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

Importance: The Integrative Medication Self-Management Intervention (IMedS) is a manualized occupational therapy intervention designed to improve adherence to medications. The intervention influences medication adherence and facilitates new medication habits and routines; however, it has not been tested in a community clinical setting. Objective: To test the efficacy of the IMedS to address medication adherence rates among community-dwelling adults with hypertension (HTN), Type 2 diabetes mellitus (T2DM), or both. Design: Randomized controlled trial using a pretest-posttest control group design. Setting: Primary care clinic in a large federally qualified health center. Participants: Adults with uncontrolled HTN, T2DM, or both. Intervention: Participants were divided into two groups: The control group received treatment as usual (TAU) per the primary care protocol, and the intervention IMedS group received TAU and the IMedS intervention. Outcomes and Measures: Primary outcome: seven-item version of the Adherence to Refills and Medication Scale (ARMS-7), pill count, blood pressure, hemoglobin A1c, or all of these. Results: The proportion of adherent participants increased in both groups, but between groups, changes were not statistically significant. Post hoc comparisons of the results of a mixed analysis of variance for ARMS-7 measurements indicated that the occupational therapy intervention had a unique effect, compared with that for the TAU control group (dc = 0.65). Effect scores for pill count (d = 0.55) also suggested that the occupational therapy intervention positively affected adherence. Conclusions and Relevance: Occupational therapists can provide assessment and intervention to positively influence medication adherence in a primary care setting.