Occupational Therapy in Primary Care What’s Happening? What’s Next?

OTAO 2016

Tiffany Boggis, MBA, OTR/L with special guests Tori Eaton, OTD, OTR/L Katie Smith, OTS Mackenzie Gamble, OTS

The Primary Care Revolution

Primary Care

New Models of

Care

Health Care

Reform (ACA)

OT Legislative Advocacy

Challenges �  OTs strive to define our role in primary care �  Justification of the efficacy of OT Intervention

in primary care through evidence & research �  Narrow awareness of primary care providers

of what OT can offer �  Primary care physicians are unaccustomed to

team-based care �  Limited opportunities to demonstrate what OT

can offer �  Funding and reimbursement for OT services

Overcoming The Challenges OTAO

Conference 2015

Breakout session

Roundtable

OOTEP

Oregon OT Emerging Practice

Listserv

Survey

Action Plan

Research the evidence base

Education

Marketing

Relationships

Contexts

Service Demonstration

Funding

OTJobs

Legislative Advocacy

Progress on Action Plan � Literature review/ Annotated bibliography � Marketing/Informational brochures � Legislative accomplishments � OT position:

Pacific Psychology & Comprehensive Health Clinic, Portland

� Clinical instructor and OT student capstones & experiential in primary care settings

� Exploration of funding & reimbursement

Research Evidence for Best Practice Katie Smith, OTS & Mackenzie Gamble, OTS Pacific University School of OT

OOTEP: Research � Annotated Bibliography

� Foundational Documents � Case for Integration � Promoting OT � ACA and OT � Integration Options � Service Provision

Service Provision Priorities ○ Demonstrate efficacy

to prevent the most deadly, disabling, and costly conditions

Our process: HealthCondi-ons Cita%ons RiskFactors Cita%ons

Diabetes -CDC,2009-CDC,2015b-ODPHP,2016a-Wille:etal.,2006

-Overweight---------------------------Physicalinac%vity--------------------Highbloodpressure----------------Unhealthycholesterollevels-----Unhealthydiet----------------------

-AHA,2015;IDF,2015-AHA,2015;IDF,2015-AHA,2015-AHA,2015-IDF,2015

Stroke -CDC,2009-ODPHP,2016b-WHO,2014-Wille:etal.,2006

-Overweight---------------------------Physicalinac%vity--------------------Highbloodpressure----------------Unhealthycholesterollevels-----Unhealthydiet-----------------------Heartdisease-------------------------Diabetes------------------------------

-CDC,2015a;NHLBI,n.d.-CDC,2015a;NHLBI,n.d.-CDC,2015c;NHLBI,n.d.-CDC,2015c;NHLBI,n.d.-CDC,2015a;NHLBI,n.d.-CDC,2015c;NHLBI,n.d.-CDC,2015c;NHLBI,n.d.

HeartDisease -CDC,2009-CDC,2015b-ODPHP,2016b-WHO,2014-Wille:etal.,2006

-Overweight---------------------------Physicalinac%vity--------------------Highbloodpressure----------------Unhealthycholesterollevels-----Unhealthydiet----------------------

-CDC,2015e-CDC,2015e-CDC,2015d-CDC,2015d-CDC,2015e

What can OT do?

○  Lifestyle modification ○  Diet, Physical Activity, Overweight

○  OTPF, AOTA Obesity Statement

○ Blood Pressure? ○ Cholesterol?

What can OT do? LIFESTYLECHANGESTHATCANREDUCEBLOODPRESSURE

LIFESTYLECHANGESTHATCANREDUCECHOLESTEROL

Findings Cita-on

-Eathealthy,reducesodium-Regularphysicalac%vity-Maintainahealthyweight-Managestress-Limitalcohol,avoidtobacco

AHA(2014)

-Eathealthy,reducesodium-Regularphysicalac%vity-Loseweight-Managestress-Limitalcohol,quitsmoking

MayoClinic(2015)

Findings Cita-on

-Eathealthy-Regularphysicalac%vity

AHA(2014)

-Eathealthy(lesssaturatedfat,transfat,andcholesterol)-Regularphysicalac%vity-Loseweight

Na%onalHeart,Lung,andBloodIns%tute(2005)

Evidence for OT treatment Overweight ○ What we don’t have:

○  Outcomes studies ○ What we do have:

○  Theoretical papers ○  Advocacy ○  Anecdotal evidence ○  Evidence-based non-OT practices within

scope of OT

Best Practice Example Guidelines

Best Practice Example Guidelines OT Theory

Best Practice Example

Anecdotal Evidence:

- Sue: solitary and gaining weight - Roger: many health and functional issues related to weight (Forhan & Richmond, 2002)

Guidelines OT Theory

Distinct Value ○  Overweight is not currently being effectively

managed in primary care (Guidelines)

○  OT addresses the prevention and concerns of obesity through a holistic and client-centered approach to lifestyle through participation in activities that promote health (AOTA Obesity Position Paper)

References AmericanHeartAssocia%on(2014).Preven%onandtreatmentofhighbloodpressure.Retrievedfrom:

h:p://www.heart.org/HEARTORG/Condi%ons/HighBloodPressure/Preven%onTreatmentofHighBloodPressure/Preven%on-Treatment-of-High-Blood-Pressure_UCM_002054_Ar%cle.jsp#.VvrcYBIrL-Y

AmericanHeartAssocia%on(2015).Understandyourriskfordiabetes.Retrievedfromh:p://www.heart.org/HEARTORG/Condi%ons/Diabetes/UnderstandYourRiskforDiabetes/Understand-Your-Risk-for-Diabetes_UCM_002034_Ar%cle.jsp#.VtOmq5MrJsM

CentersforDiseaseControlandPreven%on(2009).Thepowerofpreven6on:Chronicdisease,thepublichealthchallengeofthe21stcentury.Retrievedfromh:p://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Preven%on.pdf

CentersforDiseaseControlandPreven%on(2015a).Behaviorsthatincreaseriskforstroke.Retrievedfromh:p://www.cdc.gov/stroke/behavior.htm

CentersforDiseaseControlandPreven%on(2015b).Chronicdiseaseoverview:TheleadingcausesofdeathanddisabilityintheUnitedStates.Retrievedfromh:p://www.cdc.gov/chronicdisease/overview/

CentersforDiseaseControlandPreven%on(2015c).Condi6onsthatincreaseriskforstroke.Retrievedfromh:p://www.cdc.gov/stroke/condi%ons.htm

CentersforDiseaseControlandPreven%on(2015e).Heartdiseasebehaviors.Retrievedfrom:h:p://www.cdc.gov/heartdisease/behavior.htm

Interna%onalDiabetesFedera%on(2015).Riskfactors.Retrievedfromh:p://www.idf.org/about-diabetes/risk-factorsForhan,M.,&Richmond,J.(2002).Theimpactofobesityonoccupa%on:Implica%onsforoccupa%onaltherapy.Occupa6onal

TherapyNow,4(2),19–21.MayoClinic(2015).10waystocontrolhighbloodpressurewithoutmedica%on.Retrievedfrom:

h:p://www.mayoclinic.org/diseases-condi%ons/high-blood-pressure/in-depth/high-blood-pressure/art-20046974Na%onalHeartLungandBloodIns%tue(2005).Highbloodpressure:Whatyouneedtoknow.Retrievedfrom

h:ps://www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-htmlNa%onalHeart,Lung,andBloodIns%tute(n.d.).Whoisatriskforastroke?Retrievedfrom

h:ps://www.nhlbi.nih.gov/health/health-topics/topics/stroke/atriskOfficeofDiseasePreven%onandHealthPromo%on(2016b).Heartdiseaseandstroke.Retrievedfrom

h:p://www.healthypeople.gov/2020/topics-objec%ves/topic/heart-disease-and-strokeWille:,W.C.,Koplan,J.P.,Nugent,R.,Dusenbury,C.,Puska,P.,&Gaziano,T.A.(2006).Preven%onofchronicdiseasebymeansof

dietandlifestylechanges.InD.T.Jamison,J.G.Breman,A.R.Measham,G.Alleyne,M.Claeson,D.B.Evans,P.Jha,A.Mills,&P.Musgrove(Eds.),Diseasecontrolpriori6esindevelopingcountries(2nded.).Washington(DC):WorldBank.Retrievedfromh:p://www.ncbi.nlm.nih.gov/books/NBK11795/.

WorldHealthOrganiza%on(2014).Thetop10causesofdeath.Retrievedfromh:p://www.who.int/mediacentre/factsheets/fs310/en/

An OT’s Experience in Primary Care Tori Eaton, OTD, OTR/L Clinical Instructor Pacific University

Essential Health Benefits �  Ambulatory patient services �  Emergency services �  Hospitalization �  Pregnancy, maternity, & newborn care �  Mental health & substance use disorder services �  Prescription drugs �  Rehabilitative & habilitative services

�  Injuries, disabilities, chronic… mental & physical �  Laboratory services �  Preventive & wellness services �  Pediatric services (including oral & vision)

�  Ambulatory patient services �  Emergency services �  Hospitalization �  Pregnancy, maternity, & newborn care �  Mental health & substance use disorder services �  Prescription drugs �  Rehabilitative & habilitative services

�  Injuries, disabilities, chronic… mental & physical �  Laboratory services �  Preventive & wellness services �  Pediatric services (including oral & vision)

Pacific Psychology & Comprehensive Health Clinic

� Hybrid behavioral health & primary care �  Interdisciplinary team

https://ahpdelaware.com/wp-content/uploads/2013/12/Home-Health-Psychology.jpg

Psychology

http://www.dcc.edu/_training/images/allied-health-images/occupational-therapy.jpg

O.T.

http://westsidehospice.com/wp-content/uploads/2015/08/speech-therapy.jpg

S.L.P.

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P.T.

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Naturopath

Populations �  Individuals, couples � Low-risk � Low-income � Tri-County area � High % PSU referrals @ PDX � High % of Spanish-speaking in Hillsboro

Primary Needs � Executive function � Anxiety � Depression � Sensory � Some neuro rehab � Chronic pain management

Virginia Garcia Memorial Health Center- Hillsboro �  HRSA grant �  Interdisciplinary team

�  MD �  Community Pharmacy Services �  Occupational Therapy �  Behavioral Health

� Purpose �  Decrease hospital readmits within 30 days �  Decrease medication errors

Populations �  Individuals released from hospital within 8

days � Low-income � High % Spanish-speaking � High % geriatric population � Extremely varied backgrounds

Primary Needs �  Cirrhosis �  Diabetes �  COPD �  Anxiety/Depression �  HBP �  N-STEMI �  Chronic pain �  Pneumonia, E. coli �  Hepatitis C �  Hand injuries �  RA, lupus

Case Study � 35 y/o Caucasian male � HBP, depression, anxiety, sleep

disturbance � Stays up late watching TV � Forgets medications � Lives independently

Case Study �  38 y/o Hispanic female �  Married, 3 children (18, 14, 13) �  Hx DM, depression; A1-C is 9.2 �  Son just left for boot camp �  Youngest daughter over-eating �  Middle daughter withdrawing, pulling out hair �  Husband is alcoholic �  Hospitalized due to chest pain, dizziness

Quote from Dr. Carden "Before I worked with Dr Eaton I was unaware of the breadth of scope for OT.  She spent a morning with me and was able to offer concrete solutions for improving the health of every patient on my schedule."

- Geoffrey Carden, MD

Keep up the momentum �  Familiarize yourself with current literature and evidence

base for best OT practice in primary care to justify & develop intervention strategies in primary care

�  Determine if your facility is part of a CCO or partnered with community care, behavioral health or primary care centers

�  Seek individuals in these settings who are providing services – find a champion!

�  Identify what providers struggle with? Can you meet a need or fill a void?

�  Advocate (AOTA & OTAO) with pubic officials to include OT in legislation that identifies OT as qualified primary care providers

�  Volunteer to be a community advisor for a Pacific University OT student experiential in a primary care setting

Special Thanks Pacific University OT students

Hailey Oliver, Kelly Moore, Maggie Sutherland & Daniel Tautenhan. Karen Smoots

Class of 2017

Advocacy & Marketing Brochures

OOTEP Members

OTAO Guest Presenters

Contact Information

Tiffany Boggis boggisDL@pacificu.edu

Tori Eaton

veaton@pacificu.edu

References/Resources Amini, D. (2014). Understanding occupational therapy’s role in primary care. OT practice, 19 (11), 8-17. AOTA Commission on Practice Position Paper (2014). The role of occupational therapy in primary care. AJOT 68 (Suppl.). AOTA (2013). Review of new models of primary care delivery: Commissioned report http://www.aota.org/Publications-News/AOTANews/2013/Primary-Care-Promote.aspx

AOTA (2013). Forum on Interprofessional Team-Based Care: Identifying New Roles for OT in Primary Care http://www.aota.org/Advocacy-Policy/Health-Care-Reform/News/2013/PrimaryCareForum.aspx

Glennon, T. J., & Meriano, C. (2014). Collaboration in primary care under the ACA: What is the occupational therapy role? Administration & Management Special Interest Section Quarterly, 30(2), 1-4.

Killian, C., Fisher, G., & Muir, S. (2015). Primary care: A new context for the scholarship of practice model. Occupational Therapy in Health Care, 29 (4), 383-396. http://dx.doi.org/10.3109/ 07380577.2015.1050713

Lamb, A. J., & Metzler, C. A. (2014). Defining the value of occupational therapy: A health policy lens on research and practice. American Journal of Occupational Therapy, 68(1), 9-14. Metzler, C.A., Hartmann, K.D., Lowenthal, LA. (2012). Defining primary care: Envisioning roles of occupational therapy. AJOT 66 (3) 266-270 Muir, S., Henderson-Kalb, J., Eichler, J., Serfas, K., Jennison, C. (2014). Occupational therapy in primary care: An emerging area of practice. OT Practice 19(15). CE1-CE8

Muir, S. (2012). Health Policy Perspectives—Occupational therapy in primary health care: We should be there. AJOT 66, 506–510. http://dx.doi.org/10.5014/ajot.2012.665001 Robert, P., Farmer, M. E., Lamb, A. J., Muir, S., & Siebert C. (2014). The role of occupational therapy in primary care. AJOT 68(S3), S25-33.

AmericanHeartAssocia%on(2014).Preven%onandtreatmentofhighbloodpressure.Retrievedfrom:h:p://www.heart.org/HEARTORG/Condi%ons/HighBloodPressure/Preven%onTreatmentofHighBloodPressure/Preven%on-Treatment-of-High-Blood-Pressure_UCM_002054_Ar%cle.jsp#.VvrcYBIrL-Y

AmericanHeartAssocia%on(2015).Understandyourriskfordiabetes.Retrievedfromh:p://www.heart.org/HEARTORG/Condi%ons/Diabetes/UnderstandYourRiskforDiabetes/Understand-Your-Risk-for-Diabetes_UCM_002034_Ar%cle.jsp#.VtOmq5MrJsM

CentersforDiseaseControlandPreven%on(2009).Thepowerofpreven6on:Chronicdisease,thepublichealthchallengeofthe21stcentury.Retrievedfromh:p://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Preven%on.pdf

CentersforDiseaseControlandPreven%on(2015a).Behaviorsthatincreaseriskforstroke.Retrievedfromh:p://www.cdc.gov/stroke/behavior.htm

CentersforDiseaseControlandPreven%on(2015b).Chronicdiseaseoverview:TheleadingcausesofdeathanddisabilityintheUnitedStates.Retrievedfromh:p://www.cdc.gov/chronicdisease/overview/

CentersforDiseaseControlandPreven%on(2015c).Condi6onsthatincreaseriskforstroke.Retrievedfromh:p://www.cdc.gov/stroke/condi%ons.htm

CentersforDiseaseControlandPreven%on(2015e).Heartdiseasebehaviors.Retrievedfrom:h:p://www.cdc.gov/heartdisease/behavior.htm

Interna%onalDiabetesFedera%on(2015).Riskfactors.Retrievedfromh:p://www.idf.org/about-diabetes/risk-factors

Forhan,M.,&Richmond,J.(2002).Theimpactofobesityonoccupa%on:Implica%onsforoccupa%onaltherapy.Occupa6onalTherapyNow,4(2),19–21.

MayoClinic(2015).10waystocontrolhighbloodpressurewithoutmedica%on.Retrievedfrom:

h:p://www.mayoclinic.org/diseases-condi%ons/high-blood-pressure/in-depth/high-blood-pressure/art-20046974

Na%onalHeartLungandBloodIns%tue(2005).Highbloodpressure:Whatyouneedto

know.Retrievedfromh:ps://www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html

Na%onalHeart,Lung,andBloodIns%tute(n.d.).Whoisatriskforastroke?Retrievedfromh:ps://www.nhlbi.nih.gov/health/health-topics/topics/stroke/atrisk

OfficeofDiseasePreven%onandHealthPromo%on(2016b).Heartdiseaseandstroke.Retrievedfromh:p://www.healthypeople.gov/2020/topics-objec%ves/topic/heart-disease-and-stroke

Wille:,W.C.,Koplan,J.P.,Nugent,R.,Dusenbury,C.,Puska,P.,&Gaziano,T.A.(2006).Preven%onofchronicdiseasebymeansofdietandlifestylechanges.InD.T.Jamison,J.G.Breman,A.R.Measham,G.Alleyne,M.Claeson,D.B.Evans,P.Jha,A.Mills,&P.Musgrove(Eds.),Diseasecontrolpriori6esindevelopingcountries(2nded.).Washington(DC):WorldBank.Retrievedfromh:p://www.ncbi.nlm.nih.gov/books/NBK11795/.

WorldHealthOrganiza%on(2014).Thetop10causesofdeath.Retrievedfromh:p://www.who.int/mediacentre/factsheets/fs310/en/