Occupational Therapy and Primary Care: Updates and Trends

Today's Paper
Halle, A. D., Mroz, T. M., Fogelberg, D. J., & Leland, N. E. (2018). Occupational Therapy and Primary Care: Updates and Trends. American Journal of Occupational Therapy, 72(3), 7203090010p1-7203090010p6.

The Problem
Rising healthcare costs world-wide have renewed interest in solutions (and OT) for primary care.

The problem is that primary care (and primary health care) is still defined by the services provided only by physicians, nurse practitioners, and physician assistants - and not by other health providers such as OTs.

Defining Primary Care

You can think of primary care as:

...“the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” (IOM, 1994)

(You might want to read that one more time; it’s quite wordy.)


Access to OT in Primary Care
Access to OT services matters, as is greatly determined by the way OT is funded and paid for.

In the US, alternative payment models (APMs) allow for payment of occupational therapy services to some degree - but access varies depending on state.

Here in Canada, our provinces decide what to fund through their Medical Services Plans (or equivalent), but few plans explicitly cover OT. For example, here in BC our Medical Services Plan does not cover OT (outside of health authorities) and because of this, there’s very little access to OT in primary health.

Side note: What’s it like in your Country?


Results
For the women who received the OT treatment (as above):

  • Clinically significant improvement were found in self-reported QOL (effect sizes below). This included improvements in global quality of life, physical, cognitive, emotional, fatigue, and insomnia.

  • There was a reduced report of negative symptoms (and side effects) in the OT group.

  • Statistically significant improvements in activity engagement were found


Meaningful activity engagement was also found to relate to improved emotional function and reduced insomnia (and constipation - of all things).


How Your OT Work Helps in Primary Care
Here are some ways you may have already played a role in primary health care:

  • Helped patients maintain independence

  • Helped patients adhere to treatment (coaching)

  • Identified the need for early intervention

  • Promoted management of chronic conditions

  • Delayed long-term institutionalization

  • Assisted patient transitions through the care continuum

  • Increased activity and participation in life

  • Addressed easy to change health risks (like falls) to reduce hospital admissions

  • Improved mental health through increased access to leisure and recreation



Barriers to more OT jobs in Primary Health

  • Funding - without the money, care unfortunately just won’t happen. OTs can apply an evidence-based cost-savings or return on investment (ROI) argument when you advocate for your services.

  • Lack of clarity -  as a profession, OT lacks clarity on how to best approach primary care and describe its unique contribution and values. It doesn’t mean it can’t be done, it just means OT hasn’t yet been clear enough.

  • Ignorance - healthcare decision makers, members of the public, and other healthcare professionals don’t have a clear idea of what OT has to offer and how it can help them.  National organizations and individual therapists have a responsibility and opportunity to shape public perception of the profession and demonstrate value in primary care.

  • Education - OTs entering into practice don’t have much education in primary health care and related topics aren’t covered meaningfully in most school curriculums.


The Bottom Line
OT has a ton to offer in a primary health setting, and international models of care that use OT have demonstrated benefits.

For members of the OT community, a real opportunity exists to both advocate for services and to try out roles in the primary care setting; it’s the actions of many individual OTs who will ultimately shape the future of OT.

These efforts will also help OT as a profession avoid falling short of its potential to make a difference in a primary care setting, and will boost it’s credibility and job security in this rapidly growing sector of health.