The OT can see you now

In October, Jamie Archer, MSOT, OTR/L, will celebrate her one-year anniversary with the Program in Occupational Therapy’s Community Practice. Although she’s a relatively new face on the team, Archer has become the go-to resource for the physicians, staff and patients at the Movement Disorders Center, where she has launched and grown an OT service line for patients with Huntington disease (HD).

Archer was specifically recruited to fill this role by Pat Nellis, MBA, OTR/L, director of clinical operations, after being approached by Joel Perlmutter, MD, and Stacey Barton, MSW, from the HDSA Center of Excellence located within the Movement Disorders Center. The Center had recently received a grant from the Huntington’s Disease Society of America (HDSA), which stipulated that more services such as PT or OT be provided within the clinic. Upon discussing ways to enhance the clinic activities and meet the requirements of the grant, they decided to approach Nellis about a collaboration with OT. “The partnership was well received by Pat Nellis and the OT program, and we were thrilled,” shares Barton. “OT is a good fit because these families are struggling with a progressive neurological condition which impacts independence and function very early in the course of the disease, and we knew that OT was uniquely capable of improving the lives of these patients and their caregivers.”

Prior to her arrival on the Community Practice team, Archer worked at Barnes-Jewish Hospital as an OT in acute care, where she gained extensive experience in neurology and program development. This experience provided the perfect skill set for her to use in developing this new partnership and service line.

Positioning OT in a primary care model

Archer’s first step in implementing the program was to dive into research on OT’s role in primary care. “The literature very strongly supported getting in with the team, learning their flow and how they operate, and then taking every opportunity available to educate about OT, and that was the strongest message for me,” shares Archer. She spent time meeting with different members of the clinic team and observing and educating the physicians to best determine how OT could fit into the existing process. “In our approach to integrate OT, we tried to make the least work possible for the physicians because we assumed the likelihood of them making any changes in their practice would be greater,” says Archer. “We analyzed the existing MD assessment and were able to highlight indicators for OT
in their current assessment to avoid the need for additional components.”

After developing an outline, Archer presented her findings and implemented a pilot program requiring significant coordination of schedules between the groups and orchestration of patient flows within the clinic. Archer designates one day each week in the center to evaluate clients who elect to see her for OT during their regular visit, where they will either see her before or after the appointment with their physician. And sometimes, shares Archer, her time spent with the client is broken up so she sees them both before and after their visit with the physician. “It’s totally dependent upon the flow of the clinic that day,” she says. “Although this seems fairly simple, it has been a long process of trial and error to see what worked best for everyone on the team and more importantly, the patients. This is very much a team effort and the process is dependent on each person involved. We have a great team who all work hard each week to make it possible to offer OT to our clients.” Although it requires significant time, attention to detail and flexibility, the end results provides a much better experience for the patients and families. “The collaboration of care is much stronger since we are all able to provide a direct verbal recommendation to each team member and discuss patient cases when needed,” says Archer. “This also makes the entire visit more transparent for the patient.”

Shaping the patient experience

One of the largest benefits to patients is that this streamlined process provides them with the opportunity to see multiple members of a specialty team in one visit instead of traveling to multiple appointments in different locations. This is especially true for those patients who travel a large distance for their appointment. “This has been very well received by patients and families,” shares Barton. “Because of the nature of the disease, patients are not always aware of the extent of their deficits so sometimes they don’t know what help they could use. I think a lot of patients were unfamiliar with OT before but once they understand the role, they almost always see benefit in it.”

The physicians also appreciate the comprehensiveness of the model, adds Barton. “Our physicians are very supportive of OT interventions and I think the main benefit is that we can provide patients with another lifeline to better quality of life by referring them to Jamie. When we made external (OT) referrals before, we never knew what the quality of care would be.”

For Perlmutter, MD, who is also the Elliot Stein Family Professor of Neurology, it’s an opportunity to leverage the strengths an OT can offer for his patients. “Huntington disease causes relentless progressive cognitive impairment, motor dysfunction and changes in personality. Each of these domains leads to substantial difficulties in activities of daily living and interacting with all components of the environment including work space, home and personal interactions. Occupational therapy can play a vital role in helping devise and implement adaptive strategies for HD patients and families to maximize function and independence. We rely upon the skills and understanding of our OT colleagues to address these needs and help our patients and families cope with their challenges.”

Performance improvements and next steps

Overall, the program is continuing to develop, shares Archer. “After several modifications over the last 6-8 months, our program is continuing to evolve each week. I meet regularly with various members of the team to discuss barriers as well as to identify what is working well. My goal is to continue this follow-up so that we are able to make improvements and update the program over time in conjunction with other systematic changes.”

The Movement Disorders Center also works with patients and families affected by a variety of other disorders that similarly impair movement and cognitive capacity, such as Parkinson disease (PD). The team’s new focus is to establish a similar model for clients with PD that offers the same in-clinic service.

“Jamie has really jumped into this in ways beyond what we originally imagined,” adds Barton. “She attends our support groups (and was a recent speaker), she joined the local HDSA Chapter’s Board of Directors and is helping me plan a patient educational conference to be held in St. Louis in March. She has worked very hard to become an expert and this absolutely matters!”