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Running head: OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT 1

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

OCCUPATIONAL THERAPY AND MEDICATION MANAGEMENT 2

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.



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 multi-

disciplinary 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.


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,


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


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

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. Self-

efficacy 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 self-

efficacy 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

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 self-

care 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

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.

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).

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

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

(Billek-Sawhney & 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 self-

efficacy, 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

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 self-efficacy 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

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

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

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

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.

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

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.

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

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

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

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 open-

ended 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

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 DemographicsDemographic Characteristics Participant Response % (N=32)


Number of years practicing as an OTR < 1 year 0% (n=0) 1-2 years 6% (n=2) 3-4 years 3% (n=1) 5-10 years 3% (n=1) 11-20 years 35% (n=11) 20+ years 53% (n=17)Highest Degree Participants Obtained B.A./B.S. 72% (n=23) M.A./M.S. 25% (n=8) OTD/PhD/EdD/Other 3% (n=1)University Attended Western Michigan University 34% (n=11) Eastern Michigan University 25% (n=8) Wayne State University 27% (n=9) Saginaw Valley State University 3% (n=1) Grand Valley State University 6% (n=2) Baker College 3% (n=1) Out of State University 3% (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


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 SettingsArea(s) of Current Practice Participant Response % (n=39) Note: Participants had option to choose more than one area of current practice Out-Patient Rehabilitation 21% Home Health Care 13% Acute Care 10% Skilled Nursing Facility 8% School-Based Setting 15% Pyschosocial/Mental Health Setting 3% Other 23%

Graph 1. Setting OTs Feel Medication Management Could be Beneficial

0102030

Settings OTs Feel Medication Man-agement Could Be Benefical


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 InterventionsMedication Management Interventions Participant Response % (n=32)


Education on possible drug side effects Always 6% Frequently 22% Sometimes 47% Never 25%Educating patients on drug-food interactions Always 3% Frequently 3% Sometimes 38% Never 56% Incorporation of compliance aids/organizational skills Always 12% Frequently 22% Sometimes 38% Never 25% No Response 3%Help to establish medication routines Always 9% Frequently 16% Sometimes 28% Never 44% No Response 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 ManagementProfession Participant Response % (n=61)


Pharmacist 3% Nurse 33% Physician 17% Nurse Practitioner 7% Physician’s Assistant 7% Social Worker 8% Psychiatrist 11% No Response 4% Other 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


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

[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.


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


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


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


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

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


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

Have Have Not0

5

10

15

20

25

30

Percent of Ots That Have/ Have Not taken Pharmacology Courses

Percent of Ots That Have/ Have Not taken Pharmacology Cour-ses

Graph 3A: Pharmacology Courses are Beneficial


Yes No No Response0

5

10

15

20

25

30

Do OTs Feel Additional Pharmacology Courses would be Beneficial

Do OTs Feel Additional Pharma-cology Courses would be Bene-ficial

Graph 4A: Using Medication Management in Occupational Therapy

Yes No No Response

19

5

8

Would OT consider Using Medication Management in Future Practice?

Would OT consider Using Medication Management in Future Practice?


Documents

Lauren's Portfoliolaurennowakot.weebly.com › uploads › 1 › 7 › 5 › 6 › 175… · Web view2013/03/26 · Adherence refers to the client’s decision of whether or not