Daily Meds Are More Common Than You Think
Medication management refers to the ‘instrumental activity of daily living’ of taking medication as prescribed. It is a complex, multi-step process involving filling the prescription, understanding how to take the medication and the potential side effects, taking the medication, monitoring and sustaining the medication regimen, and lastly refilling the medication and repeating the process as needed.
This becomes an area of concern for those who struggle with medication adherence, or the extent to which a person’s behavior taking medication corresponds with agreed recommendations from a health care provider.
Not An Elderly Problem
Recent reports claim that 30-50% of people do not take their medication as prescribed, attributing the problem to forgetfulness, running out of medication, or being careless about the medication-dosing schedule (AOTA, 2017). As a result, they are at a higher risk for poorer health outcomes, disability, hospitalizations, and higher rate of all-cause mortality.
As the number of medications for an individual increases and the dosing becomes more complex, the number of problems with managing medication is multiplied. Although most people associate medication management with older adults, 25% of children are prescribed medication, revealing a need across the lifespan to address this concept (AOTA, 2017).
Although most medication adherence interventions are complex, costly, and unsuccessful, The Ecological Model for Adherence in Rehabilitation suggests that an occupational therapy (O.T.) approach can effectively modify person factors, provider factors, intervention factors, the environment, self-determination, and knowledge to improve adherence (Schwartz et al., 2017).
Client-centered Approach
O.T. practitioners contribute to medication management by utilizing task analysis to analyze, assess, and address client performance of discrete management activities in the context of the client’s daily life. We use a combination of interview, skilled observation, and assessment of selected aspects of performance to holistically elicit information about existing medication routines as well as client knowledge and beliefs about medication.
We do not alter the advice of prescribers or pharmacists, but rather, we implement client-centered, evidence-based interventions to reduce barriers and promote consistent, effective medication management.
The process for an O.T. to improve medication management and medication adherence includes:
motivational interviewing
goal setting
problem solving
assistive technology
education (learn how to read a medication label to ensure all medications are taken accurately)
advocacy
self-monitoring
organizational efforts
remediation/compensation of impairments (e.g., hand strength, dexterity, vision, functional cognition)
environmental modifications
When helping a client establish habits and routines, we want to ensure that they are sustainable, consistent with medication adherence, and compatible with potential changes in temporal and physical environments.
The Reality
Consider a student who is newly graduated from high school and off to college. This is a huge life transition in which they are living in a new city, away from parents, with the freedom to form new habits and manage their schedule however they please. Prior to college, they were accustomed to their parents telling them how to spend their time, what to eat for dinner, and when to take their medication. Now they find it difficult to structure their day and monitor all their responsibilities.
An O.T. practitioner can provide that structure and support them in identifying administration times that are more compatible with the client’s new routines such as introducing phone apps that serve as medication list, reminder system, and tracking system. An O.T. may also identify strategies to compensate for client weaknesses by modifying their environment or routine.
Incorporating visual cues, such as leaving the medication in a visible place, or implementing a checklist for the morning routine are ways in which occupational therapy practitioners can collaboratively problem-solve with the client to improve medication management.