Primary Care Occupational Therapists Research Articles

Value-based outcome evaluation methods used by occupational therapists in primary care: a scoping review.

This scoping review aimed to map how occupational therapists evaluate the outcomes of services they provide within primary care. This evidence was considered in relation to how identified outcome evaluation methods align to principles of value-based health care. Primary care services are experiencing unprecedented demands. Occupational therapy is an allied health profession that supports health and care provision in primary care, using a timely and proactive approach. There has been a notable increase in occupational therapy roles across primary care services in the past decade; however, the mechanisms for evaluating outcomes and the wider impact of these services remain under-researched. The aim of value-based health care, a global transformative approach, is to establish better health outcomes for individuals and communities through addressing value in system-wide care. However, it is not yet clear how evaluation methods used within occupational therapy align to the principles of a value-based agenda. Peer-reviewed journal articles and gray literature written in English were included to identify outcome evaluation methods used by occupational therapists to evaluate the effectiveness and impact of occupational therapy services provided in a primary care setting. Outcome evaluation methods used exclusively for the purpose of conducting research and not for capturing data within an occupational therapy primary care setting as part of routine clinical practice were excluded. This review followed JBI methodology for scoping reviews. The literature search was undertaken during June and July 2022. The following databases were searched from their earliest dates of availability: Cochrane Library, MEDLINE via Ovid, Embase via Ovid, CINAHL via EBSCOhost, Scopus, AMED, and Web of Science. Two reviewers extracted data, supported by use of an extraction form developed by the reviewers. Findings were mapped using a framework developed based on key principles of value-based health care. From 2394 articles, 16 eligible studies were included in the review. Of these, 9 were quantitative and 7 were of mixed methods design. Studies were from the UK, USA, Sweden, Spain, and Canada. The occupational therapy services represented were mainly heterogeneous. Four services were part of multidisciplinary programs of care and 12 services were specific to occupational therapy. Identified outcome evaluation methods broadly aligned to principles of value-based health care, with most alignment noted for measures demonstrating the aim of establishing better health. A wide range of evaluation methods were described to address both individual-level and service-level outcomes, with the use of patient-reported outcome measures identified in 13 studies. To capture patient experience, most studies reported a variety of methods. The aim of reducing the per capita cost of health care was least represented in the literature. This scoping review highlights a multifaceted but inconsistent approach to measuring the outcomes of occupational therapy provided in primary care. This has implications for establishing effectiveness and capturing data at scale to assist with wider planning of care and to enable the profession to demonstrate its contribution to value-based health care. Open Science Framework https://osf.io/hnaq4/.

Direct costs of rheumatoid arthritis multidisciplinary care in Ireland

Abstract Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining a chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary and secondary care within the Health Service Executive in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member of the primary (N = 21) and secondary care (N = 13) RA pathway. Overall cost of each patient type was calculated using time-driven activity-based costing along with medication and clinic running costs. Treating newly diagnosed RA patients costs second highest in primary (€337.39/year) and highest in secondary care (€922.32/year). While patients with advanced RA were most expensive to treat in primary (€469.18/year) and least costly in secondary care (€615.70/year). In primary care occupational therapists were the most expensive allied health care professionals (HCPs) at €1.19/min, followed by physiotherapists at €1.17/min. GP secretaries were the least costly at €0.30/min. In secondary care, consultant rheumatologists and phlebotomists were most and least costly respectively at €3.10 and €0.60/min/patient. Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more (€8718.98/year) than Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) (€120.87/year). In terms of personnel cost newly diagnosed patients and patients with advanced RA are expensive to treat as these require more time with the HCPs. Being referred to departments outside of rheumatology such as orthopaedics, advanced RA patients cost less in secondary care. The difference between whether a patient was on a csDMARD or bDMARD had the biggest influence on total, overall costs amongst the RA patient. Key messages • The study provides a breakdown of costs of RA multidisciplinary care in Ireland, facilitating understanding cost drivers and potential areas for cost-savings. • The study advances the understanding of RA management in HSE Ireland.

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

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. To explore facilitators of, barriers to, and recommendations for integrating occupational therapy into primary care. 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. Primary care. A purposive sample of licensed occupational therapists with at least 6 mo primary care experience in the United States. 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.

Primary Care: A Service-Learning Environment for Occupational Therapy Students

This research provides evidence on occupational therapy (OT) students in primary care (PC). OT demonstrates the skills and knowledge to address chronic medical conditions in PC with entry-level education. Limited evidence of occupational therapists in PC demonstrates a need to examine OT services in this setting. In this emerging area of practice and ever-changing reimbursement models, additional evidence is needed to define the value and continuation of OT services in PC. A mixed-methods study aimed to answer the primary research question: How are OT students used in the PC setting in fieldwork or capstone experiences? A two-phase process was involved. A survey and interview enabled an in-depth exploration of how OT students are used in PC during fieldwork, experiential, and capstone experiences. The benefits identified were: providing holistic care because occupational therapists address social detriments and improvement of patient satisfaction with simple interventions. The top barriers were: limited number of occupational therapists and reimbursement for services. Common methods of student use in PC include: provide interventions, evaluate and screen for OT services, and report patient and provider satisfaction outcomes. Identification of these benefits, barriers, and methods of OT and OTA student use in PC can further advocate for the need of OT in PC while meeting ACOTE standards in education.

Enhancing Client Outcomes in Health Reform: The Role of Occupational Therapists in Primary Care

Abstract Date Presented 4/16/2015 Perceptions of occupational therapists (OTs) working in primary care settings are presented. Unique services provided, role negotiation, strategies for educating team members on the scope of occupational therapy services, and methods for advocating for OTs’ role in primary care are explored to promote effective client outcomes.

Occupational Therapists in Primary Care: Perceptions of Incorporating New Interventions Into Practice

Abstract Date Presented 4/16/2015 A focus group was conducted with experienced occupational therapists to investigate perceptions of the opportunities, obstacles, and supports needed to assume a role in primary care. Findings inform professional association and individual therapist efforts toward role emergence in primary care.

SP0040 Collaboration across health service levels - examples of norwegian projects involving primary and specialist health care

In Norway, as in many other countries, there is a need to develop integrated care and smooth collaboration between health care levels. A new health sector reform is recently initiated...

Are primary health-care occupational therapists specialists or generalists?

The role of primary care occupational therapy needs to be clearly defined and distinguished from other community positions. Primary care occupational therapists can be described as generalists because of their varied caseload but the role does require a high level of expertise. There is potential for growth of occupational therapy in primary care that could lead to the development of referral pathways between specialists and generalists.