Occupational Therapy Perspective on Integrated Care

Abstract

Introduction Background and problem statement: The current health system is medical and diagnosis based. Doctors ask “What is the matter” The Health system and the Social system are not compatible and often not complimentary, which makes integration of care complex. How occupational therapists can contribute towards a more integrated health service delivery is not always known.1 Description of policy context and objective: Health and Social systems have different concerns and structures. Health systems focus on acute care and medical treatment, whilst the social system is more focused on life-long support. Legislation and financing of both systems are different which makes it difficult for professionals to deliver integrated services.2 The objective is to understand the additional value of occupational therapists in Integrated Primary Care.1 Targeted population: The challenges facing healthcare services include ageing populations and increasing numbers of patients with long-term conditions and multi-morbidities. These populations will benefit for a paradigm-shift from problem-oriented to goal-oriented care.3,4 Highlights innovation, impact and outcomes: To realise patient centred and integrated care Occupational Therapists can offer their expert services along the following process: Focus on what the client wants using a client centred assessment tool5,6,7 Focus on activity and participation level of functioning8 Make a good analysis of the persons’ needs, wishes and the environment7 Involve family, carers and other stakeholders9 Share knowledge and skills between professionals and other persons2,5,6,10 Comments on transferability: This activity and participation perspective of functioning is reflected in the International Classification of Functioning, Disability and Health ICF-model of the World Health Organization WHO.11 When this ICF-model is used more strategically in daily practice of health care systems, it is hypothesized that it will help to better inform and organise integrated services based on what people find important. With concepts of activity and participation the area of social systems of health care delivery entered, which is occupational therapy's perspective and its actual and possible contribution towards integrated care.1,4,12 Conclusions comprising key findings, discussion and lessons learned: When you ask patients “What Matters to you? What would you like?”, they seldom answer: • I would like more medication or operation please, or • I would like to move my arm ten degrees higher please They answer with goals based on their desired functional status and social participation.1,2,13 Examples are: • Being able to get dressed • Visiting friends, go shopping • Being outside and gardening • Getting back to work Occupational therapists can contribute to more integrated services.14,15,16 “Occupational therapy is a profession concerned with improving well-being for persons of all ages through enabling occupations to promote health and participation in society. Occupational therapists do this by supporting persons’ engagement in occupations and activities that they want, need and choose to do in everyday life. Occupational therapists explore new ways of doing things by adapting activities and physical and social environments. Occupational therapists work in partnership with those involved in the persons’ life, i.e. family and carers, teachers and employers, to achieve persons’ and communities’ desired outcomes and promote an inclusive society.”17