Occupational Therapy and Primary Care
Primary health care refers to an approach to health and a spectrum of services that includes all public-facing health services used by the population to address its health concerns.
The World Health Organization defines primary care as care that exhibits features of person-centeredness, comprehensiveness, integration, continuity of care, participation of patients, families and communities. This requires health services that are organized with close-to-client multidisciplinary teams responsible for a defined population.
It is a model of care that is comprehensive, team- based, and focused on a continuum of care that includes health promotion, prevention, and treatment. Primary care delivered by inter-professional teams provides continuity of service that is patient and family – centred and results in better patient outcomes and satisfaction. Gatchet et all identified that individuals treated by a multidisciplinary team were for times less likely to require medical treatments at follow-up appointments.
Occupational therapists (OTs), are integral to primary care teams, and use their expertise and full scope of practice to improve client health and participation in daily activities. OTs act as primary care practitioners or health promotion experts, and help address and relieve multiple stressors on Canada’s health system, including:
Chronic disease management
The prevalence of chronic diseases in Canada is on the rise. For example, more than half a million Canadians are living with dementia, with 25,000 new cases diagnosed every year. With an estimated cost of $10.4B per year, and 56,000 Canadians with dementia being cared for in hospitals, the need for occupational therapy interventions is acute, to both manage hospital flow, and to prevent hospital admission and readmission
Occupational therapists help with assessments, chronic disease management, health promotion, self-management, falls prevention and supporting and educating families and caregivers, as well as palliative and end-of-life care, driving and community mobility, and redesign of physical environments.
The Canadian Association of Occupational Therapists (CAOT) believes that occupational therapy services should be available and accessible to all Canadians, especially for people with multiple chronic conditions, mental illnesses and disabilities, and in end-of-life care, regardless of age or where they live in Canada.
By looking at the whole picture – a person’s psychological, physical, emotional, cognitive and social functions, as well as the impacts of the environment and social context in which they need to function, OTs assist individuals to achieve their goals and maintain or rebuild their independence, to participate in everyday life.
- As part of a new series of practice resources for CAOT members, CAOT is developing a role paper on primary care designed to describe the unique roles and areas of competency that occupational therapists occupy within the Canadian health care system.
- To extend the impact of our advocacy, CAOT continues to work with Canada’s family physicians to encourage them to “Put an OT on your team!”. For a second year, CAOT hosted a booth and delivered a presentation at the Family Medicine Forum, Canada’s largest and most comprehensive annual conference for family physicians hosted by the College of Family Physicians of Canada (CFPC). Former CAOT President Nicola MacNaughton presented on ‘The value proposition of having an occupational therapist on your team’ within the context of an aging demographic and the prevalence of chronic conditions, mental health issues and the opioid crisis.
- CAOT presented driving retirement sessions to help physicians identify when to refer their senior patients to an occupational therapist regarding driving assessments.
- CAOT appeared before the Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities (HUMA) to provide input on its ‘aging in place’ initiative titled “Advancing Inclusion and Quality of Life for Canadian Seniors.” CAOT delivered a briefing document and fact sheet with the recommendation that “as part of the $5B in Federal transfers to provinces for home care, provinces be mandated to ensure that occupational therapists are an integral part of all primary care teams and home and community care service teams that provide services to seniors.”
- To advocate for all Canadians to have access to primary care OTs.
- CAOT is committed to increasing the cohort of occupational therapists on all primary care teams, with a particular emphasis on Indigenous communities, Canadian Armed Forces members and veterans, where OTs may be called upon to perform a variety of services.
- To advocate for the inclusion of OTs on all primary health teams and to make this a condition of federal health transfers to provinces.
- To further promote the understanding of occupational therapy among primary care physicians and interdisciplinary teams, many who do not have a clear understanding of the role or breadth of occupational therapy (Donnelly, Leclair, et al., 2013).
- To work within and advocate for interdisciplinary primary care teams to meet the needs of clients.
- Continuing professional development opportunities specific to occupational therapy in primary care will support occupational therapists’ role in this setting. For example, in Ontario occupational therapists have become members of memory clinic within Family Health Teams.
Occupational Therapy Value Proposition
- OTs assist people in living life to the fullest. They prevent and solve problems that interfere with a person’s ability to do everyday things such as taking care of themselves, engaging in leisure activities, going to work, running errands and participating in the community.
- OTs deliver evidence-based solutions that are both clinically and cost-effective, improving health and wellness outcomes, by applying a unique mix of skills that address:
- the whole person – their physical, emotional, spiritual, cognitive abilities and their environment,
- all age groups,
- both prevention and treatment,
- care in numerous settings – home, community, institutions, schools, industry, business and government.
- Occupational therapists are an integral part of the chronic disease management team, including in primary care due to the profession’s specialized education in mental and physical health, management and advocacy and skills in functional assessments, activity analysis, skill development, problem solving barriers, environmental assessments, adaptation, compensation, and remediation, occupational therapists are well equipped to support clients in managing their multiple chronic conditions (Robinson, Fisher, & Broussard, 2016).
- As members of the care team, occupational therapy practitioners can approach the client’s functional and medical needs and enhance outcomes from an occupational performance perspective instead of a disease-specific approach. For example, complying with and managing medications associated with multiple chronic conditions (Malet-Larrea et al., 2016).
- Seeing OTs in primary care could prevent hospitalizations and decrease the risk of institutionalization, (Bierlein et al, 2015)
- Preventing the need for acute care in hospital helps decrease hospital costs. A study by the Royal College of Occupational Therapists (2016) identified that occupational therapists’ services resulted in avoidance of unnecessary hospital admission and/or reduced hospital stays, saving an average of $15M annually.
- A recent study by John Hopkins University identified that occupational therapy was the only category of health spending within hospitals where increased spending resulted in reduced readmission rates (Rogers, Bai, Lavin & Anderson, 2016). Study results link these lower readmission rates to OTs’ unique skillset, assessing whether a client can be discharged safely into home and community by addressing potential barriers outside of the hospital, including living situation, and social supports Increased physical activity in community dwelling older adults (Arbesman & Lieberman, 2012)
- OTs working as interdisciplinary team members in primary care help address a wide range of functional issues, including pain management. Gatchel et al. (2007) identified that individuals treated by a multidisciplinary team were four times less likely to require medical treatments at follow-up appointments.
- Increasing the inclusion of occupational therapy services helps to facilitate the pressing need to help seniors age in place. A May 2017 report entitled “Re-Shaping the Housing Market for Aging in Place” by the Canadian Home Builders Association cites the value proposition of OTs in home modifications that facilitate aging in place compared to the high cost of residential or hospital care. According to Home Modification Canada, the cost of including 75% of the required accessibility features in new homes costs less than $500 per home.
- OTs help to reduce the cost of fall-related injuries (Lampiasi & Jacobs, 2010) and help prevent falls at home through structural supports at home that include home modifications and assistive devices.
- Occupational therapy helps to improve outcomes in those with chronic diseases (Hand, Law & McColl, 2011) and leads to a deceased rate of functional decline (Chase, Mann, Wasek & Arbesman, 2012)