Occupational Therapists
Working in Primary Care: An
International Survey
Catherine Donnelly, Leanne LeClair, Pamela
Wener, Carri Hand, Lori Letts, Samantha
Hart, Alexia Pasquin & Madison Reid
What is primary care?
What is primary health care?
Primary health care – primary care
• Primary health care refers to an approach to health and a spectrum
of services beyond traditional health care system. It includes all
services that play a part in health, such as income, housing,
education and environment
(Health Canada, 2015)
• Primary care is the element within primary health care that focuses
on health care services, including health promotion, illness and
injury prevention, and the diagnosis and treatment of illness and
injury
(Health Canada, 2015)
Key features
First contact
Longitudinal
Comprehensive
Coordinated
(Starfield et al., 1998)
“Anchor of the health care system”
Ontario, 2013; ICES, 2015
“Anchor of the health care system”
Ontario, 2013; ICES, 2015
Background
• Interprofessional primary care has been part of health
reforms across the globe (Health Canada, 2012)
• The role and evidence for occupational therapy in primary
care is emerging (Cook & Howe, 2003; Donnelly, Brenchley, Crawford, Letts, 2013;
Richardson et al.,2012 & 2013;Tracy, Bell, Nickell, Charles, & Upshur, 2013)
• Occupational therapy professional associations in many
countries have advocated for a role in primary care (COT, 2016
Klaiman,2050; Letts, 2011; McColl et al., 2009)
• No published international data providing information on
the nature of the occupational role in primary care
What is the role of OT in primary
care across five countries?
Can we start to build a community
of primary care OT’s?
Study Objectives
1. To identify occupational therapists working in primary
care in Ireland, UK, New Zealand, Canada, Australia
2. To describe the nature of occupational therapy practice
• Roles
• Model of service delivery
• Activities and area of practice
• Understand how occupational therapists were being integrated into primary care
• Support and challenges
3. Lay the foundation for the development of a global
primary care community of practice.
Methods
Fluid Survey: an online survey tool
Open and close ended survey items
Sampling
1.
Contacted associations at each country
Association recruitment
2.
3.
UK
COT – OTNews, Twitter
Ireland
National Association - Primary Care Group
New Zealand
National Association - Email to all members
Canada
National and Provincial Associations - Email to
members, posting on website
Australia
National Association - Primary Care Interest Group
Snowball sampling
Identification of occupational therapists working in primary care by researchers – distributed
to their networks
Analysis
Descriptive statistics
Ethics was received from Queen’s Health Sciences and Affiliated Hospitals Research Ethics Board
Inclusion/Exclusion
Inclusion
1) stated their position was aligned with the description of a primary
care setting, and
2) included some element of direct service provision.
Exclusion
1) if greater than 20% of responses were missing, or
2) a setting other than primary care was stated as the location of
employment, including; acute care hospitals, rehabilitation centres,
schools, day rehabilitation programs, and outpatient clinics.
Results
312 (-15 PHC definition)*
297 (-19 non-direct role)
278 (-63 non PC setting)
215 (-33 incomplete)
182 FINAL sample
Participation by Country (n=182)
70
60
58
52
50
40
35
30
24
20
8
10
4
0
Quebec
Canada
Ireland
New Zealand Australia
UK
Demographics
Number
Payment Method
Permanent Salaried
Fee-for-service
Contract
Research Demo project
131
19
17
2
Entry to Practice Degree
Bachelor
Masters
Other (Diploma)
127
36
17
Gender
Female
Male
172
10
Number
Full Time Equivalent
Full-time
Part-time
Half-time
110
49
15
Geographical Location (n=175)
Rural Setting
Very large urban
setting (150,000+)
N=26
N=52
Town/village (500030 000)
N=31
Large urban
location (80 000-150
000)
Small urban
location (30 000-80
000)
N= 34
N=32
Work Settings
(n=222)
53
Community Agency
48
Primary Care Team
35
Community Health Centre
24
Private Practice
21
Other
18
Community Agency
10
Community Center
6
Public Health
4
Senior Center
3
Physician’s office
0
10
20
30
40
50
60
Focus of OT Intervention - % of time (n=182)
70
64%
60
50
40
30
18%
20
16%
10%
10
3%
0
Individuals
Family/Caregiver
Community
Groups
Other
Location of Service Delivery - % of time
(n=182)
50
45%
45
40
38%
35
30
25
20
15
12%
10
2%
5
0
The clinic
The client’s home
The community
As outreach to
surrounding rural or
remote communities
Age ranges - % of clients (n=124 missing QU CAN)
60
51%
50
40
30
26%
20
16%
11%
10
0
Older adults
adults
children ages children ages
0-12
12-18
Top 10 Areas of Clinical Focus (n=124 – missing QU, CAN)
Support/education to caregivers
88
Equipment prescription
87
Home safety assessment
80
Health promotion/prevention
77
Cognitive perceptual screening
77
Falls prevention
75
Wheelchair/mobility
72
Education/Consultation with the Team
70
Counselling - ADL's
67
Assistive device consultation
55
0
20
40
60
80
1
Top 10 Areas of Clinical Focus by Country
(n=124 – missing QU, CAN)
Support/education to caregivers
Equipment prescription
Home safety assessment
Canada
Ireland
New Zealand
Australia
UK
Health promotion and prevention
Cognitive/perceptual screening
Falls prevention
Wheelchair/mobility
Education/Consultation with the Team
Counselling - ADL's
Assistive Device Consultation
0%
20%
40%
60%
80%
100%
Top 3 Clinical Areas by Country
Canada (53)
Ireland (35)
New Zealand
(24)
Australia (8)
UK (4)
Equipment
Prescription
(n=39)
Support and
Education for
Caregivers
(n=30)
Equipment
Prescription
(n=16)
Support and
Education for
Caregiver (n=5)
-Falls Prevention
-Health Promo &
Prevention
(n=37)
Equipment
Prescription
(n=26)
Support and
Education for
Caregivers
(n=15)
Health Promotion
and Prevention
(n=4)
-Home Safety
-Support and
Education for
Caregiver
- Wheelchair &
mobility (n=36)
Home Safety
(n=25)
-Cog/Percept
Screening
-Education &
Consultation to
team
-SelfManagement
(n=14)
-Equipment
-Home Safety
-Case
Management
-Education
&Consultation to
team (n=3)
-Health Promo
-Equipment
-Home Safety Ax
-Cog Screening
-Splinting
-Falls prevention
-Link to
community
resource
-Wheelchair &
mobility
-Assessment for
personal care
(n=3)
Areas of Potential Clinical Focus
(n=124 – missing QU, CAN)
Functional assessment for return to work
21
Driver screening
21
Community integration facilitation
20
Screening for learning disabilities
20
Accomodation assessment
19
Ergonomic assessment
17
Educational assessment referrals
15
Consultation on childhood disorders
14
School health liason
9
Guardenship assessment
4
0
5
10
15
20
Areas of Potential Clinical Focus by Country
Functional assessment for return to work
Driver Screening
Community integration facilitation
Screening of children with learning problems
Canada
Ireland
New Zealand
Australia
UK
Accomodation assessment
Ergonomic assessment
Educational assessment
Consultation for childhood disorder
School health liason
Guardianship assessment
0%
20%
40%
60%
80%
100%
Interprofessional Teamwork
• 88% of respondents work on an interprofessional team
• 7.5/10 - Extent to which OT collaborated with team members
• 6.3/10 – Extent to which there were common team goals
• Most common team members
• Social workers, physiotherapist, dieticians, nurses, physicians
Interprofessional Collaboration in Primary Care
Facilitators of IP Collaboration
Working in close proximity
Meetings, case conferences
Electronic medical record
Frequency
N=94
N=59
N=42
Barriers to IP Collaboration
Time/workload
Communication challenges
Differing values
Frequency
N=69
N=43
N=39
Key Findings – Practice Implications
The “generalist” as “specialist” (settings, ages,
service delivery)
Importance of developing relationships with team
members
Settings and policy influence practice
Opportunities for working with children and
supporting mental health
UK – “Occupational therapists offer expert knowledge of the
significant impact that occupations and routines have on
peoples’ health and wellbeing” (COT, 2015).
US - “the professions scope of practice goes beyond
treating illness and can be incorporated into promotion of
health living and preventing disease and disability” (Metzler, et
al., 2012).
AUS – “seize the day” .. re: fall prevention in primary care
(McKenzie, Clemson, Roberts, 2013).
Thank you …. Questions?
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
The study was supported by the Primary Health Care Seed
Fund and Queen’s University start up funds
https://tinyurl.com/otipc
References
Bumphrey, E. E. (1989). Occupational therapy within the primary health care team. British Journal of
Occupational Therapy, 52, 251-255.
Cook, S., & Howe, A., (2003). Engaging people with enduring psychotic conditions in primary
mental heath care and occupational therapy. British Journal of Occupational Therapy,
66(6), 236-246.
Devereaux, E. B., & Walker, R. B. (1995). The role of occupational therapy in primary health care.
American Journal of Occupational Therapy, 49, 391-396.
McColl, M. A., Shortt, S., Godwin, M., Smith, K., Rowe, K., O’Brien, P., & Donnelly, C. (2009).
Models for integrating rehabilitation and primary care: A scoping study. Archives of
Physical Medicine and Rehabilitation, 90, 523-531.
Mackenzie, L., Clemson, L., & Roberts, C. (2013) Occupational therapists partnering with general
practitioners to prevent falls: Seizing opportunities in primary health care. Australian
Journal of Occupational Therapy, 60, 66-70
Metzler, C.A., Hartmann, K.D., Lowenthal, L.A. (2012). Defining primary care:Envisioning the roles
of occupational therapy. The American Journal of Occupational Therapy, 66(3), 266- 269
Muir, S. (2012). Occupational therapy in primary health care: We should be there.
American Journal of Occupational Therapy, 66, 506-510. doi: 10.5014/ajot.2012.665001
Richardson, J., Letts, L., Chan, D., Officer, A., Wojkowski, S., Oliver, D., et al. (2012). Monitoring
physical functioning as the sixth vital sign: Evaluating patient and practice engagement in
chronic
illness care in a primary care setting—a quasi- experimental design. BMC Family Practice,
13(29).
References cont
Richardson, J., Letts, L., Chan, D., Stratford, P., Hand, C., Price, D., et al. (2010).
Rehabilitation in a primary care setting for persons with chronic illness: A
randomized controlled trial.Primary Health Care Research and Development, 11, 382-395.
Tracy, C.A., Bell, S., H., Nickell, L.A, Charles, J., & Upshur, R. (2013) The IMPACT model of
interprofessional primary care for elderly patients with complex health care needs.
Canadian Family Physician. , 59,e-148-e155.
http://www.cfp.ca/content/59/3/e148.full.pdf+html
Tse, S., Penman, M., & Simms, F. (2003). Literature review: Occupational therapy and
primary health care. New Zealand Journal of Occupational Therapy, 50(20), 1723.
WHO – Alma Alta Declaration. Retrieved from http://www.euro.who.int/en/who-we-are/policydocuments/declaration-of-alma-ata,-1978