Katie Jordan OTD, OTR/L, FAOTA

To successfully integrate occupational therapy services in a primary care setting, it is essential to consider the administrative needs of the organization. This chapter addresses creating a strategic plan, considerations for the primary care environment, reimbursement, populations served, regulatory bodies, and service delivery models of primary care occupational therapy.

Occupational therapy is the only hospital cost category in which increased spending is statistically significantly associated with reduced readmission rates for conditions covered in the Centers for Medicare and Medicaid Services’ Hospital Readmission Reduction Program. These conditions are heart failure, acute myocardial infarction, and pneumonia. With approximately 75% of patients with heart failure, acute myocardial infarction, or pneumonia who are admitted not typically receiving occupational therapy services, the findings of this study suggest a low-cost and high-yield way for hospitals to improve the quality of care and reduce the number of readmissions by investing in occupational therapy services for more patients.

Keywords. hospital, readmission, quality, cardiovascular, pulmonary, rehabilitation

With therapy minutes generally closely aligned with regulatory and reimbursement requirements, there is little room to consider patient characteristics, time (length of stay [LOS]), and clinical judgment in determining the most cost-effective and clinically optimal plan of care. This study provides valuable insight into client-centered variables (comorbidities, functional outcomes, burden of care) that bring meaning and perspective into determining a value-based rehabilitation plan rather than one based on arbitrary required and assigned minutes. In this study, patients are assigned to one of nine recovery groups following hip fracture surgery. Recovery groups are based on therapy minutes per LOS as low, medium, or high and functional gains in self-care and mobility as measured by the Functional Independence Measure as low, medium, or high. All groups are compared on LOS, providing insight into the role of clinical decision-making and consideration of patient characteristics in determining the dose and intensity of therapy services.

Keywords. post-acute, skilled nursing facility, inpatient rehabilitation facility, acute rehabilitation unit, hip fracture, length of stay, fee-for-service, burden of care, value-based, occupational therapy

Importance. Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy’s feasibility and efficacy in primary care settings.

Objective. To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)–occupational therapy (LR–OT) diabetes management intervention in a primary care clinic.

Design. Patients were randomized to be offered LR–OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods.

Setting. Safety-net primary care clinic.

Participants. Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18–75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%.

Intervention. Eight 1-hr individual sessions of LR–OT focused on diabetes management.

Outcomes and Measures. Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR–OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations.

Results. Seventy-three patients were offered LR–OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation.

Conclusions and Relevance. LR–OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care.

What This Article Adds. This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy’s effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.

Reilly’s (1962) now deeply cherished statement that “man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health” (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly’s, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy’s role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.

Objective. Attrition is a common problem in weight management. Understanding the risk factors for attrition should enhance professionals' ability to increase completion rates and improve health outcomes for more individuals. A model that draws upon neuropsychological knowledge on reward-sensitivity in obesity and overeating to predict attrition is proposed.

Methods. A total of 52 participants in a weight-management program completed a complex decision-making task. Decision-making characteristics-including sensitivity to reward-were further estimated using a quantitative model. Impulsivity and risk-taking measures were also administered.

Results. Consistent with the hypothesis that sensitivity to reward predicted attrition, program dropouts had higher sensitivity to reward than completers (P < 0.03). No differences were observed between completers and dropouts in initial BMI, age, employment status, or the number of prior weight-loss attempts (P ≥ 0.07). Completers had a slightly higher education level than dropouts, but its inclusion in the model did not increase predictive power. Impulsivity, delay of gratification, and risk taking did not predict attrition, either.

Conclusions. Findings link attrition in weight management to the neural mechanisms associated with reward-seeking and related influences on decision-making. Individual differences in the magnitude of response elicited by rewards may account for the relative difficulty experienced by dieters in adhering to treatment.

Our study assesses changes in students' knowledge and attitudes after participation in an interprofessional, team-based, geriatric home training program. Second-year medical, physician assistant, occupational therapy, social work, and physical therapy students; third-year pharmacy students; and fourth-year dental students were led by interprofessional faculty teams. Student participants were assessed before and after the curriculum using an interprofessional attitudes learning scale. Significant differences and positive data trends were noted at year-end. Our study suggests that early implementation, assessment, and standardization of years of student training is needed for optimal interprofessional geriatric learning. Additionally, alternative student assessment tools should be considered for future studies.

Obesity is a significant and wide-ranging health and social problem in the United States. Occupational therapy is a health care profession that is qualified to provide interventions with individuals, groups, and society to effect change to promote optimum health. Occupational therapy services often are used directly and indirectly to influence weight management and related health concerns through attention to healthy lifestyle choices and engagement in fulfilling occupations. The purpose of this paper is to explain the position of the American Occupational Therapy Association (AOTA) to persons within and outside the profession on the role of occupational therapists and occupational therapy assistants in addressing the impact of obesity on people's ability to engage in daily activities.

Obesity is a significant and wide-ranging health and social problem in the United States. Occupational therapy is a health care profession that is qualified to provide interventions with individuals, groups, and society to effect change to promote optimum health. Occupational therapy services are often used directly and indirectly to influence weight management and related health concerns through attention to lifestyle and engagement in fulfilling activities. The purpose of this paper is to explain to persons within and outside of the profession the role of occupational therapists and occupational therapy assistants in addressing the impact of obesity on people's ability to engage in daily activities.