Opportunities for Occupational Therapy on a Primary Care Team

Occupational Therapy in Primary Health Care for Underserved Populations: A Scoping Review

The aim of this scoping review was to identify what current and potential opportunities exist for occupational therapy in primary healthcare for underserved populations. Search phrases were utilized across several databases and Occupational Therapy specific journals were hand searched. Nineteen articles met inclusion criteria: English, 2009-2021, services delivered by occupational therapy practitioners or supervised students, for underserved populations/individuals, in community-based care, and primary health care settings. Five synergistic themes emerged from the literature are discussed: Client-centered, team collaboration, holistic and preventative health and wellness, evidence-based program evaluation, and innovative service delivery.

Early detection of neurodevelopmental disorders in paediatric primary care: A scoping review

BACKGROUND

Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough.

OBJECTIVES

To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy's scope of practice.

METHODS

A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0-3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at https://doi.org/10.17605/OSF.IO/MD4K5.

RESULTS

We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting.

CONCLUSIONS

No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.

Describing Occupational Therapy Services in Primary Care Settings: A Qualitative Study

As occupational therapists gain recognition for their work in primary care, it is important to explore the services they provide within these settings. A qualitative study was employed whereby six licensed occupational therapists within the United States were invited via email to engage in semi-structured interviews. Interview transcripts were analyzed individually by six researchers and as a team using consensus coding. Four themes emerged: "Primary Care Benefits", "Occupational Therapy Process and Distinct Value", "Primary Care Interventions", and "Complexities of Primary Care: Patient Conditions and Challenges." Occupational therapists described a range of benefits to being positioned within primary care. Problem solving around patient barriers, funding and logistical challenges are important considerations. Emphasizing 'occupation-based practice' and 'doing' within therapy are vital for occupational therapists who wish to advocate for their services and apply their distinct skill set within primary care settings.

Exploring Occupational Therapists' Experiences in U.S. Primary Care Settings: A Qualitative Study

IMPORTANCE

Occupational therapy's scope of practice aligns with the goals of comprehensive primary care set forth by the 2010 Patient Protection and Affordable Care Act (Pub. L. 111-148). To successfully integrate occupational therapy into primary care, we must understand occupational therapy practitioners' experiences in this setting.

OBJECTIVE

To explore facilitators of, barriers to, and recommendations for integrating occupational therapy into primary care.

DESIGN

A descriptive qualitative design that incorporated semistructured interviews, member checking sessions, and deductive thematic analysis. Interviews were structured to capture occupational therapists' experiences of and recommendations for practicing in primary care.

SETTING

Primary care.

PARTICIPANTS

A purposive sample of licensed occupational therapists with at least 6 mo primary care experience in the United States.

RESULTS

Seven participants reported 1 to 8 yr of experience in primary care. Four themes emerged that contextualized the experiences of occupational therapists in primary care. The first theme captured the process of gaining entry onto the primary care team. Once structurally embedded on the team, the second and third themes, respectively, captured barriers and facilitators to navigating team-based care and providing patient-centered care. The fourth theme reflected participants' vision and ideas of how to expand reach nationally to promote consistent integration of occupational therapy into primary care. Conclusion and Relevance: Given the important role of an interprofessional primary care team in improving population health, this study is timely in that it explored occupational therapists' experiences in this emerging practice area. What This Article Adds: Occupational therapists in this study used their skills, resources, and networks to become part of a primary care team. They indicated that they contributed to positive outcomes through working with patients on self-management, functional problem solving, and behavior change.

Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness

Health services research focuses on access, quality, and cost-effectiveness of care. As a result of increasing emphasis on value-based reimbursement models, conducting health services research to demonstrate the value of occupational therapy is timely. This special issue serves to highlight health services research relevant to occupational therapy practice. Articles included in this special issue describe (1) clients' access to and use of occupational therapy, (2) the effects of occupational therapy on important quality-of-care indicators and client outcomes, and (3) the value of occupational therapy services through the lens of cost-effectiveness. This special issue illustrates the state of health services research in the field of occupational therapy and reveals key insights to advance occupational therapy practice using health services research.

Role of Occupational Therapy in Primary Care

The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).

A "Behind-the-Scenes" Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes

Introduction:

While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients at the Virginia Commonwealth University Health System’s Complex Care Clinic.

Methods:

Researchers attended twenty weekly care coordination meetings, audio-recorded the proceedings, and wrote brief observational field notes. Researchers also qualitatively interviewed ten clinic team members. Emergent coding based on grounded theory and a consensus process were used to identify and describe key themes.

Results:

Analysis resulted in three themes that evidence the structures, processes, and interactions which contributed to the ability to provide person-centred care: team-based communication strategies, interprofessional problem-solving, and personalized patient engagement efforts.

Conclusion:

Our study suggests that in care coordination meetings team members were able to strategize, brainstorm, and reflect on how to better care for patients. Specifically, flexible team leadership opened an inter-disciplinary communicative space to foster conversations, which revealed connections between the physical, and socio-emotional components of patients’ lives and hidden factors undermining progress, while proactive strategies prevented patient’s rapid deterioration and unnecessary use of inappropriate health services.

Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team

Reilly's (1962) now deeply cherished statement that "man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health" (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly's, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy's role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.