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“I’d say [an occupational therapist is a] consultant … an expert of function, which is really important for older adults, to have [a] team member who really is an expert on function and activities of daily living.”
—Geriatric Service Provider
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
23-1. Articulate the differences between primary care and primary healthcare.
23-2. Discuss potential approaches and models to primary care access.
23-3. Explain the roles of occupational therapists and members of the interprofessional team working in a primary care setting.
23-4. Identify complications and concerns of patients in primary care.
23-5. Identify important areas for assessment and intervention, within primary care settings, for occupational therapists.
23-6. Discuss the importance of documentation for reimbursement.
23-7. Create a plan for advocacy for an occupational therapy practitioner in the primary care setting.
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Mini Case Study
Mrs. Dottie 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 a limited pension, which is her only source of income. She uses public transportation or walks to access services in the community. For health care, she goes to a primary care clinic. This clinic, with 15,000 patients, employs one full-time equivalent occupational therapist where a referral is required from the provider to perform an evaluation. The role of the occupational therapist typically includes being a generalist, focusing on function, leading self-management classes, consulting with the other health care providers, and using direct practice and consultation models of care. Today the occupational therapist will be seeing Mrs. Brown for an initial assessment as part of their direct service time. According to the physician’s note in the electronic medical record (EMR), Mrs. Brown has type 2 diabetes and chronic bilateral leg pain. The pain limits her mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs), and it is preventing her from leaving her apartment. Numbness in her extremities makes fine motor tasks difficult and creates a fear of falling. Mrs. Brown reported a decreased appetite and weight loss at her last appointment.
Provocative Questions
How will the occupational therapist collaborate with Mrs. Brown to develop goals and a treatment plan?
What intervention approaches might the occupational therapist use with Mrs. Brown?
What health care professionals may be effective team members as part of an interprofessional approach to improve Mrs. Brown’s function?
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Occupational therapists working in the primary care setting are considered to be practicing in an innovative setting. New research emerges every year about occupational therapy services in the primary care setting, which helps further inform practice and program implementation. This chapter discusses primary care and primary health care from a broad perspective, including different models of care and conceptual health care models. The chapter explores the multiple roles occupational therapists can have when working ...