Opportunities for Occupational Therapy on a Primary Care Team.

Abstract

Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting. To explore the need for and potential role of occupational therapy in a team-based primary care clinic. A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes. Outpatient complex care clinic of an urban academic medical center. The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving. The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.