How can we provide the most effective medication management interventions for our clients?

Sometimes, medication management can seem like an overwhelming occupation to tackle. There are a variety of reasons why people struggle with medication management tasks, and addressing both personal preferences and environmental barriers can feel both challenging and limited in OT sessions. You may ask yourself if the pillbox you gave your client will end up getting lost, if your client will use the reminder app you helped them set up on their phone, or if your clients’ parents and teachers will fill out the behavior change tracking logs you created. How can we make sure our interventions are effective for our clients?

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The first answer lies in what may be our most important skills as occupational therapy practitioners: a holistic understanding of our clients and their goals. OTPs are skilled at zoning in on what is important to our clients and why. We assess a client or caregiver’s motivation, skills, and beliefs about performing each medication management task. OTPs are also experts at understanding how these factors interact with the environment in which people are completing medication management tasks. How does our client’s culture, living situation, and even greater society impact how they are taking their medication, storing it, and requesting refills?

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Although a thorough OT assessment sets us up for success in tailoring our interventions, choosing the most effective intervention for your client can be difficult in today’s clinical practice. In acute care, you may see your client only once before discharge. In school-based OT, parents and teachers may not understand the connection between medication management and your client’s school performance. Your inpatient rehab client’s ADL goals may leave little time left to dive into medication management. Your home health agency may not understand your role in addressing medication management and refer all patients with medication challenges to nursing only. Given all these challenges, how can we provide effective interventions for our clients?

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The second answer is OTP’s superpowers as problem solvers, adapters, and advocators. Below are some recommendations for how to match the most effective intervention to your client and their medication management needs, while considering outside factors: ?

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1.????? Your priority is your client’s priority. Focus on what medication management challenge is the most troublesome for your client. This is often what they are most motivated to address, and therefore where you may see the most gains. Use your clinical judgement to educate your client if their priority would be best addressed from an approach that they aren’t familiar with or have not yet considered. ?

2.????? Safety first. Addressing safety concerns related to medication management can directly improve your clients’ overall health, well-being, and quality of life. Be sure to reference your client’s prescription from their prescriber when providing medication routine recommendations. If you are concerned that your client is over or under dosing, always be sure that your client’s prescriber is aware.?

3.????? Document, document, document. Documentation is vital for interdisciplinary, client, caregiver, and continuum of care communication on what has been tried, what worked, what didn’t work, and why. The most effective intervention for your client may not be the most glamorous or elaborate. Remember that every little bit counts! Follow-up and carryover, building on previous interventions, or taking a new intervention approach are all possibilities as your client progresses through the continuum of care.

4.????? Use evidence to guide intervention but remember that one-size does not fit all. Many common OT approaches to improve medication management have also been shown to be supported by evidence, such as providing cues and reminders, training in assistive technology, and modifying the environment. However, note that you should consider your client, their diagnosis, skills, and preferences before selecting these interventions. For example, a home health client who is anxious about changing their medication routine may not find benefit from your recommendation of a new, more complex pill box.

5.????? Teamwork makes the dreamwork! Collaborate with your client, your client’s caregivers, and their interdisciplinary team by communicating your recommendations. For clients and caregivers who would benefit from motivational interviewing, conduct a motivational interview so that they can identify potential intervention solutions and collaborate with you to select the most appropriate solutions. If you’re working with other interdisciplinary team members, let them know how you’re working to improve your client’s medication management! Other providers with different expertise or caregivers who know your client well will often think of considerations you or your client may have not considered. It’s also helpful to have everyone on the same page to strengthen carryover of any recommendations.

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OTPs have an effective and meaningful role in assisting their clients to improve their medication management. With the careful reliance on a holistic assessment to direct intervention and superpower OT skills as advocates, adapters, and problem solvers, OTPs are the interventionists we need in our healthcare landscape to address medication management across the continuum of care.

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