Occupational Therapy in Primary Care -- Barriers, Pivots, and Outcomes: A pilot study

Purpose: Habits, roles, and routines are important behaviors that affect lifestyle and can lead to the development of chronic disease such as diabetes mellitus. Primary care physicians (PCPs) have limited time, suggesting an interprofessional team approach would be beneficial in helping patients modify behaviors for the prevention and treatment of chronic disease. Occupational therapists (OTs) specialize in addressing health behaviors, and literature supports including OTs on the primary care team to improve the self-management techniques of patients with chronic disease. This study was guided by Lifestyle Redesign®, an evidence-based program that addresses the health behaviors of patients with diabetes in primary care. We aimed to improve health outcomes by combining an OT-led lifestyle modification program with patient-centered treatment recommendations from an external interprofessional team. We hypothesized that the health outcomes of patients with diabetes in primary care would improve after participating in an OT-led interprofessional lifestyle modification program, and that reimbursement for services would be obtainable. Method: Two PCPs in community practice initially agreed to involve an OT on their primary care team. Due to reimbursement concerns, the PCPs later preferred to refer patients to receive the OT-led intervention at an offsite clinic, rather than onsite at the primary care practice. Health outcomes were measured pre- and post-intervention using industry standard assessments and biometrics. Descriptive and non-parametric statistics were used to evaluate change. Results: Thirty-one patients with diabetes were referred, and three (9.7%) participated in the offsite lifestyle modification program. While statistical significance was not achieved (p≥0.10), trends toward individual improvement were noted for occupational performance and satisfaction and empowerment, and reimbursement was received from the third-party payers. Conclusions: Patient participation in this study was consistent with participation rates for offsite behavioral health referrals. An offsite OT-led interprofessional lifestyle modification program demonstrated potential for meaningful change and services were reimbursed. These findings support practice redesign efforts to include OTs as part of an integrated primary care model. Offering onsite services will increase patient accessibility to care and improve referral completion rates, thus providing OTs the opportunity to further demonstrate the efficacy of delivering chronic disease management in primary care.