Jessica: Thank you for joining Brooke and I this morning. Brooke and I both have a passion for this topic because we realize that medication management can help our clients be able to live more independently. My interest in medication management is in skilled nursing and acute care settings. Often, we send our clients home from an acute care environment without them being able to manage their medications effectively. As soon as home health pulls out, they are unable to manage on their own. This may then cause a readmission. I feel very passionate about making sure that occupational therapists address medication management in our plan of care. Brooke also has that same level of passion from an occupational therapy standpoint. She worked as a pharmacy technician prior to coming to OT school, and would see the firsthand issues that older adults and individuals, living in the community, experience with medication management.
Introduction to Medication Management
Brooke: Medication management is classified as an IADL, Instrumental Activity of Daily Living, by the Occupational Therapy Practice Framework (OTPF), under health management and maintenance (American Occupational Therapy Association, 2014). Health and maintenance is defined as developing, managing, and maintaining a routine for health and wellness promotion, such as physical fitness, nutrition, decreased health risk behaviors, and medication routines. This is where we are defined, under the OTPF, for medication routines or medication management.
The concept of medication management is often seen as organizing pills in the appropriate pillbox compartment, however there are many components to consider when addressing medication management from an OT perspective. These include:
- Filling medications
- Understanding medications
- Taking medications
- Monitoring medications and side effects
- Continuing medication usage
- Refilling and communicating with providers for medications
There are several steps required to complete the task of medication management (AOTA, in press).
Medication Management and Its Relationship to Health
Figure 1 shows some of the findings of medication management and its relationship to health.
Figure 1. Research findings regarding medication management and relationship to health.
For those who rely on medication, whether it is a seasonal sinus infection, the management of a chronic disease, or an illness such as COPD or diabetes, the ability to manage medication can significantly impact someone's overall health and well-being. If medications are taken as prescribed, the sinus infection will clear right up, and chronic issues, like COPD or diabetes, should improve. Taking medication as prescribed can reduce the risk of hospital admissions or readmissions. As Jessica mentioned, I worked as a pharmacy tech for about seven years. The negative health-related outcomes, such as hospitalizations and exacerbations of illness or disease, due to the inability to adhere to medication, are real and scary for everyone involved, including the patient as well as the professionals that support them.
Medication Adherence
When we talk about medication management and overall health and well-being, we normally use the term medication adherence. Medication adherence is how a person's behavior corresponds with agreed recommendations from their health provider (World Health Organization, WHO, 2003, p. 2). Medication adherence is the percentage of the number of pills consumed over the number of pills prescribed as shown in Figure 2.
Figure 2. Medication adherence definition and measurement.
We normally utilize a 30-day period to measure this percentage. It is also really important to consider that there are not always 30 days in every month, no one consistently gets their prescriptions filled on the first of every month, and the opportunity to get your refills filled in just one trip to the pharmacy is not always an option for most people. So adherence to medication is a complex task. Additionally, the ability to rely on a calendar is not always that easy and can sometimes cause a good bit of confusion, especially for those with a cognitive impairment. One hundred percent adherence would mean that Mr. Jones took one of his blood pressure pills every morning with breakfast. If at the end of 30 days, Mr. Jones still has 10 pills left in his bottle that would indicate under 100% adherence, and if after 20 days, he is completely out of pills and is asking for a new refill, this indicates he is taking more than 30 in 30 days. The average rate of adherence is 50% (Nieuwlaat et al., 2014), or only half of the people take their medication as prescribed. That is a shocking statistic.
Figure 3. Adherence examples.
