Tracking Your Meds: A New Protocol for Medication Adherence with MS Outpatient Population

Background: Medication management is an instrumental activity of daily living that is essential for health management and maintenance. Over 50% of people on medication are non-adherent with medication prescriptions, which can lead to a decline in health and rises in hospitalizations (Schwartz & Smith, 2017). Medication non-compliance can be due to unintentional reasons, such as forgetting or carelessness, and intentional reasons such as altering doses to make prescribed medications last longer (Gadkari & McHorney, 2012). Additional reasons for medication non-adherence include cognitive, physical and visual deficits, emotional barriers, perceptions about medications and financial issues. Occupational therapists possess unique skills to play a vital role collaborating with other healthcare professionals to promote cost-effective measures to track and take medications as prescribed. Despite this, there are limited protocols for medication interventions and measuring adherence in occupational therapy (OT) outpatient neuro-rehabilitation settings.

Objectives: Develop a comprehensive protocol to improve the assessment, treatment, and measurement of medication adherence for patients with multiple sclerosis. 

Methods: This presentation identifies a medication management protocol used to promote medication adherence in a more objective way. Key aspects of the protocol include performing an occupational profile to assess barriers to medication adherence. OTs are skilled to perform individualized assessments to identify cognitive, physical, visual, and psychosocial factors as possibly associated with medication non-adherence. Evaluation components are essential in identifying problem-solving skills for unique situations. Standardized patient reported assessments such as Morisky Medication Adherence Scale (MMAS-8) are designed to evaluate behaviors associated with managing medications and can provide OTs with insight into whether interventions have been successful in improving adherence. This is used in conjunction with medication management tracking systems (ie. apps, checklists) to monitor medication adherence.

Intervention components of the protocol include education about personalized medication literacy, implementation of medication practices into existing routines, development of client-centered specific strategies (ie. use of pillbox, presorted medications), and prescription of assistive technology (ie. smart phone applications, alarms).

Results: Using the medication management protocol enables OTs to execute client-centered interventions with measurable outcomes and expand collaboration within the medical team.

Conclusions: While the protocol has been useful in improving ability to objectively measure interventions, further research is required to evaluate the effectiveness of the protocol in improving medication adherence in the MS population.