Abstract
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners 1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered, 2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners 1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered, 2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
Definitions
Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of the family and community (Institute of Medicine [IOM], 1994; Patient Protection and Affordable Care Act of 2010 [ACA], Pub. L. 111-148). Primary care and primary health care are used interchangeably in the literature; however, the terms have subtle but distinct differences (Halle et al., 2018). The ACA specifies that primary care providers (PCPs) are physicians, nurse practitioners, and physician assistants. The term primary health care denotes a wider view of providers, including occupational therapy practitioners, who contribute to the coordination of personal health care, population health, and social needs while sustaining authentic relationships with clients over the life course (Dahl-Popolizio et al., 2017; Keleher, 2001). To this end, primary health care delivery focuses on a broad definition of health, including preventive and behavioral care approaches.
For the purposes of this document, the term primary care models is used to describe primary care and primary health care practices. Different models of primary care and primary health care exist based on reimbursement, composition of service providers, and community or population needs. Despite differences in these models, all successful primary care includes the following shared principles and values: person and family centered, continuous, comprehensive and equitable, team based and collaborative, coordinated and integrated, and accessible and high value (Patient-Centered Primary Care Collaborative, 2019, p. 9). Many of the values of primary care align with the values of occupational therapy.
Since the implementation of the ACA, primary care delivery models have an increased emphasis on managing chronic conditions to reduce costs and improve population health (Centers for Medicare and Medicaid Services [CMS], 2019; Interprofessional Education Collaborative Expert Panel, 2011; IOM, 2010; National Committee for Quality Assurance, 2011; National Quality Forum, 2012). Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig & Stoddart, 2003, p. 380; see also AOTA, 2020b). Population health is a core value recognized in occupational therapy’s philosophical base, further supporting the importance of occupational therapy in primary care settings (AOTA, 2017c, 2020c).
A population health perspective recognizes all components of health, including the influence of social determinants of health (SDOH) on individual health status and ability to engage in family and community life. SDOH are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (National Center for Health Statistics [NCHS], 2019). Several aspects of SDOH directly align with the values of occupational therapy, including community participation, access to health care (including primary care), and healthy environments (NCHS, 2019).
CMS (2019) is making significant investments in primary care and primary health care, with targeted goals to reduce hospital readmissions and lower costs. Payment models are also transitioning from volume-based reimbursement (relative value unit, also known as fee for service) to value-based payments focused on the quality and outcomes of intervention as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; Pub. L. 114-10). With the growing attention on population health and payment models focused on quality and health outcomes, the role for occupational therapy in primary care models continues to evolve and become refined. This role will continue to evolve with the changing landscape of health care.
Importance of Primary Care
A combination of factors necessitates transformation of the health care delivery system. These factors include unsustainable public and private health care spending growth, increased prevalence of chronic health conditions, complex health and social needs, and rising demand for health care services because of the aging of the population (Patient-Centered Primary Care Collaborative, 2019).
Because of the challenges in today’s health care environment, the focus of health care is moving from managing acute issues to addressing health promotion, illness and injury prevention, chronic disease management, and population health. Management of chronic diseases such as diabetes, chronic obstructive pulmonary disease, heart disease, and arthritis in primary care has proven to be effective in improving client outcomes and cost (Reynolds et al., 2018). In addition, there is recognition of the need to address behavioral health diagnoses in conjunction with chronic conditions (Bahorik et al., 2017; Rentas et al., 2019). Challenges related to available resources and access to proper treatment, the impact of mental health diagnoses on the ability to manage chronic conditions, and limitations imposed by insurance coverage have led to an increased need for management of behavioral health in primary care (MacRae & Smith, 2019; Rentas et al., 2019).
The Quadruple Aim emerged as a response to the population health movement; it provides guidelines for primary care models in support of the following four goals: (1) improving the individual experience of care, (2) improving the health of populations, (3) reducing the per capita cost of care, and (4) caring for clinicians to help reduce the prevalence of burnout (Berwick et al., 2008; Bodenheimer & Sinsky, 2014). MACRA provides incentives to improve the integration and coordination of care delivery through evolving payment models. These payment models for primary care are expected to be the best way to address the needs of the more than 133 million people in the United States who have one or more chronic conditions—accounting for more than 75% of health care costs—and to enhance the health and wellness of the population as a whole (Centers for Disease Control and Prevention [CDC], 2009; Contandriopouls et al., 2018; Grundy et al., 2010).
Occupational Therapy’s Role in Primary Care
Occupations are personalized activities in which individuals, groups, and populations engage throughout everyday life and that have meaning and purpose (AOTA, 2020c). Occupational therapy practitioners identify factors internal and external to the client that support or act as barriers to the ability to participate in daily life. Practitioners then provide interventions and offer strategies that capitalize on the client’s strengths and address the identified barriers to facilitate successful participation in occupations. In the primary care setting, practitioners work in interprofessional teams that support each health care professional to provide the highest level of care for the client.
According to the CDC (2009, 2018), approximately one-fourth of people diagnosed with a chronic condition experience significant limitations in daily activities. As members of interprofessional primary care teams, occupational therapy practitioners address the needs of clients with chronic conditions that limit participation in daily activities by addressing client needs (physical, social, and mental health) and contextual and environmental demands. Occupational therapy practitioners’ scope of practice includes evaluation and intervention to address client and contextual aspects of health, including medication management, secondary psychosocial implications of chronic illness, functional cognition, safety, and prevention of rehospitalizations (AOTA, 2014, 2019a; Garvey et al., 2015; Leland et al., 2017; Pyatak et al., 2019).
Occupational therapy practitioners make a distinct contribution in primary care by recognizing and addressing the impact of roles, habits, and routines on management of chronic conditions and development of healthy lifestyles (AOTA, 2013, 2020b; Grijalba Illescas, 2018; Leland et al., 2017; Pyatak et al., 2019). Occupational therapy practitioners also play a significant role in lifestyle modification for chronic disease management. For example, in a study by Cunningham and Valasek (2019), occupational therapists in a primary care setting delivered a direct care intervention for clients with urinary dysfunction that included health education, diet modifications, and relaxation strategies; preliminary evidence indicated that urinary dysfunction decreased, as measured by symptom severity and functional impact. Occupational therapists are distinctly trained to evaluate and address health management routines while considering interpersonal and contextual factors and to support primary care teams by providing services such as
Client-centered and collaborative goal setting (Dahl-Popolizio et al., 2017; Synovec et al., in press),
Assessment of the client’s risk to identify the best interventions and programs to progress the client to action (Dahl-Popolizio et al., 2017), and
Recommendations for referral for additional services (e.g., adaptive devices, environmental modifications, treatment of musculoskeletal conditions or mental health conditions; AOTA, 2016, 2020c).
A growing body of evidence in geriatric care, behavioral health, and pediatric care shows the impact occupational therapy services have on client outcomes and cost-effectiveness within primary care settings (Hart & Parsons, 2015; Jordan, 2019; Synovec et al., in press). In geriatric care, successful participation in occupations can contribute to effective management of chronic conditions and improvements in health and wellness, helping to achieve the fundamental goals of new primary care delivery models (Feldhacker & Doll, 2020; Metzler et al., 2012).
Occupational therapy also has a distinct role in addressing mental health and behavioral health in the primary care setting as they pertain to occupational performance. Clients and PCPs recognize the challenges and limitations in sufficiently addressing mental health needs, including substance use disorder and pain management (MacRae & Smith, 2019; Uyeshiro Simon & Collins, 2017; Winship et al., 2019). Moreover, people with serious mental illness have higher rates of chronic conditions and comorbidities and generally less access to primary care (Bahorik et al., 2017; Maragakis & RachBeisel, 2015). Yet, primary care is where most mental health issues are treated (American Academy of Family Physicians, 2018).
Decreased access to primary care leads or contributes to increased acute care utilization and mortality rates for people with serious mental illness (Bahorik et al., 2017; Rentas et al., 2019). Through evidence-based interventions suitable to the behavioral challenges and occupational needs of individuals, groups, and communities, occupational therapy practitioners can relieve obstacles in addressing client mental health in primary care by
Highlighting the need for early intervention by identifying interruptions in occupations and daily activities,
Providing interventions to enhance independence in daily activities,
Identifying strategies to support adherence to current treatment services,
Delaying the need for long-term institutionalization by addressing barriers to care access,
Improving health outcomes and quality of life, and
Educating and advocating for clients (Conn et al., 2019; Halle et al., 2018; Stein Duker et al., 2019; Synovec et al., in press).
Demands for developmental assessments and supportive services in pediatric primary care have increased, but providers are not consistently trained to identify early intervention needs in a timely manner, which can have an adverse effect on children’s outcomes (Baranek et al., 2015; Individuals With Disabilities Education Improvement Act of 2004, Pub. L. 108-446; Jordan, 2019). Occupational therapists are skilled at providing screenings for children at risk of developmental delays. Not only do they assess early intervention needs, but they also link families with support services, resources, and appropriate community-based care for developmental delays, social–emotional delays, autism spectrum disorder, and other conditions affecting children’s participation in occupations (Jordan, 2019).
Evidence shows the efficacy and cost-effectiveness of occupational therapy interventions in primary care settings for clients across the life course (Borg & Davidson, 2008; Chang et al., 2009; Clark et al., 1997; Eklund et al., 2008; Graff et al., 2007; Gutman et al., 2009; Nagle et al., 2002; Rexe et al., 2013). Research supports the use of interactions and interventions developed in accordance with client preferences and culturally relevant self-management programs to enhance health behaviors, reduce disability, and improve health status and self-efficacy while decreasing health care utilization (Berger et al., 2018; Lorig et al., 2003). These approaches are the hallmark of occupational therapy’s client-centered, occupation-based practice.
Interventions can address physical health, mental health, and contextual barriers to occupational engagement and may be more accessible in the primary care setting (Trembath et al., 2019; World Health Organization [WHO], 2018). Examples of specific interventions include the following:
Self-management of chronic conditions and prevention of secondary complications, individualized according to specific client factors and performance skills, including functional cognition (AOTA, 2019a; Feldhacker & Doll, 2020; Garvey et al., 2015; Leland et al., 2017; Pyatak et al., 2019)
Self-management of psychiatric conditions and promotion of mental health (AOTA, 2016; Dahl-Popolizio et al., 2017; D’Amico et al., 2018; Synovec et al., in press)
Behavioral health approaches, including psychosocial and emotional interventions for coping with symptoms and life stressors (AOTA, 2016; Cunningham & Valasek, 2019; Dahl-Popolizio et al., 2017; D’Amico et al., 2018)
Health promotion and lifestyle modification (AOTA, 2016; Dahl-Popolizio et al., 2017; Schmelzer & Leto, 2018)
Management of musculoskeletal conditions, including pain, through activity modification and medication management to avoid exacerbation of symptoms (Dahl-Popolizio et al., 2017; Leland et al., 2017; Uyeshiro Simon & Collins, 2017)
Safety and falls prevention interventions within the home and community (Halle et al., 2018)
Promotion of and ensured access to community resources for social participation and community integration (AOTA, 2018; Dahl-Popolizio et al., 2017; Mulry et al., 2017)
Driving and community mobility resources for older adults (AOTA, 2020b; Mulry et al., 2017)
Redesign of physical environments to support participation in valued activities (AOTA, 2020b)
Family and caregiver assistance and support (Canadian Association of Occupational Therapists, 2013; Metzler et al., 2012).
Table 1 provides case examples illustrating occupational therapy practitioners’ roles in and contributions to primary care.
Case Examples Highlighting Occupational Therapy Practitioners’ Roles in and Contributions to Primary Care
Note. AOTA = American Occupational Therapy Association; LGBTQ+ = communities and individuals with nonmajority sexual orientations and gender identities; NP = nurse practitioner; PCP = primary care provider.
Within the primary care setting, an occupational therapist must initiate the evaluation or screening process; however, occupational therapy assistants can implement additional assessments and interventions (AOTA, 2020a, 2020c).
Authors
Joy Doll, OTD, OTR/L, FNAP
Tracey Vause Earland, PhD, OTR/L
Julie Dorsey, OTD, OTR/L, CEAS, FAOTA, Chairperson
Adopted by the Representative Assembly Coordinating Committee (RACC) for the Representative Assembly, May 2020
Note. This document replaces the 2014 document The Role of Occupational Therapy in Primary Care, previously published and copyrighted in 2014 by the American Occupational Therapy Association in the American Journal of Occupational Therapy, 68, S25–S33. https://doi.org/10.5014/ajot.2014.686S06
Citation. American Occupational Therapy Association. (2020). Role of occupational therapy in primary care. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410040. https://doi.org/10.5014/ajot.2020.74S3001
Integration of Occupational Therapy Into Primary Care Delivery Models
On some primary care teams, occupational therapy practitioners provide direct care focusing on engagement in occupations through lifestyle modification, whether the barriers are from chronic health conditions or behavioral or mental health diagnoses (Leland et al., 2017). Occupational therapy practitioners may also work within the setting to adapt the physical and social environments and recommend strategies and resources for clients to minimize social and psychological challenges that affect occupational engagement (AOTA, 2016). With the diversity of primary care team composition across health care systems, occupational therapy practitioners can fill a variety of roles.
The comprehensive training occupational therapy practitioners receive to deliver services that address the whole person provides them with opportunities to engage in a variety of primary care delivery models. The Accreditation Council for Occupational Therapy Education (ACOTE®; 2018) standards include multiple models of evidence-based approaches focused on behavioral and mental health assessment, community program development, interprofessional collaboration, health promotion, prevention, and intervention to support efforts to enhance engagement in occupation (Dahl-Popolizio et al., 2017). In alignment with occupational therapy educational training, primary care models include interprofessional collaboration, integrated health care, consultation, and community-based Federally Qualified Health Centers (FQHCs; Dahl-Popolizio et al., 2017; Jordan, 2019; Merryman & Synovec, 2020; Minis et al., 2018; Murphy et al., 2017).
Interprofessional Collaboration
Occupational therapy practitioners involved in primary care must be comfortable with and prepared to function in an interprofessional team. In this context, occupational therapy practitioners must educate primary care team members and demonstrate to them the value of occupational therapy in client care (Donnelly et al., 2013; Halle et al., 2018). Occupational therapy practitioners’ integration into the interprofessional team is necessary. Understanding the team’s dynamics and building strong relationships will ensure that practitioners receive referrals and are included in the team processes (Chapleau et al., 2011; Fiscella & McDaniel, 2018; Merryman & Synovec, 2020).
Within primary care models, interprofessional interaction and care planning often occur within huddles (Fiscella & McDaniel, 2018). Huddles are defined as “focused gatherings of functional groups” (Provost et al., 2015, p. 3). Huddles differ depending on the health care environment but essentially engage all team members in a collaborative care meeting that is brief and focused on enhancing the team process. They have helped teams build relationships to collaborate more effectively (Townsend et al., 2017). Huddles can occur daily or weekly and are often initiated as a way to provide an environment and structure for effective team workflows. Occupational therapy practitioners can find huddle attendance helpful to enhance team members’ knowledge of their roles and responsibilities while learning and advocating where their services might be most effective.
Negotiating the role and intent of occupational therapy on the primary care team is also important (Minis et al., 2018; Muir, 2012). The occupational therapy role varies according to the composition of the primary care team and client needs, and the role may be to address chronic disease management or behavioral health with a focus on occupational performance (Eichler & Royeen, 2016; Koverman et al., 2017; Merryman & Synovec, 2020).
Integrated Health Care
Because of the complexities of reimbursement and regulation and the diversity of care in primary care, multiple approaches exist for occupational therapy in primary care. One is an integrated health care approach. According to the Center for Integrated Health Solutions (n.d.), integrated health care is “the systematic coordination of general and behavioral health care” (para. 3). In integrated health care, the occupational therapy practitioner is a member of the primary care team providing care directly in the primary care setting. For example, the Patient-Centered Medical Home (PCMH) model, defined as a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety” (Patient-Centered Primary Care Collaborative, 2019, para. 1), allows for the integration of occupational therapy in primary care. Integrated health care settings have demonstrated effectiveness in helping people manage complex and chronic conditions through increased coordination and collaboration of care (Dubuc et al., 2013; Ellis & Alexander, 2016; Rumball-Smith et al., 2014).
Incorporating occupational therapy into integrated health care settings has the potential to further improve outcomes through intervention. In the PCMH model, the occupational therapist is available for screenings and brief interventions. The occupational therapy practitioner can act as a direct care provider if doing so is a fit with the interprofessional team, regulations, reimbursement criteria, and client needs. In addition, the occupational therapist actively participates in team practices, including huddles and previsit planning. The intent is to provide collaborative care delivering the most appropriate services at the most appropriate time for the client. In the PCMH model, the occupational therapy practitioner is an active team member, supporting both the team and the client in population health management. In this model, occupational therapy practitioners can provide direct care and collaborate with PCPs in the primary care setting to improve client access to health promotion and chronic disease management services.
The integrated health model often best aligns with a value-based payment system, in which reimbursement is for quality rather than quantity of care. One example in practice of a value-based payment system is the Veterans Affairs Home-Based Primary Care model, which includes occupational therapy practitioners as core providers the interprofessional team (U.S. Department of Veterans Affairs, 2020). Although within this model services are provided primarily in the home instead of the clinic, the concepts of interprofessional care planning and delivery mirror those of the PCMH model and minimize barriers to accessing primary care for geriatric and homebound populations (Schuchman et al., 2018).
Consultation
Occupational therapists provide valuable care delivery through consultation to the primary care team. In this process, the occupational therapist is a member of the primary care team but may not provide care directly in the primary care setting, often because of reimbursement challenges. The primary care team may be a PCMH, but occupational therapy is not fully integrated. When available, the occupational therapist moves out of the traditional outpatient rehabilitation setting and into the primary care area. As a consultant in a PCMH, the occupational therapist often provides a quick screening to ascertain whether occupational therapy services are appropriate for the client, followed by a PCP referral, if applicable.
The intent of this model is to ensure that clients have access to the most appropriate care as quickly as possible to decrease costs and improve the client experience. Typically, in these practice situations the occupational therapist is active in care planning, huddles, and other processes to support the primary care team. The health system is most likely supported by a fee-for-service reimbursement model.
When full integration into the primary care setting is not available, practitioners may participate in a mixed model, with some care delivery integrated into primary care and other services provided through more traditional outpatient rehabilitation. Many health care systems use multiple payment models, forcing the delivery model to adapt to these parameters. Often, this mixed model is effective when the outpatient rehabilitation clinic is co-located with the primary care clinic, allowing clinicians to provide both delivery models efficiently. This model may help facilitate access to occupational therapy services and demonstrate value to support movement toward full integration of services into the primary care clinic.
Federally Qualified Health Centers
Like PCMHs, FQHCs are community-based, nonprofit health centers that provide comprehensive, whole person–centered services, including occupational therapy, to help improve health and social–psychological well-being. They provide low- or no-cost primary care to medically underserved populations and receive funds from the Health Resources and Services Administration (HRSA) Health Center Program (HRSA, 2016). With the inclusion of rehabilitation medicine in the ACA, occupational therapy practitioners have a unique opportunity to provide habilitative, health promotion, and rehabilitation services to culturally marginalized populations (Murphy et al., 2017). Practitioners can relieve the medical services by offering occupation-based services.
Supplementing traditional medical services assists in reducing costs, because FQHCs provide services to clients with Medicaid, Medicare, and private insurance (Murphy et al., 2017). The occupational therapy profession’s distinct skill set in activity analysis, environmental modification, falls prevention, and management of chronic conditions, among other types of care, contributes to potential reductions in health care spending (Murphy et al., 2017). FQHCs must meet a stringent set of requirements, including providing care on a sliding fee scale based on clients’ ability to pay (HRSA, 2016).
As in the PCMH model, the occupational therapy practitioner may be incorporated into the FQHC team. Care collaboration is the recommended evidence-based practice for low-income populations, because clients may present with both significant medical and psychosocial needs (Allen et al., 2017; Bonin et al., 2010; Ford et al., 2018; Martin et al., 2019). People who are served by FQHCs often experience significant barriers to accessing health services, such as limited insurance, limited finances, and lack of transportation (Baggett et al., 2010; Lebrun-Harris et al., 2013). Integration of occupational therapy into FQHC primary care settings reduces these barriers and can increase access to occupational therapy services through integrated and co-located care for individuals who may not otherwise have the ability to receive occupational therapy interventions (Lebrun-Harris et al., 2013; Synovec et al., in press; WHO, 2018).
Reimbursement Models
Occupational therapy practitioners in primary care teams engage in several types of care delivery models, often dictated by the reimbursement models and payer sources within the health system in which services are delivered. As mentioned previously, two main categories of reimbursement in primary care exist: (1) relative value unit, or fee-for-service, and (2) value-based payment. To successfully engage in primary care, occupational therapy practitioners must be aware of the payment models within their setting and ensure that the delivery model for occupational therapy services is reimbursable. Many challenges come with advocating for reimbursement, including payment criteria and regulations. Being prepared to address reimbursement and regulatory issues, however, is part of the current role of occupational therapy practitioners entering primary care.
Currently, alternative payment models that focus on value-based payments are expanding through CMS, supported by MACRA, and many private insurers are following suit. For example, Medicare Advantage Plans have expanded Supplemental Benefits with a focus on addressing SDOH (Murphy-Barron & Buzby, 2019). These value-based reimbursement structures will continue to become more common, and occupational therapy practitioners need to stay abreast of these changes to advocate for client access to occupational therapy as part of the primary care team (Miller, 2018).
Ethical Considerations
It is the professional and ethical responsibility of occupational therapy practitioners to provide services within each practitioner’s level of competence and scope of practice (AOTA, 2015, 2020a). The Occupational Therapy Code of Ethics (2015) establishes principles for guidance and application of safe and competent professional practice when providing primary care (AOTA, 2015). Practitioners should refer to the relevant principles from the Code of Ethics and comply with state and federal regulatory requirements.
Conclusion
Occupational therapy practitioners are well suited to the dynamic nature of contemporary health care delivery systems by virtue of their broad educational background in the liberal arts and the biological, physical, social, and behavioral sciences, which supports an understanding of clients and the importance of occupational engagement across the life course (ACOTE, 2018). Practitioners are prepared to be direct care providers, consultants, educators, case managers, and advocates for clients and their families.
To become more efficient and effective in primary care, occupational therapy practitioners must be familiar with reimbursement and payment models to develop and implement clinical workflows that support occupational therapy in primary care. As payment models continue to evolve to support primary care and value-based reimbursement, the opportunities for occupational therapy in primary care will expand and transform. In addition, occupational therapy practitioners must advocate for and educate others about their role on interprofessional primary care teams to ensure that occupational therapy is recognized as a valued and included member.
Footnotes
1
When the term occupational therapy practitioner is used in this document, it refers to both occupational therapists and occupational therapy assistants (AOTA, 2019b).
2
Client is broadly defined as persons (including those involved in care of a client), groups, and populations; see the Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020c).