Occupational therapy in primary care: Results from a national survey: L'ergothérapie dans les soins primaires : Résultats d'un sondage national

Accessing care within team-based models of primary care for the management of chronic low back pain in Ontario, Canada: a qualitative study of patient experiences

PURPOSE

To understand experiences accessing care within team-based primary care models among adults with chronic low back pain (LBP).

MATERIALS & METHODS

We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were recruited from publicly funded, team-based primary care models in Ontario, Canada.

RESULTS

We completed interviews with 16 adults with chronic LBP (9 women; median age of 66). Participants expressed a desire to access care from team-based models of primary care in hopes of alleviating pain and its impacts on daily life. Due to no direct out-of-pocket costs, co-location of healthcare providers, and the use of technology and virtual care, participants described an ease of accessing interprofessional care within team-based primary care models. Finally, participants described experiences with and expectations for timely access to care, being heard and understood by healthcare providers, and receiving coordinated care by an interprofessional team.

CONCLUSIONS

Adults living with chronic LBP described overall positive experiences and specific expectations when accessing care within team-based models of primary care, whereby they experienced an ease of accessing interprofessional care with the hope of alleviating pain and its impacts. Results may be transferable to other chronic pain conditions and health system contexts.

[Sondage sur les pratiques des médecins de famille et sur la collaboration interprofessionnelle avec des ergothérapeutes en GMF quant au dépistage des conducteurs à risque]

Cette étude a sondé 46 médecins de famille québécois quant à leurs pratiques pour l'évaluation et le dépistage des conducteurs à risque afin 1) de mieux comprendre leur niveau de compétence perçu; 2) de recenser les difficultés rencontrées dans le processus de prise de décision et 3) de documenter leurs besoins et attitudes quant à une collaboration plus étroite avec les ergothérapeutes. Les participants (femmes : 84,8 %; moyenne d'expérience : 15,7 (±12,1) ans) ont répondu à un sondage en ligne de 30 questions. Les résultats de cette étude démontrent que malgré un certain confort à effectuer l'évaluation et le dépistage des conducteurs à risque, les médecins ne se considèrent pas comme les professionnels les mieux qualifiés pour ce faire. Ils reconnaissent également le rôle que jouent les ergothérapeutes dans le dépistage de cette clientèle et l'intervention auprès d'elle. Ils voient ainsi la pertinence d'avoir accès aux services de ces professionnels en soins de première ligne.

Primary care occupational, physical, and respiratory therapy role adaptation in the first year of the COVID-19 pandemic

BACKGROUND

Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation.

METHODS

This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation.

RESULTS

We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts.

CONCLUSIONS

Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.

Delivering Team-Based Primary Care for the Management of Chronic Low Back Pain: An Interpretive Description Qualitative Study of Healthcare Provider Perspectives

Background

Chronic low back pain (LBP) is a prevalent and disabling health issue. Team-based models of primary care are ideally positioned to provide comprehensive care for patients with chronic LBP. A better understanding of primary care team perspectives can inform future efforts to improve how team-based care is provided for patients with chronic LBP in this practice setting.

Aims

The aim of this study was to understand health care providers' experiences, perceived barriers and facilitators, and recommendations when providing team-based primary care for the management of chronic LBP.

Methods

We conducted an interpretive description qualitative study based on focus group discussions with health care providers from team-based primary care settings in Ontario, Canada. Data were analyzed using thematic analysis.

Results

We conducted five focus groups with five different primary care teams, including a total of 31 health care providers. We constructed four themes (each with subthemes) related to experiences, perceived barriers and facilitators, and recommendations to providing team-based primary care for the management of chronic LBP, including (1) care pathways and models of service delivery, (2) team processes and organization, (3) team culture and environment, and (4) patient needs and readiness.

Conclusions

Primary care teams are implementing diverse care pathways and models of service delivery for the management of patients with chronic LBP, which can be influenced by patient, team, and organizational factors. Results have potential implications for future research and practice innovations to improve how team-based primary care is delivered for patients with chronic LBP.

Occupational Therapist-Led Mindfulness Training Program for Older Adults Living with Early Cognitive Decline in Primary Care: A Pilot Randomized Controlled Trial

Background

Community-dwelling older adults with early cognitive deficits experience less efficiency in performing everyday life tasks, resulting in decreased satisfaction and other adverse psychological outcomes. Mindfulness training has been linked to cognitive and psychological improvements and, most recently, has been identified as a potential intervention supporting performance of everyday life activities.

Objective

This study aimed to evaluate whether mindfulness practice can improve perceived performance and satisfaction with everyday life activity and secondary psychological outcomes.

Methods

This study is a pilot randomized controlled trial (RCT) in an interprofessional primary care team practice in Toronto, Ontario, Canada. The participants were 27 older adults aged 60 years of age or older living with early cognitive deficits. Participants were randomized into an 8-Week mindfulness training program (n = 14) group or a Wait-List Control (WLC; n = 13) group compared at baseline, post-intervention and 4-weeks follow-up. MANOVAs with post-hoc independent t-tests were used to compare between groups at different time points.

Results

There was a significant improvement in anxiety for the intervention group compared to the WLC group at post-intervention; Time-2 (mean difference = 3.90; CI = 0.04-7.75; p = 0.04) with large effect size (d = 0.80).

Conclusion

Mindfulness training significantly improved anxiety scores for patients with early cognitive deficits post-intervention. Further work is required to test the sustainability of reduced anxiety over time, but this study demonstrated that MBSR is a promising primary care intervention for those living with early cognitive deficits. This study warrants the pursuit of a future study in exploring how long the reduced anxiety effects would be sustained.

Telerehabilitation Delivery in Canada and the Netherlands: Results of a Survey Study

BACKGROUND

Following the onset of the COVID-19 pandemic, telerehabilitation (TR) has been expanding to address the challenges and risks of in-person delivery. It is likely that a level of TR delivery will continue after the pandemic because of its advantages, such as reducing geographical barriers to service. Many pandemic-related TR initiatives were put in place quickly. Therefore, we have little understanding of current TR delivery, barriers and facilitators, and how therapists anticipate integrating TR into current practice. Knowing this information will allow the incorporation of competencies specifically related to the use and provision of TR into professional profiles and entry-to-practice education, thereby promoting high-quality TR care.

OBJECTIVE

This study aimed to obtain a descriptive overview of current TR practice among rehabilitation therapists in Canada and the Netherlands and identify perceived barriers to and facilitators of practice.

METHODS

A web-based cross-sectional survey was conducted with occupational, physical, and respiratory therapists and dietitians in Canada (in French and English) and the Netherlands (in Dutch and English) between November 2021 and March 2022. Recruitment was conducted through advertisements on social media platforms and email invitations facilitated by regulatory and professional bodies. The survey included demographic and practice setting information; whether respondents delivered TR, and if so, components of delivery; confidence and satisfaction ratings with delivery; and barriers to and facilitators of use. TR satisfaction and uptake were measured using the Telehealth Usability Questionnaire and modified Technology Acceptance Model. Data were first summarized descriptively, and then, comparisons were conducted between professions.

RESULTS

Overall, 723 survey responses were received, mostly from Canada (n=666, 92.1%) and occupational therapists (n=434, 60%). Only 28.1% (203/723) reported receiving specific training in TR, with 1.2% (9/723) indicating that it was part of their professional education. Approximately 19.5% (139/712) reported not using TR at all, whereas most participants (366/712, 51.4%) had been using this approach for 1 to 2 years. Services delivered were primarily teleconsultation and teletreatment with individuals. Respondents offering TR were moderately satisfied with their service delivery and found it to be effective; 90.1% (498/553) indicated that they were likely to continue offering TR after the pandemic. Technology access, confidence, and setup were rated the highest as facilitators, whereas technology issues and the clinical need for physical contact were the most common barriers.

CONCLUSIONS

Professional practice and experience with TR were similar in both countries, suggesting the potential for common strategic approaches. The high prevalence of current practice and strong indicators of TR uptake suggest that therapists are likely to continue TR delivery after the pandemic; however, most therapists (461/712, 64.7%) felt ill prepared for practice, and the need to target TR competencies during professional and postprofessional education is critical. Future studies should explore best practice for preparatory and continuing education.

Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial

BACKGROUND

Primary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context.

OBJECTIVES

This study's primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice.

METHODS

A convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice.

RESULTS

27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets.

CONCLUSIONS

Based on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study's end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use.

TRIAL REGISTRATION

This study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017-0056-E); Queen's University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474).

Occupational therapy services in primary care: a scoping review

AIM

To examine and describe the current evidence about occupational therapy services in primary care.

BACKGROUND

Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context.

METHODS

A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data.

FINDINGS

129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.

Psychotherapy Within Occupational Therapy Literature: A Scoping Review

Background. Recent changes in the Canadian regulatory landscape have prompted reflections on the role and scope of occupational therapy in the provision of psychotherapy. Purpose. To document how psychotherapy has been explored in occupational therapy literature. Method. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines by searching eight databases (e.g., Medline, AMED, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Sociological Abstracts, and ProQuest Dissertations & Theses). Articles included at the full-text stage were subjected to a narrative synthesis. Findings. A total of 207 articles met the criteria for inclusion, spanning 93 years. 47.3% of these articles represented non-empirical literature, with only 14% representing effectiveness studies, suggesting that this body of literature remains in an early stage of development. Implications. Occupational therapists have been writing about and practicing psychotherapy for nearly a century, yet there remains an important opportunity to develop and evaluate occupation-based psychotherapy approaches. Effectiveness studies are needed.

Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis

Introduction

Team-based care has been integrated into primary care (PC) across Canada because it improves patient safety, effectiveness, efficiency, person-centredness, and equity. However, this integration in and of itself may not lead to improved patient care without effective interpersonal relationships amongst team members. Currently, teams have few tools to guide the development of collaborative relationships. The Interprofessional Collaborative Relationship-building Model (ICRB) was developed to be a tool for understanding the stages of development of the interprofessional team's relationship-building.

Purpose

This qualitative secondary data analysis illuminates a PC team's experiences of their developing interprofessional relationships with occupational therapists and physical therapists who joined the PC team.

Method

Eleven team member interviews of one primary care team from a family medicine teaching clinic affiliated with a training university and the health region in central Canada were analyzed using secondary data analysis. The team included family physicians (n = 4), nurses (n = 2), a social worker (n = 1), a mental health counselor (n = 1), occupational therapists (n = 2), and a physical therapist (n = 1). We used the ICRB for directed content analysis using the phased approach that includes the three main steps of data preparation, data organization and data presentation.

Results

This team experienced the ICRB stages of Looking For Help, Fitting-In, and Growing Reciprocity thereby learning about one another to better understand what OT and PT may bring to the PC setting. However, contrary to the ICRB, co-location, was the context within which the collaborative relationship-building took place rather than a distinct developmental stage. Although team members did experience some level of Growing Reciprocity, this developing team had not yet established collaborative leadership processes. As the ICRB originally posited, communication and patient focus facilitated all stages of the relationship-building process and helped the team develop shared values and role clarity that establish how different team members contribute to improving quality care.

Conclusions

The context of co-location with a patient focus and open communication facilitated the team's development with the occupational therapists and physical therapist. Collaborative leadership is a worthy goal for future research and clinical focus as it has implications for improving overall patient quality care and team member work satisfaction.

Examining utility and feasibility of implementing patient-reported outcome measures in occupational therapy primary care practice

Introduction

Occupational therapists are increasingly part of interprofessional primary care teams, helping to expand primary care to meet client needs. Effectiveness of occupational therapy services is difficult to determine with currently collected data, and little is known about the best tools to use or how to integrate tools into practice. We explored the utility and feasibility of implementing patient-reported outcome measures (PROMs) within occupational therapy primary care practice.

Method

We integrated pre-test/post-test and exploratory qualitative designs. Over 7 months, nine occupational therapists administered two PROMs to clients receiving falls prevention services, addressing falls efficacy and participation in daily occupations. Subsequent interviews with therapists explored the utility and feasibility of using the tools. We assessed pre-to-post change in PROM scores and thematically analyzed interview data.

Results

The occupational therapists valued measuring function and participation in daily occupations to inform practice, communicate with team members, and demonstrate effectiveness. The falls efficacy scale appeared to capture change over time and was feasible to implement at pre-test.

Conclusion

PROMs appear useful within occupational therapy primary care falls prevention services and can be feasible with attention to administration processes. Further development and testing of PROMs is needed to support occupational therapy primary care practice.

Physiotherapy Practice in Primary Health Care: A Survey of Physiotherapists in Team-Based Primary Care Organizations in Ontario

Purpose: This study describes (1) the current state of physiotherapy practice in team-based primary care organizations in Ontario, (2) the perceived barriers to and facilitators of providing physiotherapy services, and (3) recommendations for improving how these services are provided. Method: This was a cross-sectional, web-based survey. We analyzed the responses using descriptive statistics and summative content analysis. Results: A total of 66 responses were received, and 61 were included in the final analysis. The respondents reported that most of their practice was directed toward musculoskeletal care, followed by multi-system, neurological, and cardiorespiratory conditions, and that most of their direct patient care was focused on in-person, one-to-one assessment or follow-up. Frequently identified barriers to providing physiotherapy services included a lack of space, resources, time, and equipment. The most common facilitators were support from management, recognition and support from other health care providers about the value and role of physiotherapists, and appropriate referrals from other health care providers. The most common recommendation was to increase the physiotherapist-to-patient ratio at primary care sites. Conclusions: Physiotherapists provide care to diverse populations in team-based primary care, which is influenced by specific barriers and facilitators. Our results highlight opportunities for physiotherapists in this context, such as increasing the provision of first-contact care and group-based interventions.

The effectiveness of occupational therapy for mental health disorders in primary care: A systematic review

Introduction

Occupational therapy (OT) has a rich history of integrating physical and mental health care services, however, there is a limited evidence base regarding the effectiveness of OT interventions for mental health disorders in primary care.

Methods

A comprehensive systematic review was conducted from database inception through 31 January 2021. Eligible studies had to include: (1) an intervention that involved an occupational therapist in design and/or implementation; (2) a quantitative outcome assessing symptoms related to a mental health disorder; (3) a comparison group; and (4) primary care or community dwelling patients and/or primary care clinical settings.

Results

The researchers identified five studies and there was heterogeneity in the OT interventions. There were no significant differences between intervention and control groups in depression symptoms at different time intervals. Several trials employed interventions that involved interprofessional team members, including OTs, to provide training in specific strategies that promoted functioning. Other studies utilized only OTs within the intervention arm. OT interventions demonstrated no significant difference in anxiety in one study, however, another indicated a reduction in symptoms. The overall risk of bias was considered low in three studies and unclear in two studies.

Conclusion

There is limited evidence demonstrating the impact of OT interventions in primary care settings on quantitative outcomes measuring symptoms related to a mental health disorder. Given the heterogeneity of interventions and variation in reported findings, there is need for further pragmatic trials in this area.

Interprofessional primary care during COVID-19: a survey of the provider perspective

BACKGROUND

Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic.

METHODS

Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions.

RESULTS

445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain.

CONCLUSIONS

IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.

O papel da terapia ocupacional na atenção primária à saúde: perspectivas de docentes e estudantes da área

Resumo O objetivo desta pesquisa foi compreender as perspectivas de docentes e estudantes brasileiros sobre o papel da terapia ocupacional na Atenção Primária à Saúde (APS). Trata-se de estudo de caráter exploratório e com metodologia qualitativa realizado por meio de entrevistas semi-estruturadas com 17 docentes e de nove rodas de conversa com a participação de 67 estudantes. A análise temática revelou duas categorias: 1- Contribuições da terapia ocupacional para a Atenção Primária à Saúde; e 2- O papel específico da terapia ocupacional na Atenção Primária à Saúde, que se traduzem em oferta de cuidado integral, compreensão ampliada do contexto territorial, do cotidiano e ações dirigidas à promoção da participação nas atividades em diversas áreas da vida das pessoas atendidas. No entanto, a terapia ocupacional na Atenção Primária à Saúde necessita ser ainda mais explorada para que seja possível sistematizar e aprofundar o desenvolvimento de suas práticas na APS.

Occupational Therapy in Haiti: A Pilot Study to Identify Intervention Methods Used during Short-Term Medical Missions

Due to the shortage of occupational therapists (OTs) in Haiti and over 800,000 individuals with disabilities, most occupational therapy assessments and interventions are provided by OTs on short-term medical missions (STMMs). Learning which methods OT use to provide assessments and interventions during these STMMs is the first step to understanding how to facilitate follow-up and carry-over for clients and ensure longevity for STMMs in Haiti. This study used a cross-sectional, descriptive design to gather data on methods used by OTs. Thirty-three OTs, who travelled to Haiti on STMMs, completed a 16-question, online survey. The most common method provided by OTs was education to patients, caregivers, and local providers. Training of Haitian rehabilitation technicians was also prevalent. There was an association between the years of the OTs' clinical experience and the effort of OTs to train local providers, but this result was not statistically significant. Further research should be implemented on specific methods that can be used in the absence or shortage of Haitian OTs to ensure follow-up for Haitian clients. The sharing of data regarding OT methods on STMMs will promote evidence-based, client-centered, and cost-effective therapy to enhance effective client outcomes.

Irish occupational therapists use of evidenced-based falls prevention programmes

Purpose

As one ages, the risk of experiencing a fall increases and poses a number of serious consequences; 30 per cent of individuals over 65 years of age fall each year. Evidence-based falls prevention programmes demonstrate efficacy in reducing the rate and risk of falls among older adults, but their use in Irish occupational therapy practice is unknown. This study aims to investigate the implementation of falls prevention programmes by occupational therapists working with older adults in Ireland.

Design/methodology/approach

A cross-sectional survey was used to gather data on the use of falls prevention programmes among occupational therapists working with older adults in any clinical setting across Ireland. Purposeful, convenience and snowball sampling methods were used. The Association of Occupational Therapists of Ireland acted as a gatekeeper. Descriptive statistics and summative content analysis were used to analyse quantitative and qualitative data, respectively.

Findings

In all, 85 survey responses were analysed. Over 85 per cent of respondents reported “Never” using any of the evidence-based falls prevention programmes. The “OTAGO” Exercise Programme was the most “Frequently” used programme (9.5 per cent, n = 7); 29 respondents reported using “in-department” developed falls prevention programmes and 14 provided additional comments regarding current falls prevention practices in Ireland.

Originality/value

In the absence of Irish data on the subject, this study provides a benchmark to describe the use of evidence-based falls programmes by Irish occupational therapists with older adults.

Community-based occupational therapy in Norway: Content, dilemmas, and priorities

BACKGROUND

Profound changes in municipal health services, are calling for new models for community-based occupational therapy services.

OBJECTIVE

The aim of the study is to explore how Norwegian occupational therapists position themselves in relation to the tasks delivered.

METHOD

Focus group interviews were conducted with ten community-based occupational therapists. Systematic text condensation was then used in the data analysis.

RESULTS

Norwegian occupational therapists description of professional practices can be constructed into four ideal types; being 'the all-rounder', 'the provider of assistive device', 'the fire extinguisher', or 'the innovator'. The ideal types can help us understand more of the content and dilemmas that community-based occupational therapists encountered in their daily practice, and the priorities they make during these encounters.

CONCLUSIONS AND SIGNIFICANCE

Community-based occupational therapists positioned themselves in different ways, and some of these positions were considered to be more favourable than others. The therapists struggled between 'traditional' occupational therapy tasks and new ways of delivering occupational therapy services. The study reveals similarities and differences between rural and urban occupational therapy practice. The ideal types can help community-based therapists to reflect on their own practice and empower them to be more in keeping with the OT's objectives and preferences.

Perceptions of primary health staff about falls prevention in primary care settings in the west of Ireland

Introduction

Primary care is an emerging area of practice for allied health practitioners. The effective integration of primary care services provided by different professions using diverse funding sources is challenging. Ireland has implemented a primary care strategy and set up primary care teams to address this. Acknowledging the ageing population in the community, fall prevention needs to be a core function of these services. This study aimed to explore the perceptions of general practitioners, occupational therapists and physiotherapists working in the primary care setting about falls prevention in their practice.

Method

Three general practitioners, five occupational therapists and three physiotherapists were interviewed from primary care teams in the counties of Limerick, Clare and North Tipperary, Ireland. Interviews were in person or by telephone and audiotaped, transcribed and analysed thematically.

Results

Two key themes emerged from the data: the level of primary care team integration and the nature of community fall prevention, linked by referral mechanisms.

Conclusion

Providing comprehensive falls prevention services in the primary care context is complex. Integrated processes and pathways in primary care teams are needed to identify older people at risk of falls and to engage a whole of primary care approach to fall prevention.

Occupational Therapy and Primary Care: Updates and Trends

As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care.