Occupational Therapy
Medication Adherence
Assistive Technology & Personal Assistance
Many people with poor medication adherence simply forget to take their medications. Assistive technology is the "broad range of devices, services, strategies, and practices that are conceived and applied to ameliorate the problems faced by individuals who have disabilities" (Cook & Polgar, 2007). In this instance, we will be talking about the ameliorating the issue of poor medication adherence for persons with chronic health conditions. There are four types of assistive technology sub-strategeis that can be used to improve medication adherence, 1) low technology solutions, 2) pillboxes, 3) blister packs, 4) smartphone apps, and 5) personal assistance. Any client who discusses and demonstrated deficits in memory, attention, and/or executive function may benefit from assistive technology to help compensate for cognitive deficits. Cognition is measured by The Short Blessed Test and the Pillbox Test. Cognitive deficits may also be described by the client in his or her Occupational Profile Interview. Pages 12 and 13 of the "Managing your Medicines" pamphlet provide some basic information on assistive technology, but you and the client should decide on some specific strategies. In addition to the pamphlet, you should write simple easy to read notes on the strategies you and the client choose and give them to the client.
Low Technology Solutions
Low tech solutions include things such as notes, checklists, or other everyday items.
Notes are great for people with memory impairments, and may be something like leaving a note on the back door that says "Did you take your medications today?"
Something like a checklist can help with memory and/or attention deficits. A check list can be used to mark off when a client takes their medications, helping clients to remember if they took their medication. A check list can also be used to make sure that the client completes the correct process when sorting his or her medications into a pillbox. Checklists can be completely words, or they can involve images.
Everyday items such as a watch alarm or an alarm clock can be set to remind the client of medication dosing times.
While the interventionist cannot set up the low tech devices for the client directly, the interventionist can give clients the information and resources to complete this activity on their own. There is no handout for this intervention strategy. The interventionist should help the client to problem solve and develop their own low tech solutions. The interventionist should take simple and easy to read notes to share with the client.
Pillboxes
Persons eligible for this study/intervention are managing several different medications that they take everyday. Often medications are taken in doses spread throughout the day, sometimes associated with meals and sometimes associated with sleep. Any client who has poor medication adherence and does not currently use a pillbox should consider beginning to use a pillbox as they offer three benefits.
First when using a pillbox, the user only has to sort their medication once. Otherwise, if a client has to take 3 medications (of 10 medications) in the morning, the client must look at all of the pill bottles and find the correct medications and take them. This is a lot of effort everyday, and also provides room to make mistakes, such as taking the wrong pill.
The second benefit is that the client knows if he or she has taken the medications for the day. If the medications are missing from the pillbox, it is likely that the client consumed them. If the medications are still there, then they have not yet been taken.
Finally, use of a pillbox makes traveling with medications easier. If a client goes on vacation, he or she can take the pillbox instead of having to lug several pill bottles.
A handout has been created for this intervention strategy. The handout lists the three benefits of using a pillbox and then lists four types of pillboxes and their cost at Walgreens. All of the selected pillboxes are available in Walgreens stores in Milwaukee. During your session, if the client does not use a pillbox, but your clinical judgement indicates that it may be beneficial, you may prescribe a pillbox for the client. Circle the pillbox on the handout that you think may work best for the client and recommend that they purchase one. Note that all study participants will be receiving a $20 gift card to Walgreens at the conclusion of each phase of the study. In addition to encouraging participation, the gift card provides the client with the needed funds to purchase a pillbox. Click here to download the pillbox handout, or look at the image below.
Blister Packs
A blister pack is similar to a pillbox, but is organized by the pharmacist. It looks like the image on the right. The pharmacist organizes a client's pills into daily doses (similar to a pillbox). The client then pops out the pills for each dose. This is a good option for persons who do not have sufficient cognition to complete their own medication sorting needed to manage their own pillbox. To get blister packs, clients must talk with their pharmacy to see if their pharmacist will put together blister packs on their behalf. Sometimes there is a small fee for the blister packs. If this is a good intervention strategy for the client, educate the client on talking with his or her pharmacist to request a blister pack. There is no handout, so be sure to take simple easy to read notes.
Blister Pack Image from:
http://www.prweb.com/releases/medicineontime/26JAN2010/prweb3517164.htm
Smartphone Apps
This is a great intervention strategy for clients who have difficulty remembering their medications and also own a smart phone (e.g. iPhone, Samsung Galaxy, etc.). There are several Smartphone apps available that help clients remember the name, purpose , and dosing time (vias alarms) for their medication. Some apps even allow the client to talk to a pharmacists or request refills. The PI of this study has reviewed several apps and has selected three apps to recommend to clients in this study. There is a handout describing the benefits of using an app in addition to a description of each of the three recommended apps. During your session, if the client does not use an app but owns a smartphone and your clinical judgement indicates that an app may be beneficial, you may prescribe a app for the client. Circle the app on the handout that you think may work best for the client and recommend that they download it. If you have time in the session, you can help the client to get the app set up correctly. Click here to download the app handout, or look at the image below.
Personal Assistance
In addition to technology, assistive technology also includes personal assistance. Sometimes clients face too many barriers to be successful on their own. If the client has family present in the home who can assist with medication routines or if a client has resources to pay for assistance, getting help from a person may be an easy solution. Use your clinical reasoning to figure out the part of the medication task (e.g. sorting, reminders, etc.) that the client needs assistance with, and then prompt the client about getting help from a family member. There is no handout for this intervention strategy, so be sure to take simple easy to read notes.