Establishing a New OT Service Line for Underserved Older Adults With Multimorbidity at a Federally Qualified Health Center

To describe occupational therapy (OT) services initiated at a Federally Qualified Health Center for medically complex older adults with multimorbidity, including 1) the reasons for provider referral to OT, 2) the OT treatment justification and treatments provided, and 3) how the clinic environment influenced service delivery. This descriptive retrospective case analysis included a purposive sampling strategy to select electronic health records for participants ages 55+ with multimorbidity (defined as 2+ chronic conditions) who were referred for OT services between June and August 2024. Descriptive statistics were used to analyze patient socio-demographic data. Qualitative content analysis was used to analyze the medical provider’s reason for referral, OT treatment justification, and interventions utilized. Additional qualitative data (one interview with the treating OT and photographs of the treatment space) were also collected and analyzed using thematic analysis. Participants were n = 20 older adults ages 55-85 (mean = 76); 45% female, 60% Spanish-speaking with a mean = 8.5 chronic conditions (range: 1-20). Provider referrals were most commonly for fall risk and impaired mobility. The most common OT justifications for treatment were impairments with health management occupations (63%) and activities of daily living (ADL) (35%). The most common treatment approaches utilized were establish/restore approaches (52% of treatments), assistive technology/environmental modifications (17%), and education (13%). The clinic environment was not designed to account for OT treatments and the physical space and scheduling structure posed challenges to providing optimal treatment. Clinic patients demonstrated numerous impairments to health management occupations and ADL that were associated with multimorbidity and untreated until they were given access to OT services. Establishing OT services in the primary care setting could improve access to care for disadvantaged older adults.

References

Donnelly, C., Leclair, L., Hand, C., & Wener, P. (2023). Occupational therapy services in primary care: a scoping review. Primary Health Care Research & Development, 24(7), 1–18. https://doi:10.1017/S1463423622000123

Frost, R., Rait, G., Wheatley, A., Wilcock, J., Robinson, L., Harrison Dening, K., Allan, L., Banerjee, S., Manthorpe, J., & Walters, K. (2020). What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. Health & Social Care in the Community, 28(6), 1915–1927. https://doi-org./10.1111/hsc.13085

Dahl-Popolizio, S., Sauber, T, M., & Mookadam, M. (2023). How occupational therapy can contribute to the primary care team and reduce physician burden. National Library of Medicine, 30(3), 15–19.

American Occupational Therapy Assocation. (2020). Role of occupational therapy in primary care. American Journal of Occupational Therapy, 74(3), Article 7413410040. https://doi.org/10.5014/ajot.2020.74S3001