Effect of Occupational Therapy in Promoting Medication Adherence in Primary Care: A Randomized Control Trial

PURPOSE: Hypertension (HTN) and type 2 diabetes mellitus (T2DM) are common chronic diseases affecting many occupational therapy clients (Wang et al., 2018). Poor medication adherence creates inferior outcomes in both populations (Doggrell, 2010; Stewart et al., 2014). While occupational therapy practitioners are uniquely suited to assess and address a clients’ willingness and ability to adhere to a prescribed medication regimen, there are few evidence-based interventions supporting practitioners in this role. The Integrative Medication Self-Management (IMedS) Intervention is a novel occupational therapy intervention designed to improve medication adherence. While previous studies have demonstrated the feasibility of this intervention, more research is needed prior to adoption in practice. The purpose of this study was to determine whether the addition of the IMedS to usual care, as compared to usual care alone by a clinical pharmacist, would affect medication adherence rates among community-dwelling adults with HTN and/or T2DM.

DESIGN: This experimental study leveraged a randomized controlled trial with a pretest-posttest control group design. A convenience sample of adults (age 18 years and older) with HTN and/or T2DM were recruited from a primary care clinic after being referred to the clinical pharmacist to improve HTN or T2DM management.

METHODS: There were two primary outcomes for this study. First, medication adherence was measured by the seven-item Adherence to Refills and Medication Scale (ARMS-7) and a pill count. Second, biometric outcomes were measured by blood pressure and/or hemoglobin A1c (as appropriate). Participants were seen 2-4 times by the occupational therapist and/or the clinical pharmacist based on randomization. The IMedS process was used throughout and outcome measures were completed at each visit. Data was analyzed using Fisher’s exact test for nominal data and either an independent t-test or non-parametric Mann-Whitney U test for interval and ratio data. A mixed ANOVA analysis was used to measure change across groups.

RESULTS: Twenty-nine participants completed the study. In terms of medication adherence, both groups demonstrated improvements and changes between groups were not statistically significant. However, a post hoc comparison of mixed ANOVA suggested that the occupational therapy intervention was having a unique effect as compared to the control. Effect scores (d = .55) also suggested that the occupational therapy intervention was positively affecting adherence. In terms of biometric outcomes, both groups demonstrated improvement in blood pressure and A1c values and changes between groups were not statistically significant.

CONCLUSION: Poor medication adherence is a serious problem affecting many occupational therapy clients. The findings of this study suggest that occupational therapy practitioners can positively influence adherence. This work impacts practice, policy, and science. In terms of practice, this study fills a gap in research for practitioners seeking to offer evidenced-based medication management interventions. In terms of policy, this study demonstrates the distinct value that occupational therapy practitioners can bring to the primary care team. In terms of science, this study advanced the science on the iMedS intervention. Future research should include the implementation of the IMedS with a larger sample size and over a longer time period to identify possible differences between groups and further examine the impact of the occupational therapy process on behavioral and biometric outcomes related to medication management.

References

Doggrell, S. (2010). Does intervention by an allied health professional discussing adherence to medicines improve this adherence in Type 2 diabetes? Diabetic Medicine, 27, 1341-1349. https://doi.org/10.1111/j.1464-5491.2010.03137.x

Schwartz, J. K., & Smith, R. O. (2016). Intervention promoting medication adherence: A randomized, Phase I, small-N study. American Journal of Occupational Therapy, 70(6), 1-12. doi.org/10.5014/ajot.2016.021006

Schwartz, J. K., & Smith, R. O. (2017). Integration of medication management into occupational therapy practice. American Journal of Occupational Therapy, 71(4), 1–8. https://doi.org/10.5014/ajot.2017.015032

Wang, A., Pollack, T., Kadziel, L. A., Ross, S. M., McHugh, M., Jordan, N., & Kho, A. N. (2018). Impact of practice facilitation in primary care on chronic disease care processes and outcomes: A systematic review. Journal of General Internal Medicine, 33(11), 1968–1977. https://doi.org/10.1007/s11606-018-4581-9