Occupational Therapy
Medication Adherence
A hefty evaluation component informs this study in several ways. The evaluation will allow the research team to 1) plan a client centered intervention and 2) identify client progress from before to after intervention. This section will describe the purpose, administration, and interpretation of each assessment across the study. Several assessments are administered at baseline and follow-up to check for client progress. Assessments are described in the order administered and grouped into the categories of Screening, Guiding Intervention, Outcomes, and Guiding Intervention and Outcomes. Within the description of each assessment too, you will find a link to download the paper form. Video tutorials are also available for non-survey assessment tools.
1. Medication Adherence Screen
Use the Adherence to Refills and Medications Scale to determine if the client has impairment in taking medications.
2. Occupational Profile
The occupational profile will be collected during the baseline assessment (American Occupational Therapy Association, 2014). This occupational profile is specific to medication management. In this interview, the client is asked about the number of different medications taken, number of pills, number of doses per day, impact of the health condition and medications on daily performance, current routines around medication management, and health care utilization. Note that typically in an occupational profile, one asks about the environment. Environment questions have been separated and will be discussed in the next section. Click here to view the question route for the interview. Click here to see the occupational profile tutorial.
Intervention
The occupational profile helps to plan a client centered intervention. Understanding the occupational profile, allows the interventionist to conceptualize the client's current medication regimen and it's complexity. Additionally, the discussion of current medication routines will allow the interventionist to identify adaptive strategies that should continue and maladaptive strategies that may change to improve outcomes. Discussion and where and how long the client has received care for his or her chronic health condition helps to begin to identify the client's relationship with the medical team and the duration of time that the person has been managing a chronic health condition.
3. The Pillbox Test
The Pillbox Test is an assessment in which the client is asked to sort a weeks supply of five medications into a dossette. While the test was developed as a measure of executive function by Zartman and Colleagues (2013), the tool is also informative on the client's capacities for vision, health literacy, and motor skills needed for medication management (Zartman, Hilsabeck, Guarnaccia, & Houtz, 2013). Click here to download The Pillbox Text Instructions. Click here for the tutorial on The Pillbox Test.
Intervention
This focus of this tool is to guide intervention. First, the assessment would reveal cognitive impairments that may necessitate compensatory assistive technologies such as notes, reminders, or assist from a family member (assistive technology module). Increased time (more than 5 minutes) or making more than 3 mistakes in the sorting would likely indicate an impairment in cognitive function. Watching the client manipulate the different materials has implications for different assistive technology recommendations. For example, if the client had difficulty with the pill bottle caps, he or she may benefit from easy open containers. The assessment also asks the client to look at the medication label and identify the correct information needed for the task. Persons with difficulties with this component of the task may benefit from the medication health literacy module. Finally, both the reading of the medication and the visual tracking of the pills highly utilizes vision. Persons with vision deficits may benefit from changes to the environment (medication storage), assistive technology, or help from a friend or family member.
4. Medication Knowledge Assessment
The Medication Knowledge Assessment (MKA) is a simple clinical tool that evaluates how well a person knows their medication regimen (American Society on Aging & American Society of Consultant Pharmacists Foundation, 2006). With medications present, the client is asked about 1) the name of the medication, 2) the purpose of the medication, 3) the dose and dosing schedule of the medication, 4) side effects, and 5) awareness of need for refill. The person receives one point if they get the criteria correct and no points if they do not get the criteria correct. Click here to download the Medication Knowledge Assessment Form. Click here to see the tutorial on the Medication Knowledge Assessment.
Intervention
This tool can be used to help plan the need for education. Patient scoring poorly on this assessment may benefit from the Understanding Medications module with educated targeted to the areas in which the client had the most points lost.
Outcomes
It is anticipated that clients who receive the intervention will be more knowledgeable about their medication regimen after intervention.
5. Pill Counts (Medication Adherence)
Medication adherence measures how well a client has been taking his or her medications. There is no perfect measure of medication adherence, so it is best measured using multiple methods (Kozma, Dickson, Phillips, & Meletiche, 2013). For this study, we will measure Medication adherence using a pill count.
Pill Count
During a pill count, the client presents his or her medications in the bottle form the pharmacy. Using information such as the dosage, number of pills prescribed, and the fill date, the evaluator can complete a rough calculation of what percentage of medications the client has taken since the prescription was filled. Click here for the handout on calculating medication adherence from a pill count. Click here for the tutorial on conducting a pill count.
Intervention
Medication adherence is often discussed as a percentage of the medication taken. Clients with adherence rates under 70% are at risk for negative health consequences associated with poor medication adherence. Clients with adherence rates above 100% are at risk for overdosing on their medications. A medication adherence rate of 80-100% is associated with positive health outcomes. In the intervention, the interventionist will identify the clients baseline adherence level and ask them to set a goal to improve medication adherence. Our goal for this intervention is to bring persons into the 80-100% range.
Outcomes
It is anticipated that clients in the study will demonstrate poor medication adherence (<70%). Further, it is anticipated that clients who receive the intervention will improve their medication adherence rate.
