Sherry Muir; Occupational Therapy in Primary Health Care: We Should Be There. Am J Occup Ther 2012;66(5):506-510. doi: 10.5014/ajot.2012.665001.
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© 2019 American Occupational Therapy Association
The first step to help a patient change a habit is to establish a meaningful, trusting, and supportive environment so that the patient feels comfortable enough to discuss and consider changing himself or herself. The patient must know that the clinician, without question, is a trusted source of help and is aligned with the patient’s best interests. People are more likely to change when they are given respect, understanding, and compassion. (p. 2)
High levels of fragmentation characterize health systems in the Americas. Fragmentation . . . can lead to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of resources, unnecessary increases in production costs, and low user satisfaction. . . . Fragmentation manifests itself as lack of coordination between the different levels and settings of care, duplication of services and infrastructure, unutilized productive capacity, and health care provided at the least appropriate location, especially hospitals. Furthermore, in fragmented systems, users experience lack of access to services, loss of continuity of care, and the failure of health services to meet their needs. (p. 5)
Assist the physician by means of early intervention to prevent disease or disability, reduce the impact of the disease process, and promote regimen compliance;
Provide services that extend the ability of physicians, nurse practitioners, and physician assistants to provide holistic care, focusing on identifying how symptoms are actually affecting function and participation;
Improve patient satisfaction by addressing a broader array of patient issues and thereby demonstrating a concern for more than symptom reduction;
Provide simple interventions that can be done at home or with intermittent supervision before referral for extended interventions, thereby decreasing health care expenditures;
Enable or improve participation in occupations through activity modification or adaptive equipment and techniques; and
Provide group education or intervention sessions to address prevalent issues among the population served.
Five percent of the population accounts for almost half (49%) of total health care expenses.
The 15 most expensive health conditions account for 44% of total health care expenses.
Patients with multiple chronic conditions cost up to 7 times as much as patients with only one chronic condition. (p. 1)
Instead of waiting for elderly patients to fall and sustain a hip fracture, occupational therapists could do a physical assessment in the primary care clinic and complete a safety assessment in the home. Therapists could then provide a home exercise program, suggest home modifications, and recommend and train in the use of adaptive equipment to prevent an injury from a fall—and the related costs. These interventions would also likely help spouses and families be safer as well because they would see the changes and incorporate some of them into their own lives.
While doing the initial assessment for a well 6-mo-old, a therapist notices some developmental delays in the child. The therapist could teach the parents focused intervention activities and ask them to return in a month for a follow-up. If appropriate progress has not been made, the therapist could go to the home or day care provider to provide additional education. With each interaction, the therapist is not only helping this child, his siblings, and his parents but is also reaching other children at the day care provider. The therapist would also provide a link to formal early intervention for those children who needed it.
Espouse an absolute belief that occupational therapy can benefit most every person and is able to address lifespan wellness and prevention, physical illness and injury, psychosocial issues, roles and responsibilities, and end-of-life preparation and concerns;
Be able to self-advocate, because he or she will be educating physicians and other health professionals, as well as administrators, on what he or she has to offer and must sometimes stand firm, insisting on treating patients while they are in the office and likely more receptive to change instead of asking them to return another day for an appointment with the occupational therapist;
Accept the ethical responsibility to carefully and honestly assess his or her own personal abilities and competencies, so that he or she knows who he or she is qualified to work with and which patients should be referred to another professional; and
Have a good understanding of professional boundaries: what is appropriate (but not necessarily traditional) for occupational therapy intervention and when it is appropriate to refer to another professional and to which one.
task-specific training in rehabilitation focuses on improvement of performance in functional tasks through goal-directed practice and repetition. The focus is on training of functional tasks rather than impairment, such as with muscle strengthening. . . . Neurophysiological evidence also supports the value of the object used or task undertaken in the organization of movement. . . . The evidence indicates that cortico-motor neuron pools are organized relative to specific tasks rather than specific muscles. Importantly, evidence suggests that motor skill learning capability may be retained in stroke survivors under similar conditions to healthy volunteers. (p. 176)
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