FR2838047A1 - Medical pill discharging system, for use with pills packaged individually in blister packs, whereby identification and electromechanical means are controlled to extract pills from cells in the correct sequence - Google Patents

Abstract

System for monitoring taking of medicines packaged in a blister pack, comprises optical detection means (5, 20) for determining the contents of cells in the packaging and electromechanical means (21, 22) for extracting the pills from the cell. The means are controlled by an electronic controller (6) that can be linked to a computer (54) for recording times and quantities of medicines taken. A housing (1) is used to contain the pills in their blister pack.

Description

air on inspiration and expiration.

  The present invention relates to a system making it possible to automatically record the time of taking a medicament in pre-portioned particulate form (for example a pill, a tablet, a capsule, or a capsule) packaged on a blister and allowing '' help the operator to extract the

drug out of its package.

  The system includes a box in which the wafer is installed, sensors using the effects of light, electronic means and calouls making it possible to know from the information delivered by the sensors which drug has been removed from the wafer and at which moment, possible means for extracting the drugs from their wafer, means making it possible to exchange information with a computer separate from the box and means for processing and presenting the information to the medical personnel. The boxes can be grouped together to treat several different drugs in the same set. The invention finds a particularly advantageous, although not exclusive, application in the field of control of the intake of medicaments by a patient and in particular during clinical trials and prior to obtaining marketing authorization. medication. In these studies we seek to determine the effects of the drugs on the patient, and the fact of knowing if the drug was actually taken and at what time, that is to say the therapeutic compliance,

is of great importance.

  The invention also finds an interesting application in the therapeutic adaptation of the treatment by the doctor, in particular when it is associated with devices for measuring physiological parameters representative of the pathology: the doctor, knowing with certainty thanks to the invention, doses and times of taking the drugs, control by physiological measures the effects of these doses and can knowingly decide to modify the doses and / or schedules to optimize the treatment. The doctor can take knowledge of the data recorded by the proposed system either locally from the patient, or remotely if the system is connected to a data transmission network (for example a telephone network

with a modem).

  Another application of the invention relates to the dispensing of medicines for a patient who is isolated in his accommodation and who is likely to commit errors or confusions in taking his medicines, or for a community of patients (hospital, retirement home, etc.). .) in which medical personnel can also make bruises despite the time they devote each day to

  prepare. each patient's drug doses.

  We already know electronic devices that control the distribution of drugs in the form of capsules or pills (patents FR 2 686 508; FR 2 750 857; FR 96 10971; FR 96 109 72; FR 96 109 73). These devices have the disadvantage that the drugs whose distribution is to be controlled must be 1S, prior to their introduction into the device, placed in chargers or specific compartments of the device, which means that each medication must be extracted from the packaging in which it left the factory of the pharmaceutical laboratory which manufactures it. This rupture of the factory packaging is often detrimental to the good preservation over time of the characteristics of the drug to be tested, which can distort the results of clinical studies undertaken with

vending machines mentioned.

  It is therefore important that the control system for taking

  medication respects the initial packaging of the medication.

  Now laboratories are now increasingly using blister packaging (or "blister") because it allows them to better control and for a longer time the atmosphere (humidity, sterility, light) in which the medicines are stored.

  until the last moment just before consumption.

  A medicine plate consists of a plate made of semi-rigid plastic material which is generally transparent in

  which the cells containing the drugs were pre-

  formed and of a thin cover in light metal alloy which hermetically seals each drug in its cell after this neck, erture has been glued on the semi-rigid plate. The necessary step to get the drug out of its alvecle is to tear the metal cover generally by pressing on the drug by deformation of the semi-rigid plate. A cell emptied of its medication is therefore characterized among other things

  by the deformation and rupture of its metal cover.

  This characteristic is exploited in the present invention. The object of the present invention is to propose a system for monitoring therapeutic compliance which preserves the initial packaging of the drugs in blister packs. There is already known an electronic device for dispensing drugs packaged in wafers (Patent ro 96 04881) but which has the drawback of being able to accept only one model of wafer due to its mechanical design, this model i being defined by the dimensions number, number and

  arrangement of the cells on the wafer.

  Furthermore, when the patient has to take several different drugs, he may be wrong, for example by substituting one drug for another, or by not respecting the hours.

prescribed for catches.

  In addition, in medical institutions (hospital, retirement home) the time required to prepare all of the medication for one day for each patient or resident is significant and the risk of medication errors or contusion

are of concern.

  The present invention aims to remedy all these drawbacks, by proposing a system making it possible to determine the moment of taking a drug packaged in a blister pack, the system adapting to all models of blister packs and making it possible to assist the patient. or the medical staff to dispense the medication in the prescribed dose and time without error. i According to the invention, the system is characterized in that it comprises i first means for detecting on the wafer if a medicament is present or absent from its cell, second means for locating this alvecle on the wafer, third means to develop a representation of the position and content (drug present or absent) of all the alvecles at a known time, fourth means to compare two successive representations of the same wafer, the differences between the two representations indicating which cell has been emptied of his medication in the time interval separating the two representations; the system also includes fifth electronic means and calculations with memories, sixth means for transmitting and receiving information from a separate computer means or from a network of computers (for example: Internet), seventh means for expelling drugs out of their wafer when installed in the system, eighth means to collect drugs

  expelled to a container or packaging assigned to the patient.

  The first, second, seventh and eighth means are generally installed in the same box in which the wafer stays, the third, fourth and fifth means can be installed in the said box or in a separate computer which is then part of the system and connected to the box by the sixth means. Said casing also contains an internal electrical energy source (for example cells or batteries) or a means of connecting it to an external electrical source The first means for detecting the absence or the presence of a medicament in an alvecle are sensors which preferably use the effects of light without direct contact with the wafer or a drug being necessary for their operation. These means thus characterized provide two advantages: the optical sensors can be easily arranged in the housing in such a way that they can examine all kinds of distribution of the cells on any model of wafer, without it being necessary to modify this arrangement for switching from one insert model to another, which makes the system universal; more the absence of direct contact between the drugs and the organs arranged in the box is favorable

  the cleanliness and hygiene of the system as a whole.

  These means using the effects of light can be, without the means described here being exhaustive, sensors which receive the light reflected by the metallic cover of the alvecles or the light spanning a alvecle when the drug s 2838047 it contained has been removed, these sensors producing electrical effects (voltage or intensity) proportional to the light flux they receive; these are for example photodiodes or photocouplers. The light that they can receive is emitted by point sources or distributed in the box which illuminate the plate with visible or invisible wavelengths, the emitted fluxes being able to be modulated by oscillations for

  get rid of parasites created by ambient light.

  These means can also be sensors used for example to produce images of a document (by an office "scanner") or "digital" shots: these are photodetectors or charge transfer photodiodes commonly designated by CCD or CID or CCPD, etc. in the vocabulary of electronics specialists, these cells can be grouped in strips or in matrix and associated with a system of optical lenses. The "views" taken by this type of sensor can be

  easily digitized using analog converters

  digital commonly available in the industry, then saved in the memories associated with the calauls means of the system; they are processed by said means of calculation using commercially available image processing software; they then simultaneously provide the position of the cells on the wafer and an image of each cell

  to distinguish the presence or absence of the drug.

  The second means, used to locate the alvecles on the wafer can be, without this list being exhaustive, the image provided by the so-called "digital" photograph sensors and on which the alveoli appear as actually placed on the wafer , or electromechanical means which effect and measure relative displacements between the wafer and the said optical sensors in the longitudinal and transverse direction of the wafer. The distances separating the alvecles from each other and from the edges of the plate being known to the system by the fifths and sixths described below, the distances measured by electromechanical means from the edges of the plate make it possible to determine which position is on the flyer of a cell

  that the sensors have just detected empty of its drug.

  These means of locating the empty cells of their medication have been very useful on the one hand because the system determines which cell (characterized by its position on the wafer) has just been empty when the system detects by its first means that a new alvole is empty, on the other hand to check in certain therapeutic treatments that the drugs have been taken in the sequential order prescribed by the doctor, when all the alvoles in the blister pack do not contain a

identical drug.

  A representation of the location and the content of the alveoli on a booklet is defined here as an abstract image. Developed for a moment known and contained in a memory associated with caleuls means, the display of which on a computer screen can be a rectangle. the outer contours of the plate, in which a sYmbol such as for example O is inscribed the location of an empty cell and another symbol for example 1 is inscribed the location of a

alvole containing its drug.

  The third means used by the system to draw up a representation of the room is ation and the content of each cell in the brochure can be, for example the image provided by so-called digital photo sensors> and processed by the image processing software and on which the cells appear as actually placed on the wafer, a full Atant cell distinguishes from an empty cell of its medication by the smooth appearance of its metallic protective layer which does not leave pass through the light, while an empty cell has its crumpled metal protective layer

  and dAchirde, letting through the light if the plate semi-

  rigid is transparent. The software assigns the symbol O to the locations of the cells as well as empty Detects and the symbol 1

at other locations.

  Without this list being exhaustive, these third means can also be constituted in the following manner, useful for example in cases where the first means are sensors f

7 2838047

  optics which detect the passage of light through an empty alvecle or which detect by reflection of light the crumpling of the thin metallic layer which covered a now empty alveolus: - the fifth electronic means and of calculation with s memories contain a database in which the characteristics of the platelets likely to be introduced into the system are recorded (dimensions of the platelet, number and arrangement of the cells and dosage of the drugs contained) all the characteristics of a precise platelet being designated by a unique identifier, which is linked in the database to the codes assigned by the manufacturer to this plate, these frames of the manufacturer being accessible to the system by specific readers (bar code readers, character readers) connected to the calculation means; - before using the plate, the manufacturer's codes are read by presenting the packaging or the plate to said reading means, which allows the calculation means to search the database, by the unique identifier, the dimensional characteristics of the wafer and prepare the representation of the wafer by assigning to all the locations of the cells the symbol 1 (full cell) when the wafer is completely new; 2> - then, as the first and second means allow the system to observe that the alveoli have been emptied of their medication, the calculation means assign the symbol O to the successive representations at the location

  cells which have just been emptied.

  3 0 The fourth means of comparison of 2 successive representations of the plate used are the calculation means which assign in the representations the symbols O or 1 to each cell location as described above, and store in memory the differences noted between 2 successive representations caused for example by the exit then the return of the plate in the casing or by the expulsion of a drug by the seventh means. The presumed time of taking the

8 2838047

  medication by the patient is an intermediate time between the time of exit from the blister pack and the time of its return in the case, or this is the time when the medication was expelled from its

  blister if it has remained in the case.

  The fifth electronic and computing means are electronic cards with commercial components, microprocessors or microcomputers, analog-digital converters, clocks to date events, memories to record caloul programs, the database , representations of the wafer and signal input / output circuits for the sensors and micromotors necessary for operation, and data input / output circuits for external IT means. The electronic and calculation means can be 1S located in whole or in part in the case. They may contain means of alert or reminder to the patient about compliance with his

therapeutic protocol.

  The sixth means for transmitting and receiving data from external computer means are conventional means of connection to a computer or to a network of computers: serial, parallel, USB connection cords, infrared port, modems, etc. The external IT resources can be, for example, a computer or a computer network of the institution in which the system is used, for example, to update the database of the characteristics of the platelets and prescriptions of the patients supplied by the system, or a bar code reader, or a reader for optical character recognition, or a server for remote collection and processing of data, for example to facilitate therapeutic adaptation, in particular if the patient is installed physiological measuring devices representative of the

pathology to be treated, etc ...

  The seventh means for expelling a medicament out of its wafer are constituted for example by an assembly composed of a finger or punch which, pushed for example by a spring, a microphone

  motor or an electromagnet, presses on the semi-shell

  rigid of the alvecle of the drug, pushes this shell which grows!

9 2838047

  in turn on the drug, which transmits its force to the thin metallic layer which closes the alveolus, and forces it to yield, to let the drug pass; a second component of this assembly is a part, the counter-punch, which presses on the plate on the side opposite to the punch and on either side of the punch, to make the action of the punch more effective; a third component is a small knife or perforator which, located on the side of the counter-punch, punctures or cuts the thin metallic layer of the alvecle to weaken it just before the punch exerts its force on the medication; a fourth component is the micromotor and gear system which performs a relative movement between this assembly and the wafer, so that this assembly comes to be placed in line with the drug to be expelled; the movements are controlled by the fifth electronic and computing means. These electronic and calculation means keep in memory the positions of the different alvecles on which the expulsion assembly has acted, which constitutes successive representations of the position and

the contents of the alvecles.

  The eight means for collecting the exquisite drugs from their wafer are constituted, for example, by pieces in the form of a funnel, the point of which facing downwards allows the drugs which fall by their own weight to pass through. When boxes are assembled together to treat the medicines of several patients or several plates of the same patient, the boxes will advantageously be arranged in a vertical position; the plates being vertical, the drugs expelled will fall by gravity towards the lower side wall of each casing; this wall being wide open to let the medicines pass, they fall on a common inclined plate from where they fall in the form of a funnel; they can also be picked up by a kind of squeegee set in motion by a motor for example and pushed towards a hole or a groove where they fall. The drugs thus recovered can be put in sterile containers or bags assigned specifically to a patient, without human contact, which preserves the problems.

hygiene and sterility.

  In a variant of the invention, each plate, after having been recognized by the system (by the implementation of reading means, calculation means and the database) is positioned by an operator or the patient in a stable manner and S known in advance in a wafer holder adapter which may contain, by its dimensions, all kinds of wafer shapes in a range of given dimensions. This adapter holder is reusable. Large series can be produced in advance economically in only two or three different sizes (a small model, a medium model and a large model for example) in order to be able to place all the known wafers there. It is in turn placed in the box, where it stays tar.t that the drugs have not been withdrawn from its

  blister in the quantity prescribed.

  This adapter, which is designed to contain only one plate at a time, has cutouts in its faces to allow the sensors (l9- and 2nd means), the expulsion means (7th

  means) and drug collection (8th means).

  In collective or intensive use of the system, the boxes containing the wafer adapters can be grouped in an assembly in which the adapters are brought from their rest position to a single working position where most of the operations described are performed on the wafers in the

present invention.

  This arrangement in which the expensive components appear only once (in the single working position) for a

  a multitude of pads is particularly economical.

  The invention will be better understood on reading the description which

  follows two particular embodiments given as

  non-limiting examples. The description refers to the figures

  which accompany it in which: - Figure l is a partially exploded top view of a first embodiment comprising a housing in which a drug plate is installed and treated; - Figure 2 is a sectional view of the assembly for expelling a medicament from a wafer; - Figure 3 is a sectional view giving details of the mechanism of movement of the expulsion punch; - [igure 4 is a view of an adapter porLe wafer of drugs; - Figure 5 is a view of a second embodiment comprising numerous adapter holders associated with a single mechanism for the exploration and recovery of drugs. Figure 1 is a box 1 in which a plate 2 of drugs comprising alvoles 11 a At introduced by a

  opening 3 which can be closed again by a folding cover 4.

  In the arrangement here presented with a first embodiment where a wafer is processed in an autonomous case, the case 1 contains an electronic and calculation card 6 which includes, among other things, a micro controller 19, conversion cicuits! analog digital signals, memories, clocks, control circuits for electric motors and electromagnets, and interface cicuits with external computing means, such as a computer or computer network socket 14, or in barcode reader by socket 16. The bolt box 1 contains optical sensors connected to the card 6, which make it possible to detect by the effects of light as indicated above, whether or not a cell contains its drug; these sensors can be CCD arrays or arrays with their optics 5 or photoreceptors 2 0 which move relative to the plate thanks to the movements of the slide! transersale 8 which moves on the longitudinal rulers 7 thanks to the Alectrique micromoto-reducer 9 which meshes for example on a rack connected to one of the rulers?. The light reshaped by the optical sensors 5 or 20 is Amitted by photometric diodes 51 fizes or mobile on the rAglette 8 for example and which Emit possibly pulsed light to avoid the interference of the sensors by the ambient light. The means for expelling a drug 12 from its socket 11 is mainly a punch 21 which has a movement perpendicular to the plane of the plate thanks to the micromoCc-6ducteur 22, and which can be graduated on the slide 8 by the micromoto- 6ductor 10 which rotates an endless screw parallel to the strip 8 for example. The expelled medicament 12 falls by gravity into a form of funnel 13 which directs it into a container 23 which collects the medi cam nts expelled by the system for a precis patient. The orders sent by the electronic means of the card 6 to control the micromotor reducers for expelling the drugs, comply with the medication prescription of this patient previously introduced in the memories of the card 6 by the

  connection means 14 to an external computer (54).

  lO The housing 1 is supplied with electrical energy by internal batteries 17 or by an external energy source

  connectable to the power outlet 18.

  Figure 2 is a sectional view of the assembly for expelling a medicament, while Figure 3 is a partial section giving details of this mechanism from another angle. In Figure 2 which is a section along the plane BB of Figure 3, the plate 2, once installed in the housing, is between the punch 21 on one side and the punches 24 and a perforation tool 25 of the other side. The role of the counter-punches 24 is to prevent the plate from bending under the force exerted by the punch 21 on the cells 11 to expel the medicaments 12. The role of the perforating tool 25 is to perforate the thin metal cover 50 which closes the alvecles, to facilitate

the prescription of drugs.

  Figures 2 and 3 show details of an embodiment given by way of example for the movements of the punch 21. The movements of the parts 24 and 25 can be carried out in the same way by similar mechanisms. The distance between the strip 8 and the plate 2 being relatively constant, due to the internal construction of the housing 1, the punch 21 will come to push the alvecle 11 away from the strip 8. This movement of the punch is carried out in this exemplary embodiment by a screw 26 which carries at its end the punch 21, passes through a tapped hole 27 linked to the strip 8, and at its other end is fixed to a reversible micro-reduction gear 22. When the screw 26 is put in rotation by the micromotor gearbox, its two ends move in the same direction relative to the strip 8, while

  screwing or unscrewing in the threaded hole 27, the micromoto-

  reducer 22 being prevented from rotating relative to the strip by slides 28 in which it can only have a rectilinear movement S which brings the punch closer or further away from the

  plate 2 according to the direction of rotation of the micro-gearbox 22.

  The hole 27 is tapped in a part 29 which can have a translational movement along the strip 8, to bring the punch to the right of the drug to be expelled. An exemplary embodiment of this movement of the part 29 is shown in Figure 3 which is a section along the plane AA of Figure 2. The part 29 slides along the strip 8, which is of rectangular section in the example chosen, guided by the slides 30 which surround the strip 8 on at least 3 sides. The movement of the part 29 relative to the strip 8 is given for example by an endless screw 31 held parallel to 8 by the bearings of its 2 ends and which rotates in a tapped hole in 29 parallel to the strip 8, the rotation of the screw 31 being produced by a micro-reducer 10 (not shown in FIGS. 2 and 3) fixed to one end of the strip 8, as can be seen in FIG. 1. The part 29 can carry optical sensors 20 which constitute first means for detecting whether a cell is full or empty of its medicament, these sensors 20 being able to move relative to the wafer thanks to the movements of the

Exhibit 29.

  A variant of the way of introducing and installing a medication plate in the housing 1 is characterized by the use of an intermediate container called a wafer holder adapter in which the wafer is placed beforehand, before introducing into the housing the adapter containing the plate. The adapter can only take one blister at a time; it is reusable

for other plates.

  FIG. 4 shows an exemplary embodiment of such a wafer holder adapter 15 of rectangular shape in which the wafer 2 is positioned at an angle 32 by retaining grooves 34 made in both sides of the right angle 32 and locked in place position by latches or tabs 33 which can be moved along the grooves 34, in particular if the terminated plate is replaced by a plate of different dimensions. Thanks to these provisions, a given plate will always be placed in the same position in the angle 32. The adapter is produced in such a way that it will always find itself the same position in the housing 1. The faces of the adapter are perforated so that the first and second means for detecting alvecles and the seventh and eighth means for expelling and collecting the medicaments can act on the wafer placed in

the adapter in the housing.

  These provisions make it possible to place various plates in the adapter successively, while this container does not change dimensions, which provides two advantages: on the one hand with 2 or 3 different sizes of plate holder adapters, it is possible to position in a repetitive manner in the case almost all of the existing pads, on the other hand the reusable pad holders adapters can be manufactured in large quantities in a given size, in molded plastic for example, which significantly reduces costs

Manufacturing.

  A second embodiment of the invention relates preferably to the institutions (hospitals, retirement or convalescent homes for example) in which every day the nursing staff must prepare the doses of the drugs for all the patients or residents. These preparatory works

  are long and therefore expensive and are not error-free.

  Precisely the embodiment described here overcomes these problems by proposing to relieve the nursing staff of most of the gestures necessary for the preparation of medicaments, thanks to the automation of the functions of recognition of medicaments, expulsion and collection of medicaments. in an individual container dedicated to each patient. In addition, automation significantly reduces the error rates of

distribution of medicines.

  FIG. 5 shows a transparent view of an exemplary embodiment of this second mode. This embodiment comprises 3 parts: the upper part 35 o are stored the wafer holder adapters in the rest position, the middle part 36 o are executed at a single working position the operations on the inserts lowered from the upper part in their wafer holder adapter , and the lower part 37 o are collected expelled drugs. In the upper part 35 the adapters each containing a plate are held in a vertical position in vertical slides or grooves 38, and hooked for example by leaf-shaped springs 39 which allow the adapter to escape when a tensile force is applied beyond a known limit. Each adapter can be inserted or removed manually from the upper part 35 by an opening 40 on the upper face of 35, or by an opening on one of its lateral faces (opening not shown in FIG. 5). On the right-hand side of FIG. 5, a wafer holder adapter 15 is shown in the intermediate position, descending from the upper part 35 in the middle part 36 by a mechanism carried by a charict 41 which comprises 2 vertical slides 42 between which the adapter can go up or down, under the effect of the micro-reduction gear 43 driving the worm 44. The carriage 41 can be moved along 2 horizontal slides 45 by a micro-reduction gear 46 to bring the wafer holder adapter 15 that it transports to the single working position 47, or to return the adapter after the operations carried out on its wafer to the working position, to its storage location in the upper part 35. At the single working position 47 are gathered the first and two means to detect if a cell is full or empty of its medication and to locate the cells on the

  wafer, and the seventh means for expelling the drugs.

  In the left part of FIG. 5 are represented in position 47 only a few organs of the first, second and seventh means which have been described in detail with the aid of FIG. 1. The eighth means for collecting the drugs expelled sor.t formed in the lower part 37 by the funnel 13 which directs the medicaments into a container or bag 23 which bears the name or the code of the recipient patient; this container or bag 23 can advantageously be sterile and sealed once it has received the expected drugs from the system. The electronic and calculation means are gathered in this exemplary embodiment on the card 6 which can be located in any place of this assembly and for example in the lower part S 37 near the connectors 14 and 16 which make it possible to connect the together with external IT resources. These external computing means can in particular be a computer or a network of computers of the institution in which the system is installed, which allows the system object of the invention to be incorporated into the operation of the institution in the following manner : - the medication prescriptions for each patient are computerized in the network and entered into the memories of the system by connection 14; 1S - the brochures for the drugs to be dispensed are first presented and read by optical recognition means, for example a bar code reader 53 connected to the connector 16, then installed in turn in the wafer adapters: thus the system knows which wafer is at which position in the upper storage part 35; - to prepare medicines for a specific patient at the request of an operator or automatically if the system is programmed for this, the system will take in the upper part 35 in turn each wafer necessary for this patient, in its holder adapter wafer, brings it to the unique working position 47, extracts and collects the drugs in the prescribed quantities and returns the wafer to its storage position. At the end of this cycle for a patient, a database concerning the taking of

  each patient's medication is updated.

Claims (9)

claims   1- Observance and assistance system for taking drugs packaged on a wafer, comprising detection means, calculation and transmission means to a computer, characterized in that it comprises reception means and for positioning the wafer, and means for optical detection of the presence and absence of the drugs in the alveoli of the wafer providing information for the determination of an image representative of the position and content of the alveoli, the signals of output of the detection means being transmitted to the calculation means and recorded with the corresponding time and date, the data thus produced being transmitted to the computer.   2- The system as claimed in claim 1, characterized in that the representation of the content of the wafers in the wafer is obtained from information entered on the wafer by optical sensors (5), k20) which collect the light radiated by emitting cells (51) and capable of crossing the wafer on the right of an empty cell of its medication or of being   reflected by the material covering the cell.   3- System according to claim 2, characterized by the fact that said optical sensors are associated with electromechanical means (7), (8), (9), (10) which effect quantified displacement of the light sources and of the sensors by relative to the plate, the measurements associated with these displacements making it possible to assign to each cell a position in the plane of the representation of the plate, while avoiding contact   between the board and the sensors.   4- System according to any one of claims 1 to 3,   characterized by the fact that the sensors allowing the representation of the contents of the cells and of their locations on the wafer are shooting cells (5) which capture partial or full images of the wafer, these   images being processed and stored SQUS digitally.   - System according to any one of claims 1 to 4,   characterized by the fact that the entry of information on the content of the wafer is carried out in a box (1) in which or on which the wafer stays, said boltier containing sensors, possible electromechanical means, electronic and calculation means (6), dating S events, memories, and may contain means of alert (52) or reminder to the patient about compliance with his therapeutic protoeole, and an internal source of electrical energy (17) for its autonomous operation or a means (18) of connecting it to an external power source.   6- System according to any one of claims 1 to 5,   characterized in that the detection of the taking of a medicament is obtained by the comparison of the representation of the contents of the alveoli of the wafer after sampling or expulsion of a medicament, with the representation stored in memory before a medicament is extract, the possible differences, corrected for variations in orientation of the wafer with respect to the case, making it possible to determine precisely which cell has been emptied of its medication, at an instant between the moment when the wafer has been separated from the case and the when it was returned to it, or when the medicine was expelled from its wafer if it remained in the case, the said comparison can be performed automatically by cal cul means   in the said box or in an external computer.   7- System according to one of claims 5 or 6, characterized by   the fact that the electronic and calculation means are programmable by external computer means to which they are connectable (computer (54), network, Internet, bar code reader, optical character recognition reader (53), etc. ) this link making it possible to record in the memories means of calculation of the box data such as: the drug prescription of the patient (s), the type of plate and the dosage of his drugs, alarms related to the therapy protocol, the code of the patient (s) that the system will monitor, the external computer can also handle the processing and presentation of the information it receives from the system in rsel time, or in deferred time if the connection is occasional. lg   8- System according to any one of claims l to 7,   characterized by the fact that it contains a set for expelling the medicaments from the wafer, this assembly moving from one alveolus to the other in order to expel the medicaments therefrom by the force of a punch 121) which pushes the alvecles , the movement members being micromotors (9), (10), (22) controlled by the electronic and computing resources.   9- System according to claim 8, characterized in that the representation of the position and content of the cells is constituted by the corservé memory of the position of the different cells on which the expulsion assembly acted successively.   - System according to one of claims 8 or 9, characterized by   the fact that it contains means (13) for collecting the expelled medicaments and bringing them without human contact to   dedicated containers or bags for recipient patients.   11- System according to any of claims 5 to 10,   characterized by the fact that the medication strip is positioned in a reusable intermediate piece (15) called the wafer holder adapter before being inserted into the housing, the said adapter only accepting one wafer at a time and having sufficient dimensions to be able to accommodate there without modification of numerous models of plates of different dimensions. 12- System according to claim 11, characterized by the fact that it contains several wafer holder adapters which are brought from their rest position (38) to a single working position (47) where their wafer is treated, then brought back to their position of rest, the movements being controlled by electronic and computing means, to serve automatically and economically