Medication Management for Occupational Therapy Practitioners: Assessment & Intervention (Coaching tips included)
You've likely encountered this scenario: A client knows exactly what medications they need to take and when, but they're not taking them. Despite your best efforts at education and standard interventions, medication adherence remains a problem. The result? Preventable hospitalizations, worsening chronic conditions, and frustration for both you and your client.
The numbers tell a concerning story. Recent research shows that half of people do not take their medications as prescribed (Al-Noumani, 2022). This nonadherence contributes to approximately $500 billion in avoidable healthcare costs annually (Watanabe et al., 2018). Most importantly, medication nonadherence is associated with increased morbidity and all-cause mortality (Patel, Huang, & Miliara, 2025)
Here's the opportunity: Occupational therapy practitioners can address this critical gap. Recent evidence demonstrates that occupational therapy interventions significantly improve medication adherence in primary care settings (Garrison et al., 2023). By integrating coaching approaches with your existing clinical skills, you can help clients move from knowing what to do to actually doing it.
Here's what you'll learn in this article:
Evidence-based assessment tools: Practical screening and evaluation methods to identify medication management barriers
Coaching techniques that work: Specific strategies that address root causes rather than just symptoms
5 intervention approaches: Ready-to-implement methods supported by current research
Let's focus on the practical tools and strategies you need to integrate medication management into your practice today.
Why This Matters for Your Practice
Medication management is an occupation explicitly identified in the Occupational Therapy Practice Framework (American Occupational Therapy Association [AOTA], 2020). Your unique skill set in analyzing occupational performance, implementing behavior change strategies, and prescribing assistive technology positions you perfectly to address this challenge.
Research comparing occupational therapists to other healthcare professionals reveals that OT practitioners excel in the specific skills needed for medication adherence interventions: learning strategies, monitoring, persuasion, technology design, and service orientation (Schwartz & Smith, 2017). While these skills are valuable, what matters most is the practical impact. A randomized controlled trial demonstrated that occupational therapy interventions in primary care produced statistically significant improvements in medication adherence compared to usual care (Garrison et al., 2023).
The bottom line: You already have the skills. You need the tools, assessment methods, and coaching strategies to apply them effectively.
Step 1: Screen and Evaluate Medication Management
Decision-Making Flowchart
Use this simple process to determine if and how to evaluate medication management:
Question 1: Will the client (or caregiver) be responsible for managing medications at home?
NO → No medication management evaluation needed
YES → Continue to Question 2
Question 2: Does the client have a functional impairment affecting medication management?
NO → Use adherence screening survey
YES → Conduct performance-based evaluation
Question 3: Did the client fail the screening survey?
NO → Stop here
YES → Conduct performance-based evaluation
Screening Tools for Adherence
When clients have no apparent functional impairments, quick screening identifies adherence risk:
Hill-Bone Medication Adherence Scale
14-item self-report questionnaire
Developed for hypertension and expanded for use with other conditions
Kim, M. T., Hill, M. N., Bone, L. R., & Levine, D. M. (2000). Development and testing of the hill‐bone compliance to high blood pressure therapy scale. Progress in cardiovascular nursing, 15(3), 90-96. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x
Brief Adherence Rating Scale (BARS)
4-item self-report questionnaire
Validated for mental health populations
Quickly identifies nonadherence patterns (Byerly et al., 2008)
Byerly, M. J., Nakonezny, P. A., & Rush, A. J. (2008). The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophrenia Research, 100, 60-69. https://doi.org/10.1016/j.schres.2007.12.470
Adherence to Refills and Medications Scale (ARMS)
12-item questionnaire
Designed for low literacy populations
Assesses both adherence and medication knowledge (Kripalani et al., 2009)
Kripalani, S., Risser, J., Gatti, M. E., & Jacobson, T. A. (2009). Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value in Health, 12, 118-123. https://doi.org/10.1111/j.1524-4733.2008.00400.x
Simple Pill Count
Quantity dispensed - Pills remaining = Pills taken
Date of count - Fill date = Days covered
Pills taken ÷ Days covered = Adherence percentage
Dalli, L. L., Kilkenny, M. F., Arnet, I., Sanfilippo, F. M., Cummings, D. M., Kapral, M. K., ... & Cadilhac, D. A. (2022). Towards better reporting of the proportion of days covered method in cardiovascular medication adherence: A scoping review and new tool TEN‐SPIDERS. British journal of clinical pharmacology, 88(10), 4427-4442. https://doi.org/10.1111/bcp.15391
Performance-Based Assessments
When functional impairments are present, performance-based assessments identify specific barriers:
Performance Assessment of Self-Care Skills (PASS) - Medication Management Subtest
Assesses ability to take medications correctly. Allows for the use of a standardized set of fake medications (clinic version) or client’s medications (home version)
Validated across multiple populations (Holm & Rogers, 1999; Rogers et al., 2016)
Holm, M. B., & Rogers, J. C. (1999). Functional assessment: The Performance Assessment of Self-Care Skills (PASS). In B. J. Hemphill (Ed.), Assessments in occupational therapy mental health: An integrative approach (pp. 117-124). Thorofare, NJ: Slack.
Executive Function Performance Test (EFPT) - Medication Management Subtest
Assesses ability to take medications correctly. Uses a standardized set of fake medications. Has Enhanced version (with more medications) for more complicated task
Validated across multiple populations
Access instrument here. Access Enhanced instrument here.
Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards, D. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62, 446-455. https://doi.org/10.5014/ajot.62.4.446
Boone, A. E., & Wolf, T. J. (2021). Initial development and evaluation of the Executive Function Performance Test–Enhanced (EFPT–E) in women with cancer-related cognitive impairment. The American Journal of Occupational Therapy, 75(2), 7502345020. https://doi.org/10.5014/ajot.2020.041210
Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE™)
Assesses knowledge of medications, ability to take medications correctly, and ability to procure medications
Validated in older adults
Orwig, D., Brandt, N., & Gruber-Baldini, A. L. (2006). Medication management assessment for older adults in the community. The Gerontologist, 46(5), 661-668. https://doi.org/10.1093/geront/46.5.661
Medi-Cog
Assesses ability to take medications correctly and cognitive screen
What to Assess
Your evaluation should address multiple performance components:
Cognitive Skills
Reading and comprehending medication labels
Understanding dosing instructions
Following complex schedules
Remembering administration times
Motor Skills
Opening medication containers
Manipulating pills and inhalers
Using syringes or other delivery devices
Organizing medications in pillboxes
Health Literacy
Understanding medication purpose
Recognizing side effects
Knowing when to contact prescriber
Accessing pharmacy services
Environmental Context
Medication storage location
Visual cues and reminders
Support system availability
Transportation to pharmacy
Step 2: Apply Coaching Approaches to Address Root Causes
Why Traditional Interventions Often Fail
Traditional approaches focus on prescriptive solutions: "Use this pillbox" or "Set this alarm." These interventions fail when they don't address underlying barriers like beliefs about medications, side effect concerns, or feeling overwhelmed by treatment complexity.
Research shows that most nonadherence is unintentional. In one large survey, 62% of participants reported forgetting medications, 37% ran out of medications, and only 18% intentionally skipped doses to save money (Gadkari & McHorney, 2012). This suggests that behavior change strategies, not just reminder systems, are essential.
Coaching Techniques That Support Adherence
Open-Ended Exploration
Instead of: "You need to take your medications every day." Try: "What concerns do you have about your medications?"
This approach uncovers hidden barriers like side effects, cost concerns, or skepticism about medication effectiveness.
Values-Based Motivation
Instead of: "Medication adherence will prevent complications." Try: "What activities are most important to you? How might managing your condition better support those?"
Connecting medication management to what matters most to the client builds intrinsic motivation.
Collaborative Problem-Solving
Instead of: "Here's what you should do." Try: "What solutions have you considered? What might work best for your situation?"
Clients who generate their own solutions are more likely to implement them successfully.
Strength-Based Approach
Instead of: Focusing only on missed doses Try: "Tell me about times when you've successfully managed your medications. What was different?"
Building on existing successes increases self-efficacy and confidence.
Want to learn more coaching techniques like these?
Download our free Quick Start Guide to Coaching for OT Practitioners with practical conversation starters you can use immediately in your medication management interventions.
Download Free Quick Start Guide
Step 3: Implement Interventions
1. Education and Health Literacy Support
Evidence Base: Health literacy interventions improve medication understanding and adherence (Schwartz, 2022). However, education alone is insufficient without addressing performance barriers.
Implementation:
Use teach-back methods: Ask clients to demonstrate understanding
Educate about medication timing related to daily activities
Provide reliable resources like MedlinePlus
Address myths and misconceptions about medications
Coaching Integration: Instead of lecture-style education, ask what clients already know, fill gaps collaboratively, and verify understanding through demonstration rather than verbal confirmation.
2. Routine Integration and Habit Formation
Evidence Base: Pairing medication-taking with existing habits significantly improves adherence. Contextual cues trigger medication-taking behaviors (Sanders & Van Oss, 2013).
Implementation:
Link medications to existing daily routines (brushing teeth, morning coffee, bedtime routine)
Create environmental cues (visible medication storage, automatic reminders)
Practice the complete medication routine, not just pill-taking
Include refill requests and pharmacy visits in routine planning
Coaching Integration: Guide clients through identifying their most reliable existing habits rather than prescribing specific routines. Ask: "What do you do every single day without fail? How could we connect your medications to that?"
3. Assistive Technology and Environmental Modifications
Evidence Base: Customized pillboxes and technology-based interventions can improve adherence, though effectiveness varies by individual capacity and preferences (Schwartz & Ballard, 2022; Schwartz, 2017).
Implementation:
Match pillbox complexity to client abilities (simple daily vs. complex weekly organizers)
Recommend medication reminder apps tailored to client's technology comfort
Use visual supports (photos of correctly filled pillboxes, medication charts)
Place medications in highly visible locations
Coaching Integration: Collaborate with clients to identify solutions that fit their lifestyle. Ask: "You mentioned you're often rushing in the mornings. Where could you keep your medications so you'd see them? What would actually remind you?"
Evidence-Based Options:
Prepoured dose packs for clients with dexterity or cognitive limitations
Smart pillboxes with alerts for technology-comfortable clients
Low-tech solutions (placing medications next to coffee maker) for clients preferring simple approaches
4. Caregiver Training and Support
Evidence Base: Caregiver involvement significantly impacts medication adherence, particularly for clients with cognitive impairment or complex regimens (Beals et al., 2006).
Implementation:
Train caregivers in medication administration techniques
Provide strategies that support independence while assisting where needed
Educate about the medication regimen and timing
Address caregiver burden and sustainability
Coaching Integration: Help caregivers balance providing support with maintaining client autonomy. Ask: "What parts can your mother still do independently? How can you support those abilities while helping with the difficult parts?"
5. Advocacy and Regimen Simplification
Evidence Base: Medication regimen complexity directly affects adherence. Simpler regimens improve outcomes (Coleman et al., 2012; Fleming et al., 2023).
Implementation:
Advocate with prescribers for fewer daily doses
Request synchronized refill times to reduce pharmacy trips
Train clients in self-advocacy with medication records
Coordinate between multiple prescribers to reduce duplicate medications
Note that these tasks must be complete in collaboration with the prescriber and pharmacist
Coaching Integration: Build client confidence in communicating with their healthcare team. Practice difficult conversations: "You mentioned the side effects are bothering you. What would you want to tell your doctor? Let's practice how you might start that conversation."
Moving Forward
Medication management belongs in occupational therapy practice. You have the foundational skills. With the assessment tools, coaching techniques, and intervention strategies outlined here, you can immediately begin integrating medication management into your clinical work.
Start Small:
Week 1: Screen one client per day using simple pill count or ARMS
Week 2: Add one coaching question to each evaluation
Week 3: Implement one evidence-based intervention with appropriate clients
Track Your Impact: Use simple metrics like adherence percentages, pill counts, or client-reported confidence to demonstrate your effectiveness and justify continued practice in this area.
Get Additional Training: Consider specialized training in motivational interviewing and coaching approaches specifically designed for occupational therapy practitioners. This training builds on your existing clinical skills and provides the behavioral change tools that complement traditional OT interventions.
Ready to Transform Your Approach to Medication Management?
The assessment tools and intervention strategies are just the beginning. The real breakthrough happens when you integrate coaching approaches that address the why behind nonadherence, not just the what.
Get your free Quick Start Guide to Coaching for OT Practitioners and learn:
The key differences between traditional OT approaches and coaching
How to shift from prescriptive interventions to collaborative problem-solving
Real examples of coaching questions
Plus, join the waitlist for our upcoming continuing education training on coaching skills specifically designed for occupational therapy practitioners working with chronic disease management and medication adherence.
Download Free Quick Start Guide + Join CE Waitlist
By integrating coaching approaches with your assessment and intervention skills, you can help clients with chronic conditions achieve the lasting behavior change that leads to improved medication adherence, better health outcomes, and reduced hospitalizations.
References
Al-Salmi, N., Muliira, J. K., & Lazarus, E. R. (2025). Medication Adherence in Adults with Type 2 Diabetes: A Comprehensive Qualitative Meta-Synthesis of Factors in the MENA Region. Patient preference and adherence, 2263-2281. https://doi.org/10.1177/10547738211033754
American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process—Fourth Edition. The American Journal of Occupational Therapy, 74(Supplement_2), 7412410010p1-7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001
Baum, C. M., Connor, L. T., Morrison, T., Hahn, M., Dromerick, A. W., & Edwards, D. F. (2008). Reliability, validity, and clinical utility of the Executive Function Performance Test: A measure of executive function in a sample of people with stroke. American Journal of Occupational Therapy, 62, 446-455. https://doi.org/10.5014/ajot.62.4.446
Beals, K. P., Wight, R. G., Aneshensel, C. S., Murphy, D. A., & Miller-Martinez, D. (2006). The role of family caregivers in HIV medication adherence. AIDS Care, 18, 589-596. https://doi.org/10.1080/09540120500275627
Boone, A. E., & Wolf, T. J. (2021). Initial development and evaluation of the Executive Function Performance Test–Enhanced (EFPT–E) in women with cancer-related cognitive impairment. The American Journal of Occupational Therapy, 75(2), 7502345020. https://doi.org/10.5014/ajot.2020.041210
Byerly, M. J., Nakonezny, P. A., & Rush, A. J. (2008). The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophrenia Research, 100, 60-69. https://doi.org/10.1016/j.schres.2007.12.470
Coleman, C. I., Roberts, M. S., Sobieraj, D. M., Lee, S., Alam, T., & Kaur, R. (2012). Effect of dosing frequency on chronic cardiovascular disease medication adherence. Current Medical Research and Opinion, 28, 669-680. https://doi.org/10.1185/03007995.2012.677419
Dusetzina, S. B., Besaw, R. J., Whitmore, C. C., Mattingly, T. J., Sinaiko, A. D., Keating, N. L., & Everson, J. (2023). Cost-related medication nonadherence and desire for medication cost information among adults aged 65 years and older in the US in 2022. JAMA Network Open, 6(5), e2314211. https://doi.org/10.1001/jamanetworkopen.2023.14211
Fleming, T. K., Schwartz, J. K., Belagaje, S. R., Katz, L. W., & Strow, J. T. (2023). Medication management after stroke. Archives of Physical Medicine and Rehabilitation, 104(12), 2084-2093. https://doi.org/10.1016/j.apmr.2023.03.029
Gadkari, A. S., & McHorney, C. A. (2012). Unintentional non-adherence to chronic prescription medications: How unintentional is it really? BMC Health Services Research, 12, 98. https://doi.org/10.1186/1472-6963-12-98
Garrison, T., Schwartz, J. K., & Moore, E. (2023). Effect of occupational therapy in promoting medication adherence in primary care: A randomized control trial. The American Journal of Occupational Therapy, 77(3), 7703205040. https://doi.org/10.5014/ajot.2023.050109
Holm, M. B., & Rogers, J. C. (1999). Functional assessment: The Performance Assessment of Self-Care Skills (PASS). In B. J. Hemphill (Ed.), Assessments in occupational therapy mental health: An integrative approach (pp. 117-124). Thorofare, NJ: Slack.
Kim, M. T., Hill, M. N., Bone, L. R., & Levine, D. M. (2000). Development and testing of the hill‐bone compliance to high blood pressure therapy scale. Progress in cardiovascular nursing, 15(3), 90-96. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x
Kripalani, S., Risser, J., Gatti, M. E., & Jacobson, T. A. (2009). Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value in Health, 12, 118-123. https://doi.org/10.1111/j.1524-4733.2008.00400.x
National Center for Health Statistics. (2024). Prescription medication use, coverage, and nonadherence among adults age 65 and older: United States, 2021-2022 (National Health Statistics Reports, No. 206). https://www.cdc.gov/nchs/data/nhsr/nhsr206.pdf
Patel, S., Huang, M., & Miliara, S. (2025). Understanding treatment adherence in chronic diseases: challenges, consequences, and strategies for improvement. Journal of Clinical Medicine, 14(17), 6034. https://doi.org/10.3390/jcm14176034
Robnett, R. H., Dionne, C., Jacques, R., LaChance, A., & Mailhot, M. (2007). The ManageMed Screening: An interdisciplinary tool for quickly assessing medication management skills. Clinical Gerontologist, 30(4), 1-23. https://doi.org/10.1300/J018v30n04_01
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 74(6), 668-686. https://doi.org/10.1177/1077558716666981
Sanders, M. J., & Van Oss, T. (2013). Using daily routines to promote medication adherence in older adults. American Journal of Occupational Therapy, 67, 91-99. https://doi.org/10.5014/ajot.2013.005033
Schwartz, J. K. (2017). Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions. Assistive Technology, 29(4), 181-187. https://doi.org/10.1080/10400435.2016.1219884
Schwartz, J. K. (2022). Guidelines for medication education for occupational therapists. The Open Journal of Occupational Therapy, 10(1), 1-8. https://doi.org/10.15453/2168-6408.1851
Schwartz, J. K., & Ballard, D. H. (2022). Feasibility of customized pillboxes to enhance medication adherence: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 103(12), 2288-2295. https://doi.org/10.1016/j.apmr.2022.03.018
Schwartz, J. K., & Smith, R. O. (2017). Integration of medication management into occupational therapy practice. American Journal of Occupational Therapy, 71(4), 7104360010. https://doi.org/10.5014/ajot.2017.015032
Schwartz, J. K., & Unni, E. (2021). Inclusion of people with disabilities in research to improve medication adherence: A systematic review. Patient Preference and Adherence, 15, 1671-1683. https://doi.org/10.2147/PPA.S314135
Watanabe, J. H., McInnis, T., & Hirsch, J. D. (2018). Cost of prescription drug-related morbidity and mortality. Annals of Pharmacotherapy, 52(9), 829-837. https://doi.org/10.1177/1060028018765159