
- A61J7/0445
- A61J7/0481
- IPC, 4
- A61J1 03
- B65D83 04
- A61J7 00
- A61J7 04
Designated states34
- Contracting states, 34
- Austria
- Belgium
- Bulgaria
- Switzerland
- Cyprus
- Czechia
- Germany
- Denmark
- Estonia
- Spain
- Finland
- France
- United Kingdom
- Greece
- Croatia
- Hungary
- Ireland
- Iceland
- Italy
- Liechtenstein
- Lithuania
- Luxembourg
- Latvia
- Monaco
and 10 moreShow fewer
- Malta
- Netherlands (Kingdom of the)
- Norway
- Poland
- Portugal
- Romania
- Sweden
- Slovenia
- Slovakia
- Türkiye