Expanding the impact of occupational therapy into primary care within the veterans administration
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This doctoral project presents an example of the integration occupational therapy (OT) into primary care to improve access to OT services that will address occupational performance challenges of veterans within the Eastern Colorado Veterans Affairs (VA) Health Care system. Informed by the Person Environment Occupation model of occupation and substantial evidence supporting the necessity of assessing functional cognition to better understand occupational performance, this doctoral project focuses upon the provision of OT services in a primary care setting, which included assessments of functional cognition and ADL/IADL performance and interventions addressing functional cognitive deficits, home safety, and activities of daily living/instrumental activities of daily living (ADL/IADL) performance. Satisfaction of primary care providers with inclusion of OT services as well as data on client factors of typical veterans referred to OT and assessments and interventions utilized were collected through survey and observation. Results of this project indicate that the inclusion of occupational therapy services in primary care can reduce the wait time from referral to evaluation for some veterans from 1–2 months to 15 minutes while increasing primary care provider (PCP) knowledge of the scope of OT services. However, several factors must be considered for the successful continued presence of OT in primary care. To improve OT productivity, follow-up appointments should be scheduled at the primary care office and group programing should address health and wellness and chronic disease management. Care must be taken to balance availability for “warm hand-offs” from PCPs and prescheduled appointment times. Furthermore, continued education of PCPs on scope of OT practice will be imperative for continuing to increase numbers of appropriate referrals.