Date of Award

Summer 8-24-2019

Document Type

Capstone

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

First Advisor

Susan MacDermott, OTD, OTR/L

Second Advisor

Erin Schweir, OTD, OTR/L

Third Advisor

Becki Cohill, OTD, OTR/L

Medical Subject Headings

Occupational Therapy, Primary Health Care, Physicians, Primary Health Care, Community Health Services, Consultants

Abstract

Background: With an increase in adult chronic conditions (Holstein, 2018), as well as a growing number of older adults aging in place (Dickson & Toto, 2018), primary care will continue to see the greatest number of patients as it is the first point of contact for a person to enter the health-care system. Most primary care clinics are reimbursed based on quality outcome measures, which means insurance payers are looking at the value of care instead of the quantity of services (Halle et al., 2018). There is value in as well as an absence of assessment of occupational participation in primary health care. This absence can lead to an increase in hospital admissions, increased health care costs, and a continued decline in the health of adults who suffer from acute or chronic conditions. OT’s can “recognize deficits in self-care and function that might lead to a readmission, such as problems related to meal preparation, access to medications, bathroom access, toileting, and the need for nursing aides or family education” (Rogers et al., 2016). According to a study that measured the amount of time primary care providers (PCPs) spend on preventative services with patients, it was concluded that PCPs did not have enough time to properly assess a patient’s safety and quality of life at home or in the community (Yarnall et al., 2003). Occupational therapists, being professionals in such a wide scope including prevention of health decline, rehabilitation, and physical and mental health, carry a holistic lens that can compliment primary care services.

Purpose: This capstone project aims to explore the role of occupational therapy (OT) for adults within a primary care setting by completing functional assessment interviews with patients, reviewing patient charts, and surveying providers and other healthcare staff. This project intends to educate medical staff about the distinct knowledge and skills held by occupational therapy in hopes of offering a greater understanding of the scope of practice and benefit of the addition of occupational therapy to the primary health care team.

Methods: The Occupational Participation Assessment for Primary Care (OPAPC) is a questionnaire developed specifically for this capstone and was used as a tool for interviewing adult patients at Borrego Health clinic. Once the goal of 150 participants were interviewed (50 young adults 18-44 years; 50 middle-aged 45-64 years; older adults 65+ years) data analysis was completed and results were presented to healthcare staff. Healthcare staff then completed a survey which measured their understanding and receptiveness to having an OT work on their interdisciplinary care teams. Current assessment protocol and referral process were also observed.

Results & Conclusion: The results from the patient interviews demonstrate a need for OT in the adult primary care population. ADL/IADL dependence, balance and fall concerns, DME necessities, pain, poor sleep quality, and mental health are only a few common themes found in patient interviews that can be addressed by an OT. There was a significantly significant number of healthcare staff who would agree that OT would benefit the primary care practice. A person’s overall health includes their ability to complete their valued activities therefore occupational participation and function are areas that need to be addressed in the primary care setting.

Comments

Capstone project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy.

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