Running head: OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
The Role of Occupational Therapy in Medication Management: A Survey of Practitioners
Tara Hendrix, Tricia Kamyszek, Erica Loomis, and Lauren Nowak
Saginaw Valley State University
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Abstract
This descriptive survey study was designed to learn the role that occupational therapy
practitioners currently play in medication management including their role in interdisciplinary
care, the type of patient settings in which it is utilized, and the educational requirements that
should be included for students and practitioners. This study included currently practicing
registered occupational therapists in the state of Michigan. The survey was sent out to 100
practitioners and there were 32 responses returned. This study took on both a qualitative and
quantitative method asking open and closed-ended questions. The researchers used SNAP survey
software so that the participants could complete the survey online. No names were asked when
completing the surveys and all of the data collection was performed on Saginaw Valley State
University’s campus by the researchers. There were a variety of settings in which the participants
stated that medication management should be used with the most common being home health
care. The researchers also found that occupational therapists should collaborate with other
disciplines in regards to medication management with the most common collaborations including
nurses and physicians. A majority of the participants believed that pharmacology should be
included in occupational therapy curriculum with continuing education courses being the most
likely form of education for the participants to partake in. Overall, 56% of the participants
believe that the role of occupational therapy should be further developed for future occupational
therapy practice.
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The Role of Occupational Therapy in Medication Management: A Survey of Practitioners
In the 20th and 21st centuries, much advancement has been made in the fields of medicine
and technology. Some advancements that have been made include new medications as well as a
growing amount of medications that are being taken. Along with medication advancements, there
are a multitude of different settings that patients are being treated in and a multitude of services
provided in each setting. This has allowed individuals to survive diseases and disability at higher
rates compared to the centuries prior. Today’s population is living longer and wants to remain as
independent as possible. However, forty percent of adult Americans have a low health literacy
rate, defined as a person’s ability to make knowledgeable decisions in regards to health issues,
resulting in poor medication management skills (Kripalanim, Gatti, & Jacobson 2010).
According to Kuckarslan, Hagan, Shimp, Gaither, and Lewis (2011), medication
management refers to an individual’s ability to assess medications, identify possible medication
interactions and complications, and understand proper medication use. More and more
Americans today are developing co-morbidities: “Approximately one in five adults in the United
States have more than one chronic medical condition” (Kuckarslan et al., 2011, p.336). Patients
that have multiple chronic conditions are more likely to use multiple medications prescribed by
specialists, requiring a strict medication regimen. Unfortunately, the management of these
medications can prove to be difficult for patients, especially those with low health literacy
(Kuckarslan et al., 2011). Due to these co-morbidities, it is essential for patients to be treated
using a multi-disciplinary role (Bajcar, Kennie, Eiarson, 2005). Because of this multidisciplinary role that should be taken regarding medication management, it is important that all
disciplines are educated on medication and pharmacology in order to aid those patients with low
health literacy. This education should be required for more than just physicians and pharmacists.
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The more educated the providers are, the more educated the patients will be now and in the
future.
Individuals with multiple medical conditions may take numerous pills daily. This
requires a strict regimen of medication management to control symptoms. Consequences may
occur as the result of inappropriate management of medication schedules, such as a missed or
incorrectly taken dose, which can cause the onset of undesirable symptoms. If a dose is missed
or incorrectly taken, onset of undesirable symptoms has the potential to occur. For example, if an
individual with Parkinson’s disease misses a dose or does not receive it on time, the individual
may be unable to manage mobility-related symptoms (Heisters, 2011). A collaborative approach
by multiple disciplines along with proper scheduling and sequencing of medications, as well as
the patients’ having proper health literacy, is critical for their effectiveness, and is therefore
important for health care professionals to consider while working with patients (Heisters, 2001).
The health care professional’s role can require assistance beyond that provided by the
general practitioner and pharmacist to assist the patients’ in developing a routine in regards to
their medication management (Rust & Davis, 2011). According to the OTPF: Domain and
Process (2nd edition) (AOTA, 2008), medication management is considered an instrumental
activity of daily living (IADL) and “developing, managing, and maintaining routines for health
and wellness promotions, such as physical fitness, nutrition, decreasing health risk behaviors and
medication routines”(p. 642). This is where occupational therapy can help bridge the gap
between the pharmacy, physician, hospital and the home and goes beyond developing routines.
For Example, occupational therapists can help the client develop adaptive techniques to aid them
in taking their medication as well as educating the client on possible drug side effects. However,
it can be concluded that, due to a lack of evidence based practice found on the subject,
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medication management is not currently a primary focus in the practice of occupational therapy
when compared to other instrumental activities of daily living (IADLs) (AOTA, 2008).
Statement of the Research Problem
There is a question as to the role that occupational therapists could play in training their
patients in medication management. There is a significant lack of research in literature to guide
OT practice in medication management. Prior research has indicated that medication
management training is primarily provided by nurses and physicians; however, it is now more
recognized that the education in medication management must be addressed by a collaborative
team of health care professionals, including occupational therapists (Rust & Davis, 2011). Along
with multiple professions utilizing medication management, it has also been discussed that
medication management should or could be utilized in multiple different settings. Unfortunately,
there is a lack of clarity in American Occupational Therapy Association (AOTA) documents
providing guidance on what occupational therapists could be implementing in patient
intervention regarding medication management. There is also a lack of clarity of inclusion of
pharmacology courses in the Accreditation Council for Occupational Therapy Education
(ACOTE) (2012) standards for occupational therapy education.
Purpose of the Study
The purpose of this descriptive survey study was to learn the current role that
occupational therapists play in medication management, including their role in an
interdisciplinary approach, which type of clinical settings are used for patient treatment, and the
educational requirements for occupational therapy students and practitioners. This study
specifically targeted the demographic of registered occupational therapists in the state of
Michigan, practicing in a multitude of different settings, and whether they used medication
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management with their patients. It also sought to discover whether therapists’ view medication
management as an IADL, thus deserving education and training.
Research Questions
This study explored the current role that occupational therapists in the state of Michigan
play in medication management. The researchers answered the following questions:
1. In what practice settings are medication management strategies addressed by
occupational therapists?
2. What education requirements should be included in occupational therapy curriculums to
prepare practitioners to provide training to patients in regards to medication management?
3. What other disciplines do occupational therapists most commonly work with in regards to
a client’s medication management, including dose scheduling and knowledge of
medication interactions?
Theoretical Perspective
The social cognitive theory (SCT), as described by Albert Bandura, states that learning is
an outcome of the interaction between the behavior, person, and environment (Giroux-Bruce &
Borg, 2002). According to Luszczynska & Schwarzer (2005), the SCT addresses several factors
that influence behavior such as self-efficacy, outcome expectancies, goals, and perceived
impediments. However, self-efficacy and outcome expectancies are the most pertinent to the
present study. Perceived self-efficacy is an individual’s belief in his or her capabilities to
perform a task in order to produce a desired outcome. Outcome expectancies are the beliefs that
individuals’ have about possible consequences of their actions. For example, for a patient
(person) to adhere to a medication routine (behavior) to independently manage symptoms
(environment), he or she must believe that adhering to the medication routine will improve
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symptoms (outcome expectation) and also that he or she is capable of managing their own
medication routine (self-efficacy) (Rosenstock, Strecher & Becker, 1988).
This theory relates to medication management in occupational therapy. According to
Gage and Polatajko (1994), perceived self-efficacy has relevance to the practice of OT because it
is consistent with the foundational beliefs of the profession. The OTPF: Domain and Process (2nd
edition) (AOTA, 2008), states that one aspect of the client factors include the person’s beliefs or
what they hold to be true. If the patient believes that they will succeed then this will provide
them the confidence to complete the task and they will have greater outcomes due to this. Selfefficacy is also relevant to increasing and ensuring successful occupational performance. When
individuals have high self-efficacy and outcome expectations, their compliance in managing their
medications also increases. For example, a study done by Luszczynska and Schwarzer (2005)
used the SCT to explain that adherence to retroviral medication was related to positive selfefficacy in patients with HIV. When education in regards to medication management was
provided in smaller groups there were higher outcome expectations, which resulted in better
control of the participants’ symptoms. As a result of this study, it was concluded that when an
individual sees positive outcomes from adherence to a medication regimen, his or her belief in
his or her capacity to successfully complete a task increases (Luszczynska & Schwarzer, 2005).
In occupational therapy, the therapist can educate the client on medication effects,
routines and adaptive aids or techniques. If the therapist does this successfully, the client will be
able to perform these techniques and will build self-efficacy due to this. By building self-efficacy
their compliance will increase and when the occupational therapist is no longer there, the
techniques will persist and the client will be able to better handle their medication regimen. This
theory drives the aspects of current occupational therapy practice, the settings and the
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educational requirements that are needed. This theory drives this study because if occupational
therapists are addressing medication management in the appropriate settings and in an educated
way, then the patients will ultimately benefit and their compliance will increase. Once their
compliance increases they will be able to better manage medications now and in the future which
will reduce negative effects of improper medication uses.
Definitions of Terms
Instrumental Activities of Daily Living (IADL). The tasks completed on a daily basis
in the individual’s home or community that “often require more complex interactions than selfcare in daily activities” (AOTA, 2008, p.671).
Medication management. Includes an assessment of all medication to identify potential
complications and provide patient education about proper medication use (Kucukarslan et al.,
2011).
Self-efficacy. The optimistic self-beliefs about one’s own ability to accomplish or to
complete a given task (Luszcynska & Schwarzer, 2005).
Significance of the Study (make sure it sounds good and there is enough evidence to back
up why all of our research questions are significant)
Medication management plays a critical role in a patient’s health outcomes, health-care
use, improvements in medication knowledge, and health-care costs (Rust & Davis, 2011). There
is a lack of research in the body of OT literature illustrating the role that occupational therapists
have in medication management, as discovered by conduction of the literature review regarding
this topic. However, occupational therapists need to be able to determine whether a client is able
to correctly understand the purpose, side effects of, and interactions between their medications,
as these may impact occupational performance (Ehrlich, 2007). The occupational therapist must
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also aid the client in developing routines for taking their medication so that doses are not
incorrectly taken. Along with this, adaptive aids or techniques may need to be provided by the
OT so that the patient is able to correctly and effectively take their medications. If medications
are not taken or incorrectly taken then the patient may suffer severe outcomes and by addressing
adaptive techniques or by developing routines for the patient’s, these negative outcomes may be
reduced and the patients can take their medication more effectively and safely.
Occupational therapy is not the only profession that addresses or should address
medication management. It is important for an interdisciplinary approach to be provided to the
client so that they get the holistic and best care possible. Every health care practitioner should be
involved in the patient’s care to provide the best outcomes to the patient. According to Bajcar,
Kennie, and Einarson (2005), many different health care professionals are involved in the drug
use process and a collaborative approach to medication management is needed because the use of
medications have grown more complex, especially in patients with chronic illnesses. It is
important to consider which settings practitioners would or do use medication management
because some settings may be more appropriate than others. There also may be different
techniques used by the occupational therapist as well as different levels of collaboration
depending on the setting that they work.
According to the current Accreditation Council for Occupational Therapy Education
standards, there are no requirements for the inclusion of pharmacology courses within the
occupational therapy curriculum (ACOTE, 2012). If we are going to aid the client in medication
use and side effects, then a general knowledge or background on medications is pertinent. The
results of this survey provided more information regarding the views of currently practicing
OT’s in regards to educational requirements.
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The results of this survey study provided more information regarding the role of
occupational therapy in medication management and added to the limited body of knowledge
concerning the topic. This study provides information to help further understand the beliefs and
trends in occupational therapy’s role in medication management concerning which settings it
may potentially be implemented, and whether or not alterations should be made in the
curriculum of occupational therapy students involving medication management.
Limitations of the Study
This study was a survey of current medication management practices of occupational
therapists in the state of Michigan. Occupational therapists that received this survey had to be
members of the Michigan Occupational Therapy Association (MiOTA). This had the potential
to effect results, since MiOTA members may have provided biased opinions regarding the role of
occupational therapy in medication management, as compared to occupational therapists who are
not members of MiOTA. MiOTA members may have been more engaged in their profession as
shown by their affiliation with a professional organization and thus more likely to have
responded to our survey in hopes of supporting new research in the field of occupational therapy.
Since our study was only sent to individuals in the state of Michigan, this may have limited
generalizability to national results or compared to other states. This study, which utilized a
researcher-designed survey, leaves room for error as it was sent to only 100 occupational
therapists in the state of Michigan.
Review of the Literature
As medicine and technology continue to advance, many peoples’ life expectancy
continues to increase. This increase, however, often relies on the ability of the individual to be
able to maintain an accurate medication regimen schedule (Luszczynska & Schwarzer, 2005).
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This literature review will examine current research on medication management and the potential
role of occupational therapy related to this issue. It will begin with an overview of the topic of
medication management and how it relates to the social cognitive theory. This will be followed
by a review of the implications of medication management, and individuals following a
particular drug regimen will be investigated to understand the importance of prescription
adherence. Next, a discussion regarding the current role of occupational therapy in medication
management will be provided. Following this will be a review of the importance or need of an
interdisciplinary approach to medication management as well as the settings that medication
management is or should be used. Finally, an overview of the current educational requirements
for pharmacology in occupational therapy will be reviewed as well as a need for more research
on this topic.
Medication Management
SCT addresses the psychosocial aspects of behaviors and methods to promote behavior
change. This theory explains the relationship between a person’s behavior and its impact on
their environment or cognition (Giroux-Bruce & Borg, 2002). SCT focuses on the prominent
role of social modeling in human motivation, thought, and action. It relies on the idea of
perceived self-efficacy and social modeling, which is observing and copying the actions of
another, in outcome expectations (Luszczynska & Schwarzer, 2005).
Self-efficacy refers to an individual’s belief in his or her own abilities to complete a task.
Self-efficacy is essential in the SCT. To change a behavior in order to become successful in
completing a task, a person must have an optimistic attitude towards his or her ability to be
successful (Luszczynska & Schwarzer, 2005). Positive self-efficacy can improve an individual’s
ability to obtain desired goals (Billek-Sawhney & Reicherter, 2004). Outcome expectancies are
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the beliefs an individual has about possible consequences of their actions. SCT relies on the
interactions of self-efficacy, outcome expectancies, and social modeling to successfully acquire a
desired behavior. Social modeling is a way for an individual to generate new behavioral patterns.
It also affects an individual’s motivation to complete tasks (Luszczynska & Schwarzer, 2005).
Positive self-efficacy and social modeling combined can be used to create higher outcome
expectancies which can result in an individual’s improved occupational performance (BillekSawhney & Reicherter, 2004).
Medication management is defined as a process involving reviewing a patient’s
medications to identify potential problems, and educating the patient on proper medication use
(Kucukarslan et al., 2011). It also involves the individual’s behaviors of compliance and
adherence. Compliance is the term commonly used to describe the patient following treatment
instructions, which includes the extent to which a client’s behavior matches a health
professional’s recommendations. Adherence refers to the client’s decision of whether or not to
follow these recommendations. (Kaufman & Birks, 2011).
Non-compliance with medication requirements may result in the onset of adverse
symptoms (Kuckukarslan et al., 2011). Lack of adherence may be the result of having poor selfefficacy, which may cause an individual to not try very hard to remain compliant because he or
she already doubts his or her ability to do so (Gage & Polatajko, 1994). The social cognitive
theory demonstrates how the use of social modeling and improved self-efficacy can promote an
individual’s compliance and adherence to a medication regimen, increasing their outcome
expectancies. This theory has been applied to explain, predict and influence behavior
(Luszczynska & Schwarzer, 2005). A good example of this concept is demonstrated in the ways
that medication management, which is considered an IADL, can be addressed in occupational
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therapy. If a therapist can successfully model proper medication maintenance routines to a client,
that individual may be able to learn how to successfully complete these tasks independently.
Finding success in these tasks is not only beneficial to that person’s overall health, but also helps
build a higher sense of self-efficacy towards the belief of being able to continue to independently
complete medication management tasks. This combination of modeling and improved selfefficacy can in turn produce more positive outcome expectancies in the client and thus produce
better occupational performance over all.
Medication management can include different strategies such as simplifying drug therapy,
providing proper patient education, using special packaging and labeling techniques, and the use
of compliance aids to make it easier for the patient to take the proper medication with the correct
dosage (Simonson, 1984). Simplifying drug therapy consists of using the least possible number
of medications and making them compatible with daily habits (for example, prescribing
medications designed to be taken with meals, at bed, or wake up time). Providing proper patient
education is important in medication management because patients who understand their disease
will demonstrate better adherence to a medication treatment plan. Using packaging and labeling
techniques, such as using different colored containers for different medications or using larger,
easy to read fonts on labels, allows the patient to easily differentiate their medications. Lastly,
incorporating the use of compliance aids helps the patient keep track of following a medication
regimen by using pill boxes or a calendar (Simonson, 1984).
Recent literature indicates that medication management services are primarily provided
by physicians and nurses (Ehrlich, 2007). However, these professions are found to be less
hands-on about the training and implementation of medication management as compared to other
health care professionals such as occupational therapists. This is likely due to the fact that
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physicians and nurses commonly use more of a medical model approach and rely more on an
individualistic, specific, and rational methods in the treatment of patients. According to an article
by Chewning and Sleath (1996), the medical model has traditionally dominated the manner in
which the patient-provider relationship is performed. Chewning and Sleath describe the client
role in the medical model is more passive and they have less input in their care (1996). Their
practices tend to focus more on the pathophysiological issues of the patient, with little emphasis
focused on psychosocial needs (Rust & Davis, 2011). Instead, medication management
education in patients should now be addressed through a collaborative approach of all health
professionals, including occupational therapists (Ehrlich, 2007). Hedrick, Chaney, Felker, Lin,
Hasenberg, and Heagerty’s work (as cited in Rust & Davis, 2011) defined collaborative care as
“a multidisciplinary team approach to delivering evidence-based care.” As a result of this
collaborative approach, patients’ care has been shown to improve, with a reduction in medication
mismanagement (Rust & Davis, 2011).
Importance of Medication Management
In a meta-analysis by Perterson, Takiya, and Finley (as cited in Scott & McClure, 2010),
it was found that one out of every four medical consultations results in patients not following a
medication management protocol. Low health literacy, which is an individual’s ability to read,
understand, and use knowledge to make necessary health decisions, affects about 40% of adult
Americans (Kripalani, et al., 2010). This may result in a patient’s failure to follow a treatment
plan regarding medications. Non-adherence to medication management is estimated to
contribute to 125,000 deaths in the United States alone each year (Scott & McClure, 2010).
As stated in the work of the Robert Wood Johnson Foundation (as cited in Kucukarslan et
al., 2011) it was found that one in five adults living in the United States has more than one
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chronic medical condition. The careful management of chronic conditions with medication in
people of all ages is critical to slow progression of the condition, prevent further disease, and
reduce the risk of drug interactions, which negatively affects health outcomes (Williams, Manias,
& Walker, 2008).
Heister (2011) discussed an example of a Parkinson’s patient who takes up to 15 different
medications per day. If patients with Parkinson’s disease do not take the correct medications at
the correct time then the consequences may be very severe (Heisters, 2011). By just missing one
medication, the patient can lose control of managing his or her symptoms. For example,
symptoms may include the inability to move or get out of bed. Missing a scheduled medication
could result in symptoms returning and it could take longer to regain control of these symptoms
(Heister, 2011). By addressing medication management as an aspect of intervention, health care
professionals, such as occupational therapists, can collaborate with patients to help prevent any
negative outcomes resulting from not taking medication on time or missing doses.
The Role of Occupational Therapy in Medication Management
Medication management includes the client’s ability to understand his or her medical
condition or conditions, along with their ability to make health decisions related to maintaining
good health (Foti, 2001). It is the health professional’s job to increase the client’s ability to do
this independently, or to adapt the task or their environment so that he or she can perform these
tasks to the best of his or her ability. Along with this, the client’s ability to control his or her
medications, know when it is necessary to call a physician, and to know how to call and make
medical appointments is another aspect that should be addressed by the health professional (Foti,
2001). The occupational therapist can be useful in the evaluation of the client’s ability to perform
the above listed tasks. The therapist’s assessment can be used to determine the client’s cognitive
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and perceptual abilities and level of independence; it is also qualified to identify what aspects of
a medication regimen needs to be modified to enable client adherence (Foti, 2001).
Health professionals such as nurses and pharmacists often lack the training and time that
it takes to properly identify and address the cognitive and the social needs of the patients (Rust &
Davis, 2011). According to the Occupational Therapy Practice Framework: Domain and Process
2nd edition, occupational therapists observe and analyze performance skills, which includes
cognitive function, to be able to understand some of the factors that either support or hinder that
patient’s involvement in occupations, such as managing his or her medications (American
Occupational Therapy Association, 2008). The Framework also states that clients engage in
occupations that involve their social and physical environments, which is another aspect that can
be evaluated by the occupational therapist (AOTA, 2008). Rust and Davis (2011) stated that
medication management therapy should be implemented using the biopsychosocial model, which
encompasses the whole person. Based on this model, health care professionals should recognize
the person’s strengths and limitations within the social and environmental aspects of his or her
life. The medical model, which has been used for the past several decades, does not address the
psychosocial needs of the patient (Rust & Davis, 2011).
According to Rust and Davis (2011), economic barriers such as not being able to afford
medications, and social factors such as family support, are factors that are not incorporated in the
medical model, but should be included in medication management therapy. Occupational therapy
can help in this way, by using its client-centered or holistic approach to encompass all aspects of
the patient to find a way for him or her to safely and independently manage his or her
medications.
Interdisciplinary Approach to Medication Management
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An article by Bajcar, Kennie, and Einarson, (2005) discussed the idea that a more
collaborative approach to medication management is needed because medication use has become
more complex, particularly in patients that have one or more chronic illnesses. They discussed
how to help patients attain the best therapeutic outcomes and reduce avoidable factors that may
cause adverse effects. In order to do this, different health care professionals need to address the
complexity of medication management in an integrated manner. They focused their article on a
practice model that involved a clinical pharmacist working with other disciplines to better a
patient’s care. These disciplines included 16 staff family physicians, 6 nurses, 2 social workers, 3
addiction counselors, 1 dietician and 1 occupational therapist. In the modern health care setting,
it is often challenging for only one health care provider to address all the aspects of medication
management, therefore this collaboration is necessary to best aid the patient.
The Medicare Quality Improvement Organization for Pennsylvania (2005) went into
more depth by describing who has which responsibilities when it comes to medication
management, and how a collaborative approach is important. They stated that it is the role of the
doctor, the pharmacist, registered nurse, physical therapist, occupational therapist, speech
language pathologist, aide, and patient/caregiver to coordinate doses with established daily
routines. Also, it is the responsibility of the registered nurse, occupational therapist, speech
language pathologist, and social worker to report any evidence that suggests the patient’s
medication administration methods lack organization. Disorganization is evident by bottles/pills
in multiple locations, unable to locate all medications, reported administration methods vary
from day to day (inconsistent), and lack of established or predictable routines (sleep, meals,
IADLs, etc.). This describes how a collaborative effect can be put in to use with medication
management techniques.
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Settings that Medication Management Should be Implemented
The Medicare Quality Improvement Organization for Pennsylvania (2005) created a
program for education on medication management in home health care settings. This educational
program manual was addressed to occupational therapists, physical therapists, registered nurses,
physicians, social workers and speech language pathologists. The purpose of this program
manual was to provide consistent instruction to home health clinicians in medication assessment
and clinical interventions, to improve management of medications in the home setting, to
improve quality of life for patients receiving home health services.
Gutman (2011) stated that occupational therapy had a role in mental health to help
individuals participate as fully as possible in community life and become contributing members
of society. This can be done by teaching and maintaining medication management skills amongst
other ADLs and IADLs. Bajcar, et. al. (2005) stated that one practice environment that
collaborative approaches to medication management should be utilized include family practice
and out-patient settings.
Educational Requirements
In the current standards set by the Accreditation Council for Occupational Therapy
Education (ACOTE, 2012), pharmacology is not an educational requirement. Also, in the new
standards effective July 31st, 2013 for a master’s degree education and doctoral degree education,
pharmacology is still not going to be included in the set of standards. In order for occupational
therapists to feel confident in providing medication management interventions, the first step is
for this to be added as a requirement in our education.
A Call for Research
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Non-adherence to prescribed medical therapy is on the rise and there is a need for social
cognitive behavioral interventions to help combat this rising problem. Co-morbidities and low
health literacy issues cause the mismanagement of medication, which can create problems for
patients, families and primary caregivers (Kripalani et al., 2010). Occupational therapists can
help combat this national health problem by promoting and providing the proper education
regarding the management of medication to health care professionals and clients alike. Current
barriers to adherence of medications include drug costs, multiple medications, dosing schedules,
and varying levels of understanding of the patient’s medical condition (Scott & McClure, 2010).
Recent studies have shown that self-efficacy is the key to the successful management of chronic
conditions; however there is little research showing occupational therapy’s role in medication
management (Williams et al., 2008).
Researchers Marian Arbesman and Letha J. Mosley completed a systematic review of the
literature on occupation- and activity-based health maintenance and management interventions
for productive aging (2012). One aspect of the review looked at the use of self-management
occupational therapy programs, in which peer-led programs provided participants in eleven
different studies of varying levels with relevant information on diagnoses of a clinical condition,
information on medication management, and the teaching of problem-solving skills. Results of
the review, when looking at the aspect of chronic pain as the outcome, indicated moderate
evidence in support of these methods (Arbesman & Mosley, 2012). The outcomes of this review
were found to be positive; however, the degree of decrease disability reduction and pain varied
widely, thus limiting the strength of the results. This could indicate that further research in the
role of occupational therapy in medication management could be conducted to provide further
information and potentially strengthen results.
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Recently, Kucukarslan et al. (2011) conducted a systematic review of eight randomized
controlled trials that evaluated the effect of medication management on patient outcomes. The
study focused on the roles of the social worker, physician, nurse, and pharmacist in patient care
relating to medication management. The intervention included educating patients about drug
therapy, identifying potential barriers to medication adherence, and helping patients manage their
diseases. Improvements in patient outcomes were found in only two of the eight trials. For the
other six studies, no effect of medication management services was found in patient outcomes.
Possible reasons for this lack of effectiveness could be attributed to the limits of a one-time
meeting with a health care provider, along with a lack of communication between prescribers
and patients to review medication management recommendations. Occupational therapy uses a
holistic approach to treating the patient, which relies heavily on hands-on training and
communication between the therapist and the client.
Methods
Research Approach and Design
This study gathered both qualitative and quantitative information utilizing a survey
method. There were open-ended and closed-ended questions on the survey, which participants
were able to access online. The researcher designed survey method allowed for the collection of
qualitative data by using descriptive, open-ended questions to retrieve information that was
reported by the sample population (Kielhofner, 2006). This allowed for the survey to retrieve
each participating occupational therapists’ expertise on the use of medication management in
occupational therapy as well as their beliefs, attitudes, and behaviors (Patten, 2009). The
quantitative data, or close-ended questions, included yes or no questions, as well as questions
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
21
regarding demographic information. The close-ended questions that were asked allowed for us to
do a statistical analysis of the data, such as the mean, median and mode.
Participants
Participants in this study included currently practicing registered occupational therapists
(OTRs) who are licensed in the state of Michigan. The participants must have been a member of
the Michigan Occupational Therapy Association (MiOTA) as of 2012. The researchers contacted
MiOTA for the 2012 membership/mailing list. One hundred OTRs were selected from the
membership list by using systematic sampling. Because MiOTA includes occupational therapists
from a variety of settings, it was assumed that practitioners from a variety of practice setting
were included in this study. Participants must have had at least one year of experience in clinical
occupational therapy practice at the time of taking the survey. This ensured that participants had
at least a minimal amount of experience working in the field of occupational therapy. Certified
occupational therapy assistants (COTAs) were not included as participants because they do not
play a role in the development of the intervention plan. Due to the fact that persons were required
to be practicing OTRs with at least one year of work experience, it was assumed that no one
under the age of 18 participated in this study. Retired occupational therapists were not included
as a part of the study. The survey was sent to 100 participants.
Instrumentation
This researcher-designed survey utilized both open-ended and close-ended questions.
Before implementing the survey it was peer-reviewed as well as pilot tested by five registered
occupational therapists that currently have been practicing for over a year in two different
settings. The purpose of the peer-review and pilot test was to receive feedback in regards to
changes that could be made to improve the survey, which were received and made before it was
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
22
implemented. The survey questions focused on the interventions that occupational therapists are
currently using for medication management, as well as their perspectives regarding potential
roles for occupational therapy in medication management in the future. The survey questions
also focused on the occupational therapists’ perception on whether medication management
should be a part of the curriculum in the education of occupational therapy students.
Apparatus
This study utilized Snap software, which is a computerized survey software program that
is designed to create, distribute, and organize surveys. This software allowed the survey to be
created online so that the participants could follow a link to take the survey and send it back
electronically. The link was provided in the letter and postcard that were mailed out to the
participants. This software was utilized in creating and sending out surveys to the participants
(Snap Surveys Ltd., 2011). Snap software did not ask for participants’ identity before or during
the survey. Snap survey accounts utilized encryption when the survey was published to keep
response data private and secure. Snap survey adheres to the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) and has been certified to these privacy and security
standards (Snap Survey Ltd., 2011).
Procedures
Study site. The survey was sent out to 100 possible respondents. Participants were able
to complete the survey at the time and location of their choosing using Snap survey software via
an online link. The data gathered from the online survey was collected, analyzed and stored on
secure servers at Saginaw Valley State University (SVSU) by the researchers on the SVSU
campus. Members of the research team had a unique username and password that was used to
access the database. Only the investigators involved had access to the username and password
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
23
for this project. Following the completion of the study, all survey information was deleted from
SVSU’s secure servers, and any information in hard copy format was appropriately destroyed
using a shredder.
Data collection. There was 100 cover letters regarding the online survey mailed to OTRs
in the state of Michigan who are members of MiOTA in 2012. The participants were asked to
complete the survey and submit it electronically. There was a second mailing sent out two weeks
after the initial mailing in order to encourage an increased response rate. Data was collected via
use of Snap online software. The participants completed the survey anonymously via the online
software (Snap). No names or potentially identifying information was asked for on the survey.
Snap software did not ask for participants’ identity when taking the survey. All data gathered
from the online survey was stored on a database on an SVSU server.
Data analysis procedures. Data analysis occurred on the campus of Saginaw Valley
State University. The data that was received from the closed-ended questions was analyzed by
utilizing measures of central tendency such as mean, median and mode. The data from the openended questions was read thoroughly to develop a general sense of the information and a
reflection on the answers that were given. The data was then organized by using the coding
method of data analysis.
For this coding process, the data was categorized using open, axial and selective coding,
focusing on five to seven categories or themes. Open coding was used to categorize the data into
meaningful information. Axial coding narrowed down the categories determined from the open
coding into central categories. Finally, selective coding identified the perceptions and
perspectives of the participants into the five to seven general themes for analysis. In order for
this process to ensure accuracy of the interpretations of the responses, there was discussion of the
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
24
results of the data between peers, professors, and professionals within the field, utilizing an
unbiased peer review process.
One strategy that was used to increase the trustworthiness of our data was code-recode procedure.
Code-recode involves coding a segment of data then waiting two weeks to return and recode the
same data and compare the results. This allowed for dependability of our results. (Krefting,
1991). Results
A total number of 100 surveys were sent out, and 32 responses were received, giving a
total response rate of 32%. All of the surveys that were sent back were filled out by members of
MiOTA who were currently practicing OTRs in the state of Michigan. The participants that
responded have been practicing as an OTR for a varying number of years, from one year to 20 or
more years. The participants who completed the survey have a minimum of a bachelor’s degree
in occupational therapy from different universities, while some hold a Master’s degree or higher.
Respondents received such degrees from various universities in Michigan or out of state. Refer
to Table 1 for the summary of participant demographic information.
Table 1. Participant Demographics
Demographic Characteristics
Participant Response %
(N=32)
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
Number of years practicing as an OTR
< 1 year
1-2 years
3-4 years
5-10 years
11-20 years
20+ years
Highest Degree Participants Obtained
B.A./B.S.
M.A./M.S.
OTD/PhD/EdD/Other
University Attended
Western Michigan University
Eastern Michigan University
Wayne State University
Saginaw Valley State University
Grand Valley State University
Baker College
Out of State University
25
0%
6%
3%
3%
35%
53%
(n=0)
(n=2)
(n=1)
(n=1)
(n=11)
(n=17)
72%
25%
3%
(n=23)
(n=8)
(n=1)
34%
25%
27%
3%
6%
3%
3%
(n=11)
(n=8)
(n=9)
(n=1)
(n=2)
(n=1)
(n=1)
Practice Settings
The individuals who participated in the survey represented working in a variety of
settings (participants could select more than one work setting). Popular responses included
outpatient rehabilitation and school-based setting. Full results are summarized in Table 2. The
participants were also asked in which settings medication management should be implemented,
again being allowed to select more than one choice. The most common setting that the
participants believed medication management should be used was in home health care with
twenty six responses (n=26). There were twenty responses for inpatient rehabilitation (n=20) as
well as twenty responses for mental health settings (n=20), making these two settings the second
most commonly thought of to use medication management. Outpatient rehabilitation settings was
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
the third highest response rate with nineteen responses (n=19). The full results of this question
are summarized in Graph 1.
Table 2.
Current Practice Settings
Area(s) of Current Practice
Participant Response %
(n=39)
Note: Participants had option to choose more than one area of current practice
Out-Patient Rehabilitation
Home Health Care
Acute Care
Skilled Nursing Facility
School-Based Setting
Pyschosocial/Mental Health Setting
Other
Graph 1. Setting OTs Feel Medication Management Could be Beneficial
Settings OTs Feel Medication
Management Could Be Benefical
30
25
20
15
10
5
0
21%
13%
10%
8%
15%
3%
23%
26
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
27
Intervention Strategies
The participants were asked which medication management strategies they are currently
using in their interventions within their practice, as well as how frequently. These strategies
include educating patients on possible drug side effects, educating patients on drug-food
interactions, incorporation of compliance aids and organization skills (i.e. pill boxes), and
helping establish medication routines (i.e. taking medications when waking up or at bed time).
Table 3 shows the frequencies for use of each strategy. The most commonly used strategies
include educating patients regarding possible drug side effects, with 47% (n=12) of participants
“sometimes” implementing this strategy. A second popular strategy used the incorporation of
compliance aids or organizational skills with 38% (n=12) of practitioners “sometimes”
implementing this strategy.
Table 3. Frequency of Utilization of Medication Management Interventions
Medication Management Interventions
Participant Response %
(n=32)
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
Education on possible drug side effects
Always
Frequently
Sometimes
Never
Educating patients on drug-food interactions
Always
Frequently
Sometimes
Never
Incorporation of compliance aids/organizational skills
Always
Frequently
Sometimes
Never
No Response
Help to establish medication routines
Always
Frequently
Sometimes
Never
No Response
28
6%
22%
47%
25%
3%
3%
38%
56%
12%
22%
38%
25%
3%
9%
16%
28%
44%
3%
Other Disciplines
The participants were asked to report whether or not they had worked in collaboration
with any other types of health care providers in regards to a patient’s management of
medications. The most common responses were nurses and physicians, among others.
Collaboration with nursing contributed to 33% (n=24) of the responses and 17% (n=12) for
physician collaboration. Table 4 summarizes this data.
Table 4. What Other Health Professions OTs Collaborate with in regards to Medication Management
Profession
Participant Response %
(n=61)
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
Pharmacist
Nurse
Physician
Nurse Practitioner
Physician’s Assistant
Social Worker
Psychiatrist
No Response
Other
29
3%
33%
17%
7%
7%
8%
11%
4%
10%
Education Requirements
When asked whether or not any of the respondents had taken any educational courses in
pharmacology, seven responded with yes (22%), having taken them in either undergraduate
education or through continuing education courses. The participants were also asked if
education requirements in regards to medication management would be beneficial. Twenty-four
of the participants (75%) feel that further learning in this area would be beneficial to a career in
occupational therapy. 71% (n=17) of the participants reported that such education should be
required as part of the occupational therapy curriculum.
There are different areas of education that occupational therapists partake in that can
contribute to improving knowledge on medication management. The participants replied they
were most likely to participate in continuing education courses in the future, with 53% (n=17)
selecting this method of education. Course requirements were the second highest proposed
method of education with 19% (n=6). Lastly, certification courses were the third highest
proposed method of education with 12% (n=4). Overall, eighteen of the respondents (56%)
believed that the role of occupational therapy in medication management should be further
developed for future practice. Ten of the respondents (31%) were opposed to this idea and four
(13%) gave no response.
Key Themes
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
30
Current Practices. Several themes were developed from the responses of the participants
regarding the role of occupational therapy in medication management. The first theme identified
was that participants are already implementing medication management in their occupational
therapy practice. Participants described the concept of medication management as a part of an
occupational therapist’s “tool box,” identifying it as a relevant activity in many individuals’ lives.
One participant stated that “we treat the whole person and that is a part of their ADLs,”
indicating a necessity for medication management to be practiced in occupational therapy. It was
also conveyed that occupational therapists provide a resource for clients to discuss or ask
questions about medication management. Overall, it was concluded that many occupational
therapist use medication management techniques in their current practice.
Collaborative Approach. Another theme identified addressed the importance of the
collaboration among health care professionals when working with patients in regards to
medication management. The survey asked participants to identify any of the health care
professionals that they currently collaborate with in regards to medication management, and the
most common responses included nurses and physicians. Respondents supported the inclusion
of occupational therapy in this collaboration, with one implying that it could be encouraged
among other disciplines by “[Informing] [doctors]/payers how OT intervention can improve
[patient] compliance with medication.” Another participant indicated that this collaboration
could also be beneficial to the occupational therapists, stating that “We specialize in
compensatory tools and education. [We collaborate] with doctors to educate our role.” The
survey also identified the idea that a collaborative approach to medication management provides
better service overall, as supported by the claim that “Interdisciplinary approach for medication
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
31
[management] for patients is the most therapeutic.” Overall, it was concluded that the
collaborative approach is the best way to utilize occupational therapy in medication management.
Occupational therapy curriculum. Of the participants who supported the idea of practicing
medication management in occupational therapy, a common theme was identified in regards to
education in the area of pharmacology. Currently, this area is addressed on a limited basis in
occupational therapy programs. Most respondents supported the idea of implementing further
education on the subject of pharmacology, potentially in course requirements for obtaining an
occupational therapy degree, in continuing education courses, or in certification courses. One
participant noted, “Knowledge of drugs and their [effect] on ADLs needs to be further
understood.” Another one stated, “Yes. More emphasis during OTR school would be helpful.”
As stated by one respondent, “Understanding pharmaceuticals would help address [medication
management] with confidence.” It appears that many OTs believe that more education in
medication management would allow for better overall treatment of the patient.
Medication management and OT scope of practice. In contrast to the previously identified
statements, some participants believe that implementation of medication management is out of
the scope of OT practice. One recurring opinion was that by providing this treatment,
occupational therapists would be encroaching on the practice of other health care professionals.
One respondent stated “I feel physicians prescribe meds and it isn’t our role to manage meds.”
Another commented “OTs need to leave the role of [medication management] to [nursing].”
Respondents who were opposed to incorporating medication management in occupational
therapy practice indicated that this form of treatment is not in the area of occupational therapy
expertise.
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
32
The results discuss varying opinions regarding how OT can participate in medication
management interventions. This may be due to participants’ differing demographic data. For
example, over half of our participants have been practicing for at least 20 years as OTRs. Their
opinions may differ when in comparison to practitioners who have only been practicing 1 to 2
years. Individuals who have been practicing for multiple years may be comfortable with their
current practice skills and may not feel the need to venture their practice in a new direction.
Discussion
The purpose of this survey study was to explore the practice settings within which
occupational therapists are implementing principles of medication management, whether
occupational therapists are currently implementing medication management strategies within
their interventions, the educational requirements that should be provided to train occupational
therapists, and the other disciplines that occupational therapists work with in regards to
medication management.
Previous literature and current practice. Previous studies have focused on
understanding medication routines of community-dwelling older adults. It has been shown that
many older adults embed their medication management strategies into mealtimes and sleep
routines. The common aids used to promote adherence were pillboxes or self-made adaptations.
Sanders and Van Oss’ (2013) study included interviews that covered the topics of individual
routines, medication storage locations and equipment, and any assistance needed to adhere to a
medication routine within a home environment. Sanders and Van Oss (2013), discovered that
there were findings to “substantiate occupational therapy practitioners’ role in developing
specific, individualized, concrete plans for integrating medications into daily routines” (p. 97).
This supports what is stated within the practice framework in regards to medication management
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
33
being an IADL and OT having a role within medication management. Similar results were found
in the present study, including a theme that medication management interventions should be
included in the holistic treatment of a patient.
Bajcar, Kennie and Einarson (2005) developed a conceptual framework that was created
to identify, define, and discuss roles and responsibilities in collaborative medication management.
This conceptual framework was based off of the authors’ own experiences as practitioners in
implementing a pharmaceutical care-based consulting practice within a family medicine practice
setting. Within this conceptual framework the authors feel that different health care
professionals need to be involved in aiding patients to achieve the maximum therapeutic benefits
and reduce preventable factors that may result in adverse effects related to medication
management (Bajcar et al., 2005). The authors also developed a practice model in which a
pharmacist works in collaboration with physicians, nurses, social workers, addiction counselors,
a dietician and an occupational therapist (Bajcar et al., 2005). The present study also found that
patients’ care involving medication management should be a result of collaborative effort from
the healthcare team (including: occupational therapists, nursing, physicians, psychiatrists, and
social workers).
Implications. There are three main implications arising from the results of this study.
The first implication is that it appears that more education in the subject area of pharmacology
would be beneficial to assist OTs in implementing medication management in OT treatment.
However, despite support from this idea in the 2011 ACOTE Standards (effective July 31, 2013),
specific pharmacology courses are not addressed as a mandatory accreditation standard within
master’s or doctoral occupational therapy curriculum (ACOTE, 2012). It was discovered within
the results of the present survey study that in order for occupational therapists to utilize
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
34
medication management interventions, they feel that they would need to become more competent
in addressing this issue by first taking a pharmacology course. If pharmacology courses were
offered through continuing education credits, course requirements within OTR school, or a
certification course, this could provide therapists with the knowledge base needed to address
medication management in treatment.
The second finding from this study is that while the majority of respondents are already
implementing some form of medication management, they do not implement it every time with
every patient. Most participants feel that medication management is a part of a patient’s IADLs
and therefore should be addressed by the occupational therapist. However, some settings could
be more conducive in utilizing medication management techniques more so than other settings.
For example, occupational therapists that were surveyed felt that home health, inpatient
rehabilitation, and psychosocial/mental health settings would be the most beneficial settings for
implementing medication management strategies.
The last finding that was identified within this survey study was that occupational
therapists should collaborate with the entire healthcare team, regarding medication management,
in order to provide a comprehensive treatment approach for the patient. This allows for the
integration of knowledge from all healthcare professionals’ backgrounds. This also addresses
the issue that it is not necessarily just one healthcare professional’s (i.e. nursing) responsibility to
be aware of the patient’s medication management needs, but rather all healthcare team members
that may be working with a particular client.
Limitations. There are limitations within this researcher-designed survey to consider.
The overall sample size was small, with only 32 out of 100 people contacted completing their
survey. All of the respondents were from the state of Michigan. Therefore, it may be difficult to
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
35
generalize results to the entire United States. A final limitation is that all respondents were
members of MiOTA. This may have affected results because, as members of MiOTA, these
respondents may be more heavily involved in the profession of occupational therapy, including
the development of evidence based practice in order to provide the most comprehensive client
care.
Future research directions. Based on the outcomes of this study, there are several
proposed directions for future research. First, it is recommended a more experimental research
should be implemented focusing on the frequency of implementation of medication management
techniques by occupational therapists after receiving education in pharmacology. Future
research directions could also include focusing on patients’ responses to medication management
techniques implemented during occupational therapy intervention.
Conclusion
This was a descriptive survey study that was implemented to determine the role that
occupational therapy currently plays in medication management. The survey was sent out to 100
possible participants, of which 32 responded. The data was analyzed and it was concluded that
medication management interventions can be employed in a variety of healthcare settings, and
should be included in the holistic approach that occupational therapy uses in treating the patient.
It should also be considered in a collaborative approach among other healthcare professionals,
such as nurses and physicians, to provide best practice care. It was determined that further
education in the area of pharmacology could prove to be beneficial when it comes to the therapist
implementing medication management intervention strategies. Currently, the most commonly
used intervention strategy was education on possibly drug side-effects, followed by the
incorporation of compliance aids/ organizational tools. Overall, over half of the participants
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
36
believe that the role of occupational therapy in medication management should be further
developed.
Acknowledgments
The researchers would like to thank the participants for their support and for taking the
time to fill out the survey and aid us in completing this research project. The researchers would
also like to thank the occupational therapy professors for their help and guidance throughout the
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
37
research and implementation of the survey study. A thank you to Jeremy Broughton for bringing
this topic to our attention and for his guidance in regards to our project.
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Appendix
Graph 2A: Pharmacology Courses Taken
Percent of Ots That Have/ Have Not taken
Pharmacology Courses
30
25
20
Percent of Ots That Have/ Have
Not taken Pharmacology
Courses
15
10
5
0
Have
Have Not
Graph 3A: Pharmacology Courses are Beneficial
41
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
42
Do OTs Feel Additional Pharmacology
Courses would be Beneficial
30
25
20
Do OTs Feel Additional
Pharmacology Courses would
be Beneficial
15
10
5
0
Yes
No
No Response
Graph 4A: Using Medication Management in Occupational Therapy
Would OT consider Using Medication
Management in Future Practice?
Would OT consider Using Medication Management in Future Practice?
19
8
5
Yes
No
No Response
OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT
43