Abstract:
A medication dispensing system comprising an on-site medication dispensing unit and a central monitoring facility. The on-site medication dispensing unit holds bulk amounts of medication in a plurality of separate receptacles from which it selects a desired medication dosage according to an entered and stored prescription regimen and then notifies the patient by an audible or other sensory signal. If the patient presses a button within a prescribed time, the unit dispenses the dosage. If the patient does not press the button within the prescribed time, or if the unit detects a failure to dispense the selected canister, the unit makes the receptacle inaccessible and contacts a predetermined list of caregivers and the central monitoring facility.

Description:
FIELD OF THE INVENTION 
     The present invention relates to a prescription medication dispensing apparatus for automatically effecting a physician prescribed medication program by selectively providing and withdrawing a prescribed dose of medication at desired times from a bulk medication loading format and also monitoring and communicating patient compliance with the medication program to a remote monitor or caregiver. 
     BACKGROUND OF THE INVENTION 
     Doctors commonly prescribe a regimen of pills to be taken by ill persons, for example, a regimen such as “take two of the blue pills every six hours and one of the green pills every four hours” or the like is not uncommon. For some persons, such a specific regimen or course of medication may be easily followed. For other persons however, confusion can arise both concerning the schedule and concerning whether or not the medication has been taken. This problem occurs frequently where a large number of different medications are prescribed or with elderly persons who may have suffered some loss of mental faculties. 
     A variety of automated dispensers of pills which are purportedly aimed at some aspects of this dispensing problem are described in the related art. According to their respective descriptions these dispensers are intended to provide for dispensing of pills according to some specified regimen. In addition, in some cases, they have some described means to permit a determination of deviations from their programmed regimen. These dispensers, however have shortcomings in their complexity, cost, flexibility, ease of use and error resistance for use in many conventional medication dispensing needs. 
     Many dispensers which overcome the above noted drawbacks are highly dependent upon attention and diligence by caregivers. Some apparatus require the caregiver to properly fill the medication cups and stack them in the appropriate order in the device for subsequent dispensing. Other apparatus require the care giver to place medication into small containers within the dispenser. Thus, the use of such a device requires substantial amounts of handling and effort by a knowledgeable caregiver which is expensive and susceptible to error. 
     SUMMARY OF THE INVENTION 
     Wherefore, it is an object of the present invention to overcome the above mentioned shortcomings and drawbacks associated with the prior art. 
     It is an object of this invention to provide an on-site medication dispensing unit that is readily programmable for dispensing pills to a patient over an extended period of time and which monitors patient compliance with the programmed medication regime. 
     Another object of this invention is to prevent overdosing or multiple dosages in the unit&#39;s output mechanism by having a visual and/or audible alerting feature which notifies the patient at a prescribed dosage time in accordance with the regimen that is programmed into the unit and then, and having a limited time window during which the patient must press a button or similar input device to activate the unit&#39;s output mechanism to effect a physical dispensing of the dosage from the unit. The time window is reprogrammable. If the patient has not pressed the button or activated the input device when the time window ends, the dosage is inaccessible to the patient. This missed medication can be reissued to the patient the following delivery or day if appropriate or will be locked away until the caregiver intervenes. A further feature of the unit alerts the patient in steps of escalating intensity, either audibly and visually, or both, if the button or similar input device is not activated. 
     It is another object of this invention to provide a medication dispensing unit which is directly linked to a 24-hour monitoring facility or directly to a caregiver if an occurrence that is defined by the unit&#39;s program to be an emergency situation arises. An example emergency situation is the patient&#39;s failure to activate the dispensing button which, as described above, causes the dosage to be inaccessible to the patient. If this occurs more than a predetermined number of times over a predetermined time duration, it would cause an alert to be sent directly to a caregiver and/or an alert to a monitoring facility. 
     Another object of the present invention is to provide a medication dispensing device which permits bulk loading of the device for at least a 30-day supply of medication. 
     A further object of the present invention is to provide a device which is capable of being resupplied from a chain pharmacy&#39;s managed care pharmacy division in a bulk loading format. 
     Yet another object of the present invention is to provide a bulk loading format where once the bulk medication is loaded in the device, no further human interaction with the medications is necessary to dispense the appropriate dosages of medications. 
     A still further object of the present invention is to select a desired prescribed medication dosage from the bulk loading format and deliver the dosage to the patient for only a prescribed period of time. 
     One embodiment of the on-site medication dispenser unit includes a rotating carousel wherein the canisters carried by the carousel may be loaded with at least a week&#39;s worth of a particular type of medication or types of medication. Anticipating when a medication dosage, or series of dosages is to be dispensed, the carousel is rotated so that the canister containing the appropriate pill is positioned at a selecting mechanism. The selecting mechanism selects a pill from the canister and drops it into a waiting receptacle, the selecting mechanism continues to select pills from individual canisters on the rotating carousel until a required dosage has been dropped into the receptacle. 
     At the prescribed dosage time the dispenser&#39;s program initiates an alert to the patient. As described above, when the patient is alerted, he/she is required to push a dispensing button within a programmable time window. If the button is pushed, the aligned receptacle releases its contents into a chute accessible to the patient. If the patient does not dispense the medication when alerted to do so, the dispenser first, for certain embodiments, steps through a progressive alerting of audio (tones and prerecorded voice messages) and visual alerts with increasing intensity, and if the medicine is not dispensed, the medication remains in the collection receptacle where it is inaccessible to the patient and the unit attempts to contact, in order, a preprogrammed list of caregivers and then if not successful, notifies the 24-hour central monitoring facility. 
     A still further embodiment of the invention provides a dispensing unit programmable to notify a patient to take a medication which is not dispensed by the unit. One example is the dispenser prompting the patient to take insulin using the above-identified visual display audible alarm and/or an audio message such as a prerecorded voice. 
     According to one example embodiment, the on-site dispensing unit is loaded by first filling the appropriate plurality of canisters, with the individual medication prescriptions, then transporting the filled canisters to the on-site unit, and loading them into the dispensing mechanism&#39;s canister carousel. The medication prescription canisters may be filled at the location of the on-site unit, or prefilled at a central distribution facility, or at a local station, such a place within a nursing home. 
     After loading the bulk medications into the canisters, the unit is programmed using one of the following three methods; call the central monitoring facility and have the unit programmed remotely, use a setup panel to select a preprogrammed standard, use a setup control panel to enter in a customized schedule. 
     A control panel for programming the dispensing unit is preferably located under a cover of the dispensing unit thereby, preventing accidental or other altering of the stored medication dosage schedule. 
     In addition to the medication dispensing and monitoring functions of the dispensing unit, a further embodiment includes a wireless communicating device worn by the patient which is communicatively linked with the dispenser to provide additional emergency protection to some patients. In an emergency, the patient can activate the wireless communication device which would communicate with the dispensing unit. The dispensing unit would, in turn, send an emergency message to the central monitoring station. The personal communication device may be.a pendant worn around the neck or any other suitable device that can be worn on the patients body. The medication dispensing unit may optionally incorporate an emergency button that serves the same function as the personal communication device. Other embodiments of the wireless emergency communications device are a wall mounted wireless emergency button and a table top wireless emergency button. 
     The present invention also relates to a medication preparation and dispensing apparatus for selecting and delivering at least one prescribed medication from a plurality of bulk medication amounts to a patient, the preparation and dispensing apparatus comprising a housing accommodating a plurality of receptacles containing the bulk medication amounts and a selection mechanism for obtaining the at least one prescribed medication from at least one of the plurality of receptacles, a medication dosage holder for collecting the at least one prescribed medication from the selection mechanism, a dispenser for dispensing the at least one medication collected by the medication dosage holder to the patient within a desired time period, and wherein a programmable computer instructs the selection mechanism to obtain the at least one medication from the bulk medication amounts and deliver the at least one medication to the dosage holder, the computer also communicating with the dispenser to issue the at least one medication to the patient within the desired time period. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The invention will now be described, by way of example, with reference to the accompanying drawings in which: 
     FIG. 1 is a schematic system diagram indicating the dispensing and monitoring functions of the medication delivery system; 
     FIG. 2 is a perspective view of the complete bulk medication dispenser; 
     FIG. 3 is a cross sectional view of the internal pill manipulating mechanisms; 
     FIGS. 4A and 4B are cross sectional views of the pill receptacles of a first embodiment; 
     FIGS. 5A,  5 B and  5 C are a cross-sectional side view, a perspective view and a top planar view of a second pill receptacle embodiment; 
     FIGS. 6A and 6B are top planar views of the pill receptacle carousel of a first and second embodiment respectively; and 
     FIG. 7 is a block diagram of the functions of the apparatus computer controller. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     FIG. 1 is a high level system diagram of an example medication dispensing and monitoring system according to the present invention. The FIG. 1 system includes an on-site medication dispenser  2  which stores a plurality of canisters described in detail further below, each canister filled with one or several pills of one type or prescription for dispensing at a prescribed time. The canisters can be individually loaded or preloaded with medication and loaded into the on-site dispensing unit  2  by authorized persons from a visiting nurse facility (VNA)  8  or from a doctors office  6 , or by a pharmacy or local caregiver  4 . The specific apparatus and details of operation of the medical dispensing unit  2  are described further below in reference to FIGS. 2-6. 
     The on-site dispensing unit  2  has a microprocessor-based controller  100 , which is described further below, the controller  100  having a standard data storage function (not shown). The dispenser unit  2  data storage receives and stores a dispensing program, or receives data entries into a pre-stored user-prompt program, representing the patient&#39;s prescribed medication regimen. The program or data is entered into the unit  2  manually, by either the patient or the caregiver  4 , or is received via a web based computer network from one of several remote sites including the patient&#39;s physician office  6 , a nursing facility  8 , a central control/monitoring facility  20 , or a pharmacy. 
     The on-site dispensing unit  2  then, by its example apparatus and operation described below, executes the entered dispensing program by alerting the patient, by a visual and/or audible means  3 , at each of the programmed dosing times and, concurrent with each alerting operation, places or assigns one of its internally selected and stored dosages into a ready-to-dispense mode or mechanical state. The controller  100  concurrently establishes a window of time, relative to the alerting signal, during which the patient can input a dispensing signal  5  via, for example, a button  31 , shown in FIG. 2, or other input device, such as a touchscreen (not shown). The duration of the time window is set by the entered program or by a default value. If the user input signal  5  is received before expiration of the time window, the assigned dosage is output from the unit, as shown by label  7 . The apparatus and method of the on-site dispensing unit  2  for carrying out the patient alerting and dispensing operations are described in further detail below. 
     If the patient has not yet responded, e.g. pushed the button  31  of the medication dispensing unit  2 , at the end of the time window, the unit  2  for the FIG. 1 embodiment immediately transmits an alert  14  via, for example, a unit modem and telephone to a first designated caregiver  16 . In addition to generating the alert  14 , the on-site dispensing unit  2  prevent missed medication from being delivered to the patient for this dose period by an apparatus and operation described in further detail below. 
     If no response is received by the unit  2  from that first designated caregiver, the unit  2  sends another alert  14  to a second designated caregiver for instance a retirement/nursing home monitoring facility  12 . Alerting sequences different from the example above are readily written into the dispenser unit  2  microprocessor-based controller  100  to achieve different priority sequences. A preferred example notifies the central monitoring facility when there is no valid response from any of the designated caregivers  16  or from the retirement home monitoring facility  12 . 
     Instead of a unit  2  modem and a computer network system communication with the remote sites, such as  16 ,  12  and  20  can be realized by direct phone line or cellular phone connection. Regarding the specific form of receipt verification signal that the remote monitoring sites  16 ,  12  and  20  transmit back to the on-site dispensing unit  2 , that is a simple design choice, with examples including a specific phone keypad entry, or sequence of entries, or a designated key (not shown). Further, the dispenser unit  2  may be equipped with a voice-recognition feature, recognizing, for example, “I&#39;ll be right over.” Various commercial voice recognition hardware/software modules, readily incorporated into a standard microprocessor-based controller  100  are available as off-the-shelf items. 
     In the description above of the FIG. 1 example system, the on-site dispensing unit immediately transmits an alert signal  14  if there has been no user input of the dispensing signal when the time window ends. A further embodiment, uses a plurality of, for example, two time windows during which the user may input the dispensing signal, e.g. press the button  31 . In that further embodiment, the audio or visual alarm is generated at a first intensity during the first time window. If that first time window ends and the user has not yet entered a dispensing signal, the unit increases the alarm level. The increased alarm level is continuous or, alternatively, is steadily increasing, until the end of the second time window. If the user, at the end of the second time window, has still not entered the dispensing signal then the unit  2  generates the alert signal  14  as described above. 
     Referring to FIG. 1, the central monitoring facility  20  is connected to the on-site medication dispenser  2  via a modem and the computer network system and, in addition to receiving alerts  14  from the unit  2 , unit  2  is optionally programmed for periodic reporting concerning the operation and status of the unit  2 . The information transmitted by such reporting is a design choice, preferably including a history of all dispensing operations over a set time period. In addition, the central monitoring facility may send a query to the on-site dispensing unit  2  over the computer system requesting information. Still, further, the patient&#39;s health care provider  6  may request a record of dosage schedule compliance from the central monitoring facility  20  to further enhance the treatment of the patient. Such records may be generated as hard paper copies or electronic files. 
     Turning now to FIG. 2, a general description concerning the medication dispensing unit  2  will now be provided. The medication dispensing unit  2  is a self contained, programmable and automated medication dispenser efficiently delivering at least a 30 day supply of medication to a patient with no human caregiver intervention. The unit  2  is functionally capable of selecting desired medications from a number of internal bulk pill bins or receptacles  21  within the apparatus and preparing a particular prescription for delivery to a patient at a desired programmed time. The unit  2  carries out these selection and dispensing functions in accordance with instructions programed into the controller  100  which also monitors patient compliance with the prescription regimen and communicates associated data to a remote caregiver via the central monitoring facility as previously described. A detailed description of the unit  2  follows below. 
     The dispensing unit  2  is encased within a removable housing cover  23  supported on a base  25 . The cover  23  encloses and protects the medication delivery mechanisms, the bulk medications and the dispensing cups into which the selected medications are delivered. The housing cover  23  may be provided with an opening M in a top most portion of the cover for allowing the bulk medication to be loaded into the apparatus, alternatively, the cover  23  may be made removable from the base  25  in its entirety for the same purpose or for servicing. An exit opening E is provided in a lower portion of the cover  23  or alternatively in the base  25  as shown for enabling the patient to retrieve the required dose of selected medications from the unit  2 . 
     Situated on the base  25 , and easily accessible to a user is a manual keypad  27  for programming instructions into the controller  100 . A visual indicator or warning light  29  may be provided to alert a user that a dosage is prepared and should be retrieved and a graphic display for any type of information pertinent to the particular function or dosage being delivered may be shown by a visual display window  32 . A dispensing button  31  is also positioned on the base, actuation of the button enabling a user to dispense the currently available dosage through the exit E. 
     Turning to FIG. 3, the medication dispensing mechanisms contained within the housing cover  23  for preparing and dispensing a dosage will now be described. The base  25  provides support not only for the housing cover  23 , but also for the internal medication dispensing mechanisms. Supported on the base  25  is a hollow center spindle  35  having a through passage  37  defined about a central axis A of the unit  2 . The center spindle  35  extends vertically upward from a lower end  39 , substantially supported at a central portion of the base  25 , to a top end  41  spaced from the base  25 . 
     At the lower end  39  of the center spindle  35 , a communicating tube  43  is attached to enable the communication of a vacuum pump  45  contained within the housing cover  23  with the hollow passage  37  of the center spindle  35 . A pressure sensor  46  is provided together with the vacuum pump to monitor vacuum pressure in the system by the internal computer  100 . Increased vacuum pressure indicates pickup arm  47  picks a pill properly from container  21 . 
     Connected to and communicating with the top end  41  of the center spindle  35  is a substantially flexible and vertically movable, hollow vacuum pickup arm  47 . The vacuum pickup arm  47  has a first end having an outer diameter which slidably fits inside the through passage  37  to facilitate the vacuum pressure extending through the pickup arm  47  while enabling the first end of the pickup arm  47  fitted within the through passage  37  to be axially slidable therein. 
     A remainder of the pickup arm  47  extends from the top end  41  of the central spindle  35  and is provided with a substantially 180 degree bend turning a second end of the pickup arm  47  vertically downwards to define an opening O, which, when the vacuum pump  45  is turned on creating a vacuum through the hollow passage  37  causes suction at the opening O strong enough to retain a pill or desired medication dosage selected from one of the receptacles  21 , a further description of which will be provided below. 
     The flexible pickup arm  47  is maintained as a 180 degree bend by a pickup arm support  49 . The support  49  is a rigid arm extending horizontally from a first end portion having slidable engagement with the center spindle  35  to a second end portion spaced from the center spindle and supporting the second end of the pickup arm  47 , specifically the opening O, in a desired pill engaging and retaining position. The support arm  49  is vertically moved up and down with respect to the center spindle  35  by a motor  75 , it can be appreciated that this motor  75  may be any type as known in the art, but in this embodiment is a screw motor mounted on the spindle  35 . As is to be appreciated, as the motor  75  raises and lowers the support arm  49 , due to the inherent flexibility, the second end of the pickup arm  47 , as well as opening O, secured at the second end of the support  49  is respectively vertically raised and lowered. 
     The opening O and the vacuum produced there engages and retains in general one pill at a time. Thus once a pill or medication is retrieved by the pickup arm  47 , the pill or medication is subsequently dropped into a waiting container or cup before another pill or medication can be obtained. Because the pick up arm  47  is vertically movable, the receptacles  21  containing the individual medications must be positioned underneath the opening O to permit retrieval of the pill or medication. 
     Supported about the central axis A and the central spindle  35 , a rotating carousel  51  supports and maneuvers a plurality of pill bins or receptacles  21  The carousel  51  is provided with a horizontally extending planer surface supporting the pill receptacles  21 . The receptacles  21 , which may be permanent or removable, are each capable of receiving and containing a bulk amount of a required medication. The receptacles  21  are supplied with the bulk medication via the medication supply entrance M or by removal of the cover  23 . Each pill receptacle  21  is filled with a homogenous type of pill or medication such that when the opening O is brought into close proximity with the pills in a desired receptacle, only that type of pill can be engaged by the vacuum suction of the opening O. A further description of the pill receptacles  21  will be provided below. 
     The carousel  51  is rotatably driven about the central axis A by a carousel gear  65  located adjacent an outer rim of the carousel  51 . The carousel gear  65  is connected to and driven by a carousel motor  67 . Thus, the carousel motor  67 , establishes direct control over the rotation of the carousel  51  and the positioning of the pill receptacles  21 . In addition, to ensure the appropriate alignment of the receptacle  21  with the end  49  of the vacuum pick up arm, there is a position reader  71  which, via IR or any other means as is known in the art, is able to verify the correct positioning of the carousel  51  and the location of the desired receptacle  21  from which a dosage or medication is to be removed. 
     Turning now to FIGS. 4A and B, in the preferred embodiment of the invention, each pill receptacle  21  is designed having a main compartment  56  to which a bulk supply of a particular desired homogenous pill or medication can be supplied. The main compartment  56  may be of any desired size or volume to handle any number of desired pills or medications, the main compartment  56  can accommodate 0 to 500 pills, and usually about 50 to 300 and most preferably around 100-150 pills. 
     Each receptacle  21  is provided with an elongate vertically depending bottom cavity  58  at the bottom of the main compartment  56 . The bottom cavity  58  contains a compression spring  88  biasing a plunger  60 . The plunger has a first position wherein the plunger  60  is depressed and substantially withdrawn the main compartment  56 . In a second position shown in FIG. 4A, the plunger moves from its first position and extends upward through the bulk medication, extracting at least one of the bulk loaded pills or medications to a supported position above the bulk pills on a top surface  62  of the plunger  60 . 
     The extension of the plunger  60  pushes the extracted pill up above the bulk population of pills and brings it into close proximity of the opening O of the arm  47 . The top surface  62  of the plunger  60  may be shaped with a particular pill size depression which assists in extracting and maintaining a pill thereon, and for placement of the pill in close proximity to the arm  47  and opening O. The bottom cavity  58  and plunger  60  may also be cooperatively threaded in order to provide a rotation for the plunger  60  as it extends upwards and through the bulk pill population facilitating the engagement of one pill positioned on the top surface  62  of the plunger  60  as depicted in FIG.  4 B. 
     As shown in FIG. 3, the plunger  60  is actuated by a pill container motor  82  which drives a plunger gear  84 . The plunger gear  84  extends through a slot  86  in the receptacle  21  engaging the plunger  60 . It is to be appreciated as the plunger gear  84  rotates, engaging threads or notches (not shown) in the plunger  60 , allowing the spring  88  to bias the plunger  60  upwards through the bulk population of pills. Once the plunger  60  has been fully extended and the pill removed therefrom by the arm  47  and opening O, the motor  82  reverses direction and the plunger gear  84  cooperatively changes direction, lowering the plunger  60  against the spring bias  88  down into the cavity  58  of the pill receptacle  21 . Having engaged and retained a pill via the vacuum suction produced at opening O, the pickup arm  47  is raised to allow the carousel  51  to rotate to a subsequent position as described in greater detail below. 
     Turning now to FIGS. 5A,  5 B, and  5 C a second embodiment of the pill receptacle is provided. The receptacle  121  of the second embodiment is essentially a canister having a sidewall  91  defining a space  93  for containing the bulk medications. The receptacles can be provided with either a solid attached base  94  or base  94  can be a mixing drum which is capable of rotating relative to the sidewall  91 , a further description of which will be provided below. 
     The sidewall  91  of each receptacle  121  is a modified cylinder having an upper portion and a lower portion. In the upper portion the sidewall  91  extends around in a cylindrical fashion between about 270-320 degrees. The cylinder is modified by an indentation  95  in the remaining  90 - 40  degrees. The indentation  95  is formed by a first and second planar walls  99 ,  97  extending inwardly from the sidewall  91  to a common intersection. The depending walls  99 ,  97  intersect with the sidewall  91  from a top edge or rim  101  of the sidewall  91  down to a point  65  between the sidewall rim  101  and the bottom edge  61  of the sidewall, the point being spaced a distance from the bottom edge  61  to form an opening  107  leading to a complete cylindrical lower pill pocket in the receptacle  121 . 
     The lower portion of the sidewall  91  forms a complete cylinder surrounding the rotating base  94  and defines the pill retrieval area accessible through the opening  107 . The rotating base  94  has a generally conical shaped surface  96  having a raised apex  98  in the center substantially vertically aligned with the intersection of the first and second planar walls  97  and  99 . The conical shaped surface  96  provides for distribution of the pills toward the sidewall  91  of the receptacles  121 . The conical surface  96  of the base  94  is also provided with an indentation or pill pocket  109  toward the sidewall  91  in the approximate size and shape of a single medication pill or tablet. This pill pocket  109  is sized to accommodate a pill or medication extracted from the bulk loaded portion  93  and deliver it into the pill retrieval area  107 . The pill sits down in a defilade position in the pill pocket  109  and is carried out of the bulk loaded area  93  under the lower edge  92  of one of the first and second planar walls. This lower edge  103  is positioned close enough to the conical surface of the rotating base  94  to stop pills not in the pill pocket  109  from sliding into the pill retrieval area. Additionally, a device may be provided along the lower edge  92  to assist in preventing any pills other than that in the pocket  109  from entering into the pill retrieval area, such as a stiff bristle brush. 
     The opening  107  is the access point for the vacuum pick up arm to enter into proximity of the pill or medications extracted from the bulk loading area  93 , and to retrieve a pill contained in the pill pocket  109  of the receptacle  121  when the container is rotated into the pick up position. 
     In one embodiment of the present invention shown in FIG. 6A, the carousel  51  is also provided with a drop chute  54 . After engaging a pill, the support arm  49  and opening O is raised to allow the carousel  51  to rotate so that the drop chute  54  is positioned directly underneath the opening O and the pill retained thereon. When the vacuum is turned off the pill falls from the opening O into the drop chute  54  which directs the pill or medication into a dosage collection cup  79  located beneath the drop chute  54 . Once the pill has been deposited in the dosage collection cup  79 , the pick up arm  47 , opening O and carousel  51  may be subsequently realigned to retrieve another pill or medication from a pill receptacle  21 . 
     In another embodiment shown in FIG. 6B, any number of drop slots  73 , a drop slot  73  being a passageway through the planer surface of the carousel  51 , may be provided to allow the deposition of a pill in the collection cup  79 . The drop slots  73  may be positioned adjacent and between each of the receptacle  21  and are also capable of being aligned with the end  49  of the vertical depending pick up arm  47  and verified by position sensor  71 . After the vacuum pick up arm  47  has obtained a pill or dosage from the aligned receptacle  21 , the motor  67  turns the gear  65  and thus the carousel  51  to position the drop slot  73  adjacent the receptacle  21  beneath the opening O of the pick up arm  47 . The pill may then be dropped from the opening O and pass through the drop slot  54  to the pill collector cup  79 . 
     Returning to FIG. 3, the vacuum pick up arm  47  works cooperatively with the rotation of the carousel  51 . The pick up arm  47  has in general two positions: a first lower position for retrieving a pill from a receptacle  21 , as shown in FIG.  3  and for dropping a pill through the drop chute  54  or drop slot  73 , and a second upper position (not shown) wherein the pick up arm is positioned clear of any obstructions, i.e. the receptacles  21 , so that carousel  51  can rotate to the next proper alignment. The vertical raising and lowering of the pick up arm  47  is driven by the screw motor  75  mounted on the center spindle  35  and having an upper and lower limit to ensure proper vertical alignment of the pick up arm  47  and specifically, the opening O for purposes of retrieving and dropping a pill. 
     The controller  100 , generally an internal computer, in cooperation with the position sensors controls the coordination and cooperation of the motors and mechanisms described above. To prepare a dosage of medication, the controller  100  ensures the pick up arm  47  is in the upper position and the carousel  51 , driven by the motor  67  is rotated until a receptacle  21  containing the required medication and dosage is properly aligned. Thus, the vertically depending end having the opening O of the pick up arm  47  is poised directly vertically above the pill receptacle  21 . The optical position reader  71  verifies the positioning of the receptacle  21  with the controller  100  which then causes the vacuum pump  45  to be turned on. The pick up arm  47  is then lowered by the screw motor  75  until the arm attains a pill pick up level wherein the depending end and opening O are substantially inserted within the receptacle (as shown in FIG.  3 ). The vacuum force developed at the opening O of the vertically depending end of the pickup arm  47  then grabs the dosage of medication from the receptacle and/or the top surface  62  of the plunger  60  and the pressure sensor  46  located in conjunction with the communicating tube  43  detects whether the pill is retained on the pick up arm thus indicating that the controller  100  can continue operation. 
     The motor  75  then raises the pick up arm  47  holding the dosage to the second position. The carousel  51  is then rotated by the motor  67  to position the drop chute  54  or drop slot  73  immediately beneath the opening O, via the optical position sensor  71 . The pickup arm  47  is lowered to the first lower position, and the vacuum pump  45  is turned off thus releasing the pill into the awaiting collector cup  79 . Leaving the collector cup  79  in place, this process is then repeated for as many times as necessary to provide the required medication for a dosage into a single collection cup  79 . 
     Located below the carousel  51  platform is a pill collector carousel  81  supporting at least one of the above described collection cups  79 . The pill collector carousel  81  is also aligned about the central axis A and has a central through hole, through which the hollow central spindle  35  passes. The pill collector carousel  81  is rotatable relative to the central spindle and carousel  51  and is provided with at least a pill collector cup  79  for collection of medication dosages dropped from the vertically depending end of the vacuum pickup arm  47  as described previously, although it is foreseeable that any number of collection cups may be supported by the pill collector carousel  81 . 
     The pill collector carousel  81  is a substantially planar surface having openings forming or supporting a rim of the collector cup  79  which may be permanent or removable or replaceable. The pill collector carousel  81  is provided with a pill collector carousel gear  55  which is driven by a pill collector carousel motor  57  so the pill collector carousel  81  is enabled to rotate relative to the center spindle  35  as well as the carousel  51 . The pill collector carousel  81  positions the collection cup  79  beneath the opening O of the pick up arm and accepts the required dosage through the drop chute  54  or drop slot  73  from the pick up arm  47 . The collection cup  79  remains in place as the above described process is repeated as many times as necessary in order to provide the required dosage, or number of pills to the collector cup  79 . 
     The pill collector carousel motor  57  is also connected to the controller  100 , and when the computer acknowledges the completion of a complete dosage delivered to the collection cup, the motor  57  rotates the pill collection cup to a position substantially adjacent the exit opening E of the housing which can be verified by a position sensor  72 . 
     A sliding surface  85  is positioned below the pill collection carousel  51  and substantially supports a bottom of the pill collection cup  79 . The bottom of the collector cup  79  may be provided with a hinged trap door  74 . The door is supported during filling operations and during rotation of the collector carousel sliding on the sliding surface  85 . The pill collector cups  79  are in contact with and allowed to slide across the sliding surface  85  as they are horizontally rotated by the pill collector carousel  81 . 
     Adjacent the exit opening E, the sliding surface  85  is provided with a delivery opening  87 . When a cup  61  encounters the opening  87 , the trap door opens due to gravity and the weight of the pills, allowing the pills to be dispensed to the patient. The sliding surface  85  supports the cup vertically and ensures that the cup  61  is properly positioned, i.e. the mouth of the cup defines a substantially horizontal plane as the cup is positioned in the pill collector carousel  81 . The sliding surface  85  is attached to the base  25  and also provides support and separation of the motors driving the pill collector carousel  81  and the carousel  51  from the medications and other delivery mechanisms. 
     Once the required dosage has been delivered to the collection cup  79  by the pick up arm  47  via either the drop chute  54  or drop slot  73 , and the collection cup rotated by the collection cup carousel  81  to the appropriate position, a latch  110 , connected with the patient dispense input  5 , and operated thereby is provided whereby the dosage is only delivered if the patient operates the latch  110  via the input  5 . A med tray  113  is provided in the base  94  of the unit  2  for receiving the allotted medications from the collection cup and providing the required medications to the patient. The collection cup containing the medication is positioned over the med tray  113  via rotation of the collection cup carousel when a time for supplying the medication is noted by the computer. The opening  87  of the sliding surface  85  is provided with a door  89  directly over the med tray  113 , and directly beneath the collection cup  61  containing the desired medication positioned over the med tray  113 . 
     The door  89  is connected to an offset cam  117  which is rotatably connected with a motor  119 . When the motor  119  is instructed to open the door the motor  119  rotates the offset cam  117  which slides the latch away from the opening  87  in the sliding surface  85  and allows the medication to pour from the collection cup  61  into the med tray  113 . The motor  119  may then close the door  89  by rotating the offset cam  117  in an opposite direction closing the door. An optical reader  121  may also be provided in conjunction with the door  89  to ensure the proper and complete opening and closing. 
     Where the patient fails to indicate that they are prepared to accept the medication, the door  89  will not open, and the contents of the collection cup are analyzed to ascertain if they can be either used for a subsequent dose or whether the dosage is to be removed from circulation. 
     Based on the programmed instructions provided to the controller  100  the operation and function of the unit  2  is conducted in the following manner. 
     FIG. 7 is a function block diagram of the controller  100  control of the aforementioned unit  2 . The controller has a CPU  200  electronically coupled to a main motor control, controlling the rotation and availability of the pill receptacles  21 . The controller  100  receives feedback from the position sensor of the carousel  23  and adjusts the motor control and hence the carousel  23  to accordingly align an appropriate receptacle  21  or drop slot  73 . The main controller  100  also controls a collection cup carousel motor which rotates the appropriate collection cup  61  into the drop zone  52  beneath the receptacle carousel  23  in order to accept a retrieved medication from the pickup arm  47 . A collection cup carousel position sensor is also related to the controller  100  in order to assure the collection cup carousel is properly aligned a collection cup  79  under the pick up arm  47 . The main controller  100  also operates simultaneously and in conjunction with the main motor control and the collection cup carousel motor control a vacuum pickup motor control for retrieving and aligning the desired medications from the appropriate receptacles  21  to the proper collection cups  61 . The vacuum pickup arm assembly  47  is also provided with a position sensor so that the controller  100  is aware of and able to coordinate the proper vertical positioning of the vacuum pickup arm assembly  47 . 
     The main controller  100  also coordinates the activation and deactivation of the vacuum pump  45  for retrieval and release of the desired medications from the receptacles  21  into the collection cups  61 , respectively. 
     The main controller  100  is generally supplied with a 120V AC power supplied to the controller  100  and respective motors and position sensors. The main controller  100  operates according to instructions imparted by a caregiver through a key pad  105 . The key pad  105  may be either attached to the unit  2  or may also be remote therefrom. The main controller  100  further operates a liquid crystal display LCD for displaying a particular desired input information or output information to and from the controller  100  for either the patient or the caregiver. The main controller  100  is further connected with a dispense button  107  to which the patient has access to in order to retrieve the desired medications. The dispense button  31  is required to be operated before the appropriate medication is provided to the patient. To inform the patient that it period in which a medication is to be properly dispensed, an audio or visual signal may be put out by the controller  100  and unit  2  in order to alert the patient or caregiver. Thus the controller  100  may include a CPU having a microprocessor based CPU with internal memory to hold all software and scheduling information. The controller  100  also includes an imbedded Modem for communication between the controller  100  and an outside computer. The computer controls all electrotechnical elements of the machine including the vacuum pump and is provided with a battery backup for continued operation during any externally applied power failure. 
     Since certain changes may be made in the above described invention without departing from the spirit and scope of the invention herein involved, it is intended that all of the subject matter of the above description or shown in the accompanying drawings shall be interpreted merely as examples illustrating the inventive concept herein and shall not be construed as limiting the invention.