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"Primary health care starts with people. Our common humanity compels us to respect people's universal aspiration for a better life. It compels us to respect the resilience and ingenuity of the human spirit, and the great capacity of individuals and communities to solve their own problems."
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—Dr. Margaret Chan, Director-General of the World Health Organization, International Federation of Red Cross and Red Crescent Societies, May 14, 2008
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
Define primary care and primary health care.
Articulate the differences between primary care and primary health care.
Discuss potential models that could be used as a foundation on which to construct and deliver primary care services for older adults.
Describe how the Expanded Chronic Care Model (ECCM) can be applied to rehabilitation in a specific primary care setting in order to engage the health-care team and older adult clients as partners in the delivery of care.
Discuss specific roles related to the functional assessment of older adults for occupational therapists and physical therapists working in a primary care setting.
Identify important areas for assessment, within primary care settings, for occupational therapists and physical therapists.
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Clinical Vignette
A primary care clinic with 15,000 patients employs one full-time equivalent (FTE) occupational therapist (OT) and one FTE physical therapist (PT), where clients do not require a physician's referral to book an appointment. The role of the occupational therapist typically includes leading self-management classes, consulting with the other health-care providers, and using direct practice and consultation models of care.
Today, you, the physical therapist will be seeing Mrs. Dottie Brown for an initial assessment as part of your direct service time. The electronic medical record (EMR) shows that Mrs. Brown is a 75-year-old woman who lives alone in community-funded housing. Mrs. Brown's partner passed away more than a year ago. She has few social supports and has a limited pension, her only source of income. She uses public transportation or walks to access services in the community.
According to the physician's note in the EMR, Mrs. Brown has chronic bilateral leg pain, which is limiting her mobility and preventing her from leaving her apartment. She also has type 2 diabetes, with early sensation changes in her feet. Mrs. Brown reported a decreased appetite, weight loss, and an increased fear of falling at her last appointment, and her physician suggested she start using a walker and to see you, the therapist. According to the EMR note, Mrs. Brown refused to try the gait aid. She did, however, follow through on booking an appointment for rehabilitation services.
Why might you be seeing Mrs. Brown in a primary care setting rather than a rehabilitation setting?
How you will collaborate with Mrs. Brown to develop goals and a treatment plan?
What might be an effective team to work with Mrs. Brown to improve her function?