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Occupational therapy and primary care*

Authors:
  • Bolt ergotherapie
  • Council of Occupational therapists for the European countries

Abstract and Figures

This article is the first in a series of two articles about Occupational Therapy and Primary Care. This first article describes the health policy context in which primary health care should be strengthened. A definition of occupational therapy is given and the scope of the profession is explained. Based on a survey amongst the (experts of) member associations of COTEC, an overview is given of the main target groups and how occupational therapy is embedded and organized in different countries. In a position statement it is argued why occupational therapy can and should contribute to a comprehensive integrated primary care and challenges to strengthen the position of the profession are described.
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Occupational therapy and primary care*
Marije Bolt
1
, Tiska Ikking
2
, Rosa Baaijen
3
and Stephanie Saenger
4
1
Occupational Therapist, Cordaan Primary Care Team, Amsterdam, The Netherlands,
2
Occupational
Therapist, Evean - Primary Care Team, Wormerveer, The Netherlands,
3
Occupational Therapist,
Vermoeidheid&PijnCentrum - Lelystad, The Netherlands and
4
Occupational Therapist, Rolmaat - Abcoude, The
Netherlands and COTEC presidentlll
Abstract
This article is the first in a series of two articles about Occupational Therapy and Primary
Care. This first article describes the health policy context in which primary health care should
be strengthened. A definition of occupational therapy is given and the scope of the profession
is explained. Based on a survey amongst the (experts of) member associations of COTEC, an
overview is given of the main target groups and how occupational therapy is embedded and
organized in different countries. In a position statement it is argued why occupational therapy
can and should contribute to a comprehensive integrated primary care and challenges to
strengthen the position of the profession are described.
Purpose of the article
The purpose of this article is to outline the role of occupational therapy within primary care.
This article informs consumers, academics, health service managers, professional associations
and government bodies about occupational therapy in primary care, and informs service and
policy development at a local, national and European level.
Introduction: occupational therapy profession and primary care
Across Europe there are great differences in the availability of occupational therapy in
primary care.
The need for integrated care that enables people to participate in decision-making and to
self-manage their own health and well-being is widely recognized.
The challenges facing health care services include ageing populations and increasing
numbers of clients with long-term conditions and multi-morbidities and all the social and
economic consequences. These populations will benefit from an approach that is focused on
possibilities and functioning rather than on a more medical treatment of symptoms (De
Maeseneer and Boeckxstaens, 2012).
Occupational therapists can deliver an important contribution to the primary care work-
force (Donnelly et al., 2014). A clear fithas been identified between the holistic, health-
promoting nature of occupational therapy and primary care (Donnelly et al., 2013). Occu-
pational therapists recognize the importance of meaningful occupations in promoting mental,
physical and social well-being. They are skilled in assessing the impact of developmental,
physical and mental health conditions on a persons ability to participate in activities that are
important to them, and in devising intervention plans that facilitate occupational engagement
(College of Occupational Therapists Ltd, 2015a).
Occupational therapists work in partnerships with other professions and can reduce the
pressure on GP services. For example, in prevention and early intervention to prevent diseases
or disability, reduce the impact of an illness and help support individuals in maintaining their
healthy lifestyles (College of Occupational Therapists Ltd, 2015b). Within primary and early
intervention services, occupational therapy interventions will reduce the risk of admission and
re-admission into hospitals and other institutes from incidents such as falls (College of
Occupational Therapists Ltd, 2016).
Occupational therapy
According to Occupational Therapy Europe (OT-EU):
Occupational therapy is a profession concerned with improving well-being for persons of all ages through
enabling occupations to promote health and participation in society. Occupational therapists do this by
supporting personsengagement in occupations and activities that they want, need and choose to do in
everyday life. Occupational therapists explore new ways of doing things by adapting activities and physical
and social environments to improve function, capacity and participation. Occupational therapists work in
Primary Health Care
Research & Development
cambridge.org/phc
Position Paper
*Written on behalf of COTEC by:
Marije Bolt, Tiska Ikking, Rosa Baaijen,
Stephanie Saenger.
Cite this article: Bolt M, Ikking T, Baaijen R,
Saenger S. (2019) Occupational therapy and
primary care. Primary Health Care Research &
Development 20(e27): 16. doi: 10.1017/
S1463423618000452
Received: 27 July 2017
Revised: 2 April 2018
Accepted: 14 June 2018
Key words:
evidence-based practices; home based
therapy; interventions; occupational therapy;
primary care
Author for correspondence:
Marije Bolt, Occupational Therapist, Cordaan
Primary Care Team, Amsterdam, The
Netherlands, E-mail: marijebolt35@gmail.com
© The Author(s) 2019. This is an Open Access
article, distributed under the terms of the
Creative Commons Attribution licence (http://
creativecommons.org/licenses/by/4.0/), which
permits unrestricted re-use, distribution, and
reproduction in any medium, provided the
original work is properly cited.
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partnership with those involved in the personslife, for example, family
and carers, teachers and employers, to achieve personsand communities
desired outcomes and promote an inclusive society. (OT-EU Occupa-
tional Therapy Europe, n.d.)
For occupational therapy in primary care it should be added
that occupational therapists work in the clientsown environment
where the activities take place at home, school work and/or social
environment.
Health policy context
In many countries, there is a shift from more institutional care to
community care, both in mental and physical health care. The
way health care is organized is not sustainable from both a
financial and workforce point of view. In all countries in Europe,
governments are struggling to reorganize the health systems and
the workforce to meet the future needs. Although all health care
systems aim to improve their populations health, countries
appear to organize their health care systems differently in
response to their own political, economic, social, demographical
and cultural context (Ros et al., 2000). In Western Europe
emphasis on primary care is expected to be an answer to ques-
tions of rising costs and changing demand. Central and Eastern
European countries are each in their own way struggling to
fundamentally improve the performance of their entire health
systems following their restoration of independence. Primary
care, which used to be poorly developed in these countries, is now
being developed to bring adequate and responsive health services
closer to the population. Approaches and models of primary care
reforms introduced have varied widely from country to country.
Some countries have attempted systemic interventions combining
legal, structural, organizational and financing reforms. Most
countries however, touch on one or more aspects of primary care
such as changes in the provision of services delivery by intro-
ducing evidence-based protocols; improving the generalist
approach of primary care by improving the academic embedd-
edness of general practice; or introducing financial incentives for
patients or providers to stimulate long-term relationships between
single providers and patients (Kringos, 2012).
Primary care
Primary care is at the top of the agenda of World Health Orga-
nization (WHO) and the European Commission. It is undeniable
that strong primary health care is foundational to achieving health
for all, as well as todays leading global health movements including
Universal Health Coverage, Health System Strengthening, Health
System Resilience, Integrated People-centred Health Services, and
health related Sustainable Development Goals (SDGs)(World
Health Organization, 2016). The Resolution WHA62.12 urging
WHO member states to strengthen their health care systems
through the values and principles of primary care. The WHO
report 2008 articulates the need to bring responsive health services
closer to the population and to provide people-centered care
organized in primary care (World Health Organization, 2008).
In a recent report of the European Commission two of the five
key conclusions are: A strong primary care guides patients
through the health system and helps avoid wasteful spending and
integrated care tackles a labyrinth of scattered health services to
the benefit of the patient (European Union, 2017).
In the final consultation of the European Framework for Action
on Integrated Health Service Delivery (WHO regional office
for Europe) and Health 2020 it is stated that Strengthening
people-centred health systemsrequires reorienting health care
systems to give priority to disease prevention, foster continual
quality improvement and integrate service delivery, ensure con-
tinuity of care, support self-care patients and relocate care as close
to home as is safe and cost-effective. Key elements in future health
service delivery are investing in health through a life course
approach and empowering people (World Health Organization,
2008). Strengthening the primary care level of health care systems
have increasingly been considered to be of great importance to
dealing with specific health care system challenges and improving
the overall performance of a health care system (Kringos, 2012).
Primary care is the first level of a health care system where people
present their health problems and where the majority of the
populations curative and preventive health needs are satisfied
(Starfield, 1994). Strong primary care is assumed to contribute
positively to health system goals including (equity in) population
health, sustainable health care expenditures and responsiveness of
care (Kringos, 2012).
Not only the policymakers but also the patients in Europe are
striving for accessible (primary) health care: Sustainability stra-
tegies should include reducing the burden on secondary care by
strengthening primary and community care, which is accountable
for 80% of seeking treatment. Strong primary care systems are
needed to provide continuous, comprehensive and coordinated
care for the whole population(European Patients Forum, 2017).
An international comparative study to the strength of primary
care resulted in listing the European countries with strong,
medium and weak primary care (Kringos, 2012).
The performance on all primary care structure dimensions
(incl. primary care governance, economic conditions, workforce
development) and services delivery process dimensions (incl.
access, continuity, coordination, and comprehensiveness of pri-
mary care) were taken into consideration (Figure 1).
Primary care definitions
Primarycareistheentrylevelofahealthcaresystemproviding
accessible, comprehensive care in an ambulatory setting to patients
in their own context on a continuous basis. Primary care coordinates
the care processes of patients across the health care system (Starfield,
1994). Primary care ideally provides accessible care to all patients
with any kind of health problems regardless of age, sex or any other
personal characteristic (World Health Organization on behalf of the
European Observatory on Health Systems and Policies, 2006).
These characteristics are also mentioned in the definition of the
WHO regional office for Europe. Primary health care is health care
received in the community, usually from family doctors, commu-
nity nurses, staff in local clinics or other health professionals. It
should be universally accessible to individuals and families by
means acceptable to them, with their full participation and at a cost
that the community and country can afford(World Health
Organization, 2008).
Primary care exhibits features of person-centeredness, compre-
hensiveness, integration, continuity of care, participation of patients,
families and communities. This requires health services that are
organized with close-to-client multidisciplinary teams responsible
for a defined population, collaborate with socials services and other
sectors, and coordinate the contributions of specialists and com-
munity organizations (World Health Organization, 2016).
In July 2014 The Expert Panel on Effective Ways of Investing in
Health (EXPH, 2014) adopted the Report on Definition of a frame
2 Marije Bolt et al.
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of reference in relation to primary care with a special emphasis on
financing and referral systems. In this report, the EXPH publishes a
core definition of primary care in which occupational therapy is
mentioned as one of the professions active in primary care teams.
The Expert Panel considers that primary care is the provision of universally
accessible, integrated person-centred, comprehensive health and community
services provided by a team of professionals accountable for addressing a
large majority of personal health needs. These services are delivered in a
sustained partnership with patients and informal caregivers, in the context
of family and community, and play a central role in the overall coordi-
nation and continuity of peoples care.
The professionals active in primary care teams include, among others,
dentists, dieticians, general practitioners / family physicians, midwives,
nurses, occupational therapists, optometrists, pharmacists, physiotherapists,
psychologists and social workers. (EXPH, 2014).
Occupational therapy and primary care
There are many differences in the European countries regarding the
definition and criteria of primary care. This is the same for occu-
pational therapy in primary care. For instance, in the UK primary
care is defined as being the first contactin health care. In the
Netherlands the way the occupational therapy services are financed
defines whether it is primary care. Other countries have the referral
system as criteria. Referral systems are often directly connected with
financing and are as such an important issue. Some countries have
the environment/context where the occupational therapist works as
criteria which can be home, school, workplace and or private
practice or are called community based. The WHO definition states
primary care services should be universally accessible to indivi-
duals and families by means acceptable to themwhich in fact
would exclude all care that has to be paid for by the person.
Occupational therapy services in primary care are not only
aimed at the individual in health care but also in groups and
communities and are delivered in public health and the social
area. Occupational therapy plays an important role in working
with those who have chronic conditions etc., but also in working
with the well. As the financing systems of the different areas
health insurance, social insurance, municipality are separately
organized and occupational therapy services are often delivered at
the borders and both sides of these areas, the financing is a major
challenge. As this article aims to give an overview of the state of
the art of occupational therapy in primary care in European
countries and to support those countries developing occupational
therapy in primary care, all possible contexts are taken into
account, even though in some countries they wont meet all the
criteria set by the definitions above.
Statement of the position taken by COTEC (Saenger, 2016)
Occupational therapists critically embrace the definition of the
concept of Positive Health. The ability to adapt and to self-
manage, in the face of social, physical and emotional challenges
(Huber et al., 2011) and find that health as a state of complete
physical, mental, and social well-being and not merely the
absence of disease or infirmityas defined by the WHO in 1948
(World Health Organization, 2006) seems not applicable in these
times with ageing populations and increasing numbers of patients
with long-term conditions and multi-morbidities.
Occupational therapists possess professional skills that enable
them to work with a wide range of clients of all ages who are faced
with limitations in their participation due to physical, mental and/
or social economic causes.
Occupational therapists recognize the importance of meaningful
occupations in promoting mental, physical and social well-being.
They are skilled in assessing the impact of developmental, physical
and mental health and social conditions on a persons ability to
participate in activities that are important to them, and in devising
intervention plans that facilitate occupational engagement.
Fig. 1. Countries with strong, medium and weak primary care, considering PC structure and key aspects of PC services delivery
Primary Health Care Research & Development 3
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Although occupational therapists have the medical knowledge,
their focus is on functioning and participation. They operate in
both health and social systems. Occupational therapists have
distinct knowledge of the significant impact that daily habits and
routines have on individualshealth and well-being. They are
experts when it comes to finding in partnership with their
clients solutions for situations in which there is a gap between
the clients physical and/or mental abilities and the skills that are
necessary to perform daily activities. Occupational therapists
support people to live safely at home, prevent unnecessary hos-
pital or other institutional admissions and prevent an excess of
care-use at home.
Because occupational therapists address the entire area of daily
living, they are used to work with every other professional in both
health- and social care and also with professionals in the more
technical fields, such as architects, ICT, product developers and
designers. This makes occupational therapists fully equipped to
play a central role in interprofessional teams in primary care and
integrated care.
Occupational therapy services should be available and acces-
sible in primary care in all health- and social care systems across
Europe. Having an occupational therapist in a multi-professional
team could be helpful in identifying ways to integrate the health
and social services to better effect. Looking for solutions that
address the impact of illness or disability and how individuals
participate in society is the key to robust integrated health care
delivery systems.
Survey
To make a start with the investigation to what extent members of
COTEC differ in the strength of occupational therapy in primary
care, the project group sent out surveys to all 30 members of
COTEC.
1
In total, 20 surveys were returned, two from the same
country. Since each country in Europe is in a different stage of
development of their primary care information infrastructure,
inevitably, some countries have a more comprehensive, up-to-
date or reliable set of data than other countries. These surveys
were ordered and analyzed by eight themes: total number of
occupational therapists in private practice, summary of the pro-
fession, organized interest group within National Association,
payment system, accessibility, client groups, main working area
and main challenges. The project group expected that countries
vary in the strength of occupational therapy in primary care,
which can be explained by variation in their political-economical,
cultural and health care system contexts. Strong primary care is
expected to be beneficial to important health care system out-
comes (Kringos, 2012). Currently, countries with relatively strong
PC have higher total health care expenditures than countries with
relatively weak PC in Europe. The results confirm that strong PC
has a positive impact on population health, reducing disparity in
health, and avoiding unnecessary hospitalizations. Patient per-
ceived quality of care is not related to the strength of PC (Kringos,
2012).
Number of occupational therapists
In total, 11 member associations of COTEC have returned the
survey with a positive answer on the question whether they have
occupational therapists working in primary care. Their number
varies between 6 (Luxembourg) and 1400 (Norway).
Out of the 30 member associations of COTEC, 26 completed the
2016 summary of the profession on the topic of occupational
therapists working in private/independent practice(COTEC Execu-
tive Committee, 2017). 23 member associations of COTEC have
occupational therapists working in private/independent practice and
their number varies between 3 (Iceland) and 26 000 (Germany).
We choose to compare the primary care and private/inde-
pendent practice data in Table 1.
Some differences in numbers are remarkable. That might be
due to differences in interpretation of primary care and private/
independent practice and/or the position and level of knowledge
of the person who answered the questions.
Special interest groups
As a special interest group is often started when a country wants
to develop or has developed a special area of practice, in this case
primary care, this item was included in the survey.
There are four interest/expert groups about occupational therapy
in primary care identified according to the returned surveys. Both
the countries with the largest and smallest number therapists
working in private practices have established such a group.
Funding of services
Out of 18 answers (with several payments systems existing next to
each other), the most common payment system is health insur-
ance, followed by clients paying for themselves, payment systems
of the municipality and other (government, general taxation,
public system and private providers) (Table 2).
Referral systems
Out of 14 countries, 11 offer the possibility for occupational
therapy through direct access, two of them as being the only
option to start occupational therapy treatment. Two other
member associations outlined the fact that no referral or direct
access check is needed when clients pay for the occupational
therapy treatment themselves.
Main working area
The main group of clients being treated by occupational thera-
pists in primary care is the elderly. Three countries do not offer
occupational therapy in primary care for this group at all. They do
offer specific occupational therapy in primary care for adults
(with mental disabilities) and children.
Main challenges
There is no single source of information that provides basic
information on the organization and delivery of primary care
services across Europe. A major cause is the lack of a common
definition of primary care that can capture the variation in orga-
nization and services delivery models (Kringos, 2012). The lack of
comparable information on primary care across Europe, limits
opportunities to provide benchmark information on the func-
tioning of primary care to policymakers (eg, to measure the impact
of healthcare policies on primary care), identify strong features or
options to improve the functioning of primary care, and explain
variation in the strength of primary care between countries
(Kringos, 2012). The same applies for occupational therapy.
1
The survey is available by mailing the author.
4 Marije Bolt et al.
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The results of the survey show that a clear and well-accepted
definition of primary care is needed to be able to get the right data
of occupational therapists working in this area. Further and more
in depth research is needed to describe the financing systems of
occupational therapy services across Europe.
The main challenge for occupational therapy in primary care,
according to the analyses of the survey, is the difficult accessibility
to occupational therapy services caused by:
A lack of occupational therapists in primary care;
A lack of knowledge among the general public and the
medical professionals regarding the services of occupational
therapy in primary care;
Table 1. Number of occupational therapists working in primary care or
private/independent practice
COTEC member Number of occupational
therapists working in
primary care according
to 2016 survey
Number of occupational
therapists working in
private/independent
practice according to 2016
summary of the
profession
Austria No answer (Na) 1200
Belgium 400 1057
Bulgaria Na 0
Croatia Na 20
Cyprus Na 43
Czech Republic Na 5
Denmark 400 821
Estonia Na Na
Finland Na 300
France 800 800
Georgia Na 0
Germany Na 26000
Greece Na Na
Iceland Na 3
Ireland 500 120
Italy Na 1300
Latvia Na 19
Lithuania Na Na
Luxembourg 6 6
Malta Na 8
The Netherlands 740 900
Norway 1400 12
Portugal 68 Na
Russia Na 0
Serbia Na 50
Slovenia Na 10
Spain 75 1560
Sweden Na 850
Switzerland 1200 850
United Kingdom 700 752
Table 2. Most common payment systems for occupational therapy in
primary care
COTEC member Health insurance Municipality Self Other
Austria X X
Belgium X X X X
Bulgaria No answer (Na)
Croatia Na
Cyprus Na
Czech Republic X
Denmark Na
Estonia Na
Finland Na
France X X
Georgia Na
Germany Na
Greece Na
Iceland Na
Ireland X
Italy Na
Latvia Na
Lithuania Na
Luxembourg X X
Malta Na
The Netherlands X X X
Norway X
Portugal X
Russia Na
Serbia X
Slovenia X X
Spain X X X X
Sweden Na
Switzerland X X
United Kingdom X X
Total 9 3 9 6
Primary Health Care Research & Development 5
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A fragmentation of the organization of health care and social
services;
The complexity of the financing structures;The other
challenge is the professional development and the limited
possibilities to build a robust knowledge base.
Most occupational therapist work solitary in primary care
without the possibility to be supported and learn from
each other;
If occupational therapists work in a multidisciplinary team,
they experience unrealistic caseloads and inadequate
resources due to a high number of referrals (Tinelly and
Byrne, 2016).
Scope of the profession;
Referrals are:
for very specific OT tasks which limits the scope of the
profession;
or the scope is too broad which results in a lack of focus.
Cooperation between practice, education and research are not
optimal.
Lack of research on (cost) effectiveness.
Conclusion
Strong primary care will not emerge spontaneously: it will require
continuous efforts to maintain, restore or strengthen its functions
to deliver high-quality primary care (Kringos, 2012).
Occupational therapy has a lot to offer in primary care espe-
cially if it is embedded in the local, regional and national health
and social systems.
Although occupational therapy is named as a key profession
in the core definition of Primary Care (EXPH, 2014) (new
reference has been added) and is (well) established in primary
care at least 14 European countries, occupational therapy is
according to Professor Jan de Maeseneer still the most
underused profession in primary care(De Maeseneer, 2017).
Reasons are the way primary health care is organized and
financed which hinders the accessibility of occupational ther-
apy in primary care, the relatively small number of occupa-
tional therapists and the unfamiliarity with the profession by
policymakers, referrers, other professionals and the general
public.
To develop and strengthen the position of the profession in
primary care, promotion to policymakers and public is needed, as
is evidence of the (cost) effectiveness of the interventions.
This article and the second article describe and capture just a
phase of the development and state of the art of occupational
therapy and primary care. Seeing the developments in health and
social care and especially in primary care in Europe, and given the
efforts and results of COTEC and OT-EU and its members in
promoting the profession on European and national level, it is to
be expected occupational therapy will follow and will be devel-
oped, expand and established in more countries and in
many ways.
Acknowledgments. The authors thank all who have in any way contributed
with data, research findings and evidence-based practices.
Additional literature concerning this topic can be requested by the authors.
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https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1463423618000452
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... Occupational therapy is a developing rehabilitation profession in Rwanda. Meanwhile, the University of Rwanda started the occupational therapy training program in 2014 [10] and the program was accredited by the World Federation of Occupational Therapists in 2016 [11]. ...
... titled new graduates' experiences of learning to practice occupational therapy, it was reported that newly graduate of occupational therapy program encounter challenges related to practice skills, system issues, professional identity, unstructured work environment, bridge between academic training and clinical settings. More so, occupational therapists need continuous professional development, suitable work environments, ongoing strengthening of the training centers, professionals supports, mentorship and clearly define their role to better satisfy their clients[11] [15] [16][37]. ...
... [4] For example, specific OT workforce, evidence-based OT service delivery, insurance coverage, policies, and pathways for the provision of evidence-based services have been developed, periodically reviewed, and implemented effectively with adequate funding, especially from government health systems in HICs. [5] Continued efforts are underway to develop and retain the OT workforce in HICs. [5,6] Despite this, awareness and recognition for OT in India are just emerging, especially among people with disabilities (PWDs) who require such services. ...
... [5] Continued efforts are underway to develop and retain the OT workforce in HICs. [5,6] Despite this, awareness and recognition for OT in India are just emerging, especially among people with disabilities (PWDs) who require such services. [7] Interestingly, even among health-care providers in India, little awareness exists regarding OT. [8] Not many government institutions in India have OT education or services. ...
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Background: Occupational therapists are considered an important workforce for the rehabilitation of persons with disabilities globally. However, in India, the profession is just beginning to gain recognition within the national and state-level systems for health care. One of the reasons for this could be the paucity of specific research related to the development of occupational therapy (OT) and its benefits to the health systems. Therefore, it is of immense public health importance to explore the priorities and gaps in OT research in India. A vast majority of the OT research in India is promoted and disseminated through the All-India Occupational Therapists Association (AIOTA) and its annual national conference (ANC). Objectives: The objective of this study is to descriptively review the conference abstracts of the AIOTA ANC published in the Indian Journal of OT (IJOT), an official publication of the AIOTA, from 2017 to 2021. Study design: The study design was a descriptive, nonsystematic review. Methods: Review of the abstracts selected for the AIOTA ANC published in the IJOT from 2017 to 2021. A data extraction form was developed and used to synthesize data related to the clinical and demographic characteristics of OT research in India. Results: The search yielded 218 abstracts. State-level trends indicated that close to 85% of the research submissions were from four states and no submissions from the northeastern states until 2020. Nearly 60% of the abstracts were clinical research with OT interventions. About 40% of these research abstracts were related to pediatrics, followed by neurology (17%), musculoskeletal (15%), mental health (10%), and ergonomics and assistive technology (8%). There were 1%-2% of research abstracts submitted related to coronavirus disease-2019 (COVID-19) and geriatrics. About 85% of the research abstracts were related to impairment (39%), activity limitation (26%), and social participation (22%). Conclusion: This review highlights the need for diversifying the research in OT in India. This is particularly important in relation to expanding from selected states to pan-India research and development, especially in the northeastern states. Furthermore, the focus of OT research must move beyond impairments and approach disability from the biopsychosocial perspective. It is also very important to diversify the research in OT to areas that are of public health importance such as COVID-19, geriatrics, noncommunicable diseases, and rehabilitation in health systems. Priority setting for research in OT in India is an important implication of this review.
... Although 17.6% of participants had received an OT intervention at some point, almost half of the participants reported that they had never heard about OT before. As previously reported, lack of knowledge about OT can lead to a delay in access to OT services [12]. Moreover, time elapsed between initial symptom progression in ATTRv patients and provision of OT services was extremely delayed despite their crucial role in the implementation of compensatory strategies. ...
... OT is still underused for patients who require this service. Several factors may explain this, such as the relatively small number of OT professionals in Spain and the unfamiliarity of patients, referrers, health care professionals, and the general public with the profession [12]. In studies evaluating reasons why patients do not have access to OT, most respondents report that their primary care doctor has never recommended it [13]. ...
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This study was designed to investigate the global utilization of occupational therapy (OT) services by patients with hereditary transthyretin amyloidosis (ATTRv) in Spain. The main objective was to find out whether these patients have access to OT services and the types of interventions being offered to them, together with their satisfaction and real benefits as users. We developed an online questionnaire which was distributed to patients with ATTRv in Spain through patient associations. Seventy-four patients with a diagnosis of ATTRv residing in Spain participated in the study. Thirteen had already used OT services at least once, felt that OT interventions improved their quality of life, would recommend OT services to others, and would return to see an occupational therapist. However, 61 had never used this type of service before. Of these, 35 knew what OT is and 13 declared that they considered that OT interventions in ATTRv could be positive for them. The results suggest that the use of OT services by ATTRv patients is low, mainly because of the lack of information about the occupational profile of individuals with this disease. The low response rate obtained for the survey limits generalization, and thus further research to confirm these preliminary findings is needed.
... 7 Upper limb manual training is an integral component in the interdisciplinary treatment of individuals with cerebral palsy and has effects on promoting fine motor functionality. 3 Its main purpose is to improve their ability to perform daily functions, facilitate successful adaptations to disruptions in lifestyle, prevent loss of function, and improve or maintain psychological status. 8,9 Different upper limb manual training protocols have been proposed to help these children develop better functional skills. Hand-arm bimanual intensive therapy, 10 hand-arm bimanual intensive training including lower extremity, 11 constraintinduced movement therapy, 10,12 modified constraint-induced movement therapy, 13 action observation therapy, 14 and mirror therapy 15 are all common training protocols. ...
Article
Objective There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand–arm bimanual intensive training, hand–arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. Data sources We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. Review methods To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. Results We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand–arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand–arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( − 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. Conclusion We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.
... In particular, these engaged learning practices incorporate potent characteristics such as a significant investment of time and effort, substantive interactions with faculty and peers, experiences with diversity, real-world applications and opportunities to reflect and integrate learning (Kuh & O'Donnell, 2013). In addition, among several areas demanding attention, it is evident that in order to promote optimal health outcomes for all people efforts must be directed toward addressing the needs of older adults (Institute of Medicine, Board on Health Care Services and Committee on the Future Health Care Workforce for Older Americans [IOM], 2008), primary care services (Bolt et al., 2019;Kuo et al., 2013) and global health (Satcher, 2000). ...
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Este artigo apresenta um protocolo de uma revisão de escopo da literatura, que se caracteriza como um tipo de revisão, conduzida sistematicamente, que tem como objetivo realizar um mapeamento de conceitos, teorias, fontes de evidências em uma determinada área de pesquisa, possibilitando a exploração em profundidade da literatura, seu mapeamento e a sumarização de conteúdos, identificando lacunas e direcionamentos para novas pesquisas. Conduzida de acordo com o guia de produção de revisões de escopo do Joanna Briggs Institute (JBI), aliado às orientações do Prefered Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR), o estudo do presente protocolo é regido pela seguinte pergunta condutora: “o que a literatura relata sobre a atuação da Terapia Ocupacional na promoção de saúde com adolescentes?”, elaborada com base no Mnemônico PCC (População - estudos que abordem a atuação da Terapia Ocupacional com adolescentes; Conceito - textos em que os autores caracterizem processos de intervenção em Terapia Ocupacional explicitamente enquanto ações de promoção de saúde e/ou bem estar; Contexto – identificado a partir dos contextos nos quais as ações da Terapia Ocupacional direcionadas para a promoção de saúde na adolescência acontecem). As buscas serão realizadas nas bases de dados PubMed, LILACS, CINAHAL, PsycoInfo, Web of Science, Scopus e Scielo, junto à pesquisa manual em revistas específicas de Terapia Ocupacional. Os resultados da pesquisa e as reflexões dela originadas serão sistematizadas em um relatório no formato de artigo científico, o qual será encaminhado para análise e possível publicação em periódico científico.
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Interprofessional care provided in a free community-based clinic that focuses on chronic health conditions and health promotion provides an innovative solution to improve societal health. Many existing clinics provide a range of professions, but few include allied health services such as occupational and physical therapy. This paper provides a description of the development and implementation of an expanded faculty-guided student-led community-based primary care clinic that includes occupational and physical therapists as part of an interprofessional collaborative practice model. A detailed description and explanation of the partners involved, the institutional missions that drive this work, the logistics completed that enabled the 'doors to open,' faculty and student roles, and initial outcomes will be provided. A review of the service delivery model, lessons learned, and future directions for the clinic will also be offered.
Article
Introduction Occupational therapy (OT) has a rich history of integrating physical and mental health care services, however, there is a limited evidence base regarding the effectiveness of OT interventions for mental health disorders in primary care. Methods A comprehensive systematic review was conducted from database inception through 31 January 2021. Eligible studies had to include: (1) an intervention that involved an occupational therapist in design and/or implementation; (2) a quantitative outcome assessing symptoms related to a mental health disorder; (3) a comparison group; and (4) primary care or community dwelling patients and/or primary care clinical settings. Results The researchers identified five studies and there was heterogeneity in the OT interventions. There were no significant differences between intervention and control groups in depression symptoms at different time intervals. Several trials employed interventions that involved interprofessional team members, including OTs, to provide training in specific strategies that promoted functioning. Other studies utilized only OTs within the intervention arm. OT interventions demonstrated no significant difference in anxiety in one study, however, another indicated a reduction in symptoms. The overall risk of bias was considered low in three studies and unclear in two studies. Conclusion There is limited evidence demonstrating the impact of OT interventions in primary care settings on quantitative outcomes measuring symptoms related to a mental health disorder. Given the heterogeneity of interventions and variation in reported findings, there is need for further pragmatic trials in this area.
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Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice.
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![][1] Today we face an important demographic and epidemiological transition, confronting us with the challenge of non-communicable diseases (NCDs), which occur more and more in the context of multimorbidity. In the next decade, multimorbidity will become the rule, no longer the exception: 50% of the those aged ≥65 years have at least three chronic conditions, whereas 20% of the ≥65-year group have at least five chronic conditions.1 In the case of COPD, for example, more than half of the patients have at least one comorbid disease.2 In recent years, not only Western countries, but also developing countries started with ‘chronic disease management-programmes’ to improve care. The design of those programmes include most frequently: strategies for case-finding, protocols describing what should be done and by whom, the importance of information and empowerment of the patient, and the definition of process- and outcome-indicators that may contribute to the monitoring of care. Wagner has described the different components of the Chronic Care Model (CCM) as developed in the context of primary health care.3 The CCM has inspired policy makers and providers all over the world and is widely accepted in the US and Canada, Europe, and Australia. Taking into account the epidemiological transition, we are faced with the question: ‘How will this approach work in a situation of multimorbidity’? Let us illustrate this with a patient from our general practice, we call her ‘Jennifer’ (Box 1). #### Box 1. Jennifer Jennifer is 75 years old. Fifteen years ago she lost her husband. She has been a patient at the practice for 15 years now. During these 15 years she has been through a difficult medical history: hip replacement surgery for osteoarthritis, hypertension, type 2 diabetes, and COPD. She lives independently at home, with some help from her youngest daughter, Elisabeth. I visit her regularly … [1]: /embed/graphic-1.gif
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The current WHO definition of health, formulated in 1948, describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 At that time this formulation was groundbreaking because of its breadth and ambition. It overcame the negative definition of health as absence of disease and included the physical, mental, and social domains. Although the definition has been criticised over the past 60 years, it has never been adapted. Criticism is now intensifying,2-5 and as populations age and the pattern of illnesses changes the definition may even be counterproductive. The paper summarises the limitations of the WHO definition and describes the proposals for making it more useful that were developed at a conference of international health experts held in the Netherlands.6
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In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing. We found that some combinations are more present: different payment systems for primary care physicians go together with different forms of cost sharing, different services have different forms of cost sharing. In countries with a GP as gatekeeper no charges are in use for the GP. No distinct relationship could be found between the financing system (tax-based or insurance-based) and the form of cost sharing or the exclusion of vulnerable populations. It is concluded that there are two ways of filtering 'unnecessary' demand. One is by introducing cost sharing for directly accessible services such as GPs. The second way is by having GPs act as gatekeepers to more specialized, and more costly care.
Article
Few studies have examined the role of occupational therapy working in a primary care setting. The objective of the study was to describe the emerging role of occupational therapy in Family Health Teams, a model of interprofessional primary care. A multiple case study design was used to provide in-depth description of the occupational therapy role. Data collection included interviews, document analyses, and questionnaires. Each case was first analyzed individually, followed by cross-case analyses to determine common themes. The role of occupational therapy in Family Health Teams epitomizes that of a generalist, whose overarching focus is on function. Occupational therapists are working across the life span with a wide range of client populations. Older adults and individuals with complex chronic conditions are two prominent areas of occupational therapy focus. Understanding the impact of health conditions on daily function and enabling participation in activities are unique and important contributions of occupational therapy.
The contribution of occupational therapy to GP services
  • Occupational Therapists Ltd
Occupational Therapists Ltd (2015a) The contribution of occupational therapy to GP services. London, UK: College of Occupational Therapists Limited.