The role of OT in the primary care clinic

For almost 10 years, Stephanie Stegman, MOT, OTR/L, worked within a large academic medical center, handling everything from patient rehabilitative care to oversight of a growing occupational therapy service. At the same time, she also was a lecturer in the Program in Occupational Therapy at Washington University School of Medicine.

“The problem, as we all know, is that health care has become very fragmented, and there is a definite need to better coordinate care,” she says. “In the years that I worked in the hospital setting, I saw continual readmissions. I came to the realization that we, as occupational therapists (OTs), can help minimize and prevent this. I decided to flip sides to fix it.”

By flipping sides, Stegman means she wants OTs to have a stronger role directly embedded into primary care practices—what she calls the front end of care, versus the back end in hospitals. It would enable OTs to have a stronger preventative role versus a more traditional reactionary role.

“We, as a profession, have talked about this for more than a decade,” she says. “But the changing landscape of health care delivery is putting more emphasis now on overall population health management and better ways to prevent hospital readmissions, reduce costs, and improve outcomes and patient compliance. That environment creates an opportunity to position our profession to better impact patient health.”

For years, the Program in Occupational Therapy has had a clinical community practice program, which provides functional risk assessments and interventional care plans for patients referred to the program. Referrals come from physicians as well as community or governmental agencies. OTs in the program have specialty certifications and work with patients of all ages in niche areas, such as pediatrics, geriatrics, neuromuscular, orthopedics or oncology. Stegman, however, is the first to focus solely on primary care.

“I would like to establish a new model of occupational therapy care in the primary care setting and compile evidence that this model works to enhance outcomes, reduce costs and improve patient experiences,” she says. “In this manner, primary care physicians will be able to see the true value of an OT in their clinics.”

She admits it’s an uphill battle. Primary care physicians typically have little space, if any, to allocate for OTs to provide services within the practice. But with Medicare providing incentives to reduce hospital readmissions nationwide, a growing number of studies is finding that hospitals are actively working with both primary care physicians and post-acute care providers to better coordinate care and patient follow-up in order to minimize the risk of readmission. It’s that focus on the role of primary care where Stegman knows OTs can make a difference.

“We can identify the individual and environmental factors that can lead to functional decline and increase the risk of hospitalization,” she says. “In a primary care practice, we can evaluate behaviors, lifestyle routines, physical dysfunction and activity levels that could be barriers to patients effectively managing their medical conditions. Then, we can follow the patient into their home and see how specific interventions and modifications can remove or minimize those barriers in order to reduce the risk of functional decline and hospital admissions or readmissions.”

Stegman adds, “We are a core component of a team-based approach to health care. From primary care to inpatient, outpatient, rehabilitative and community settings,
we have a role throughout the full care continuum.”