Winship Jodi M, Ivey Carole K, Etz Rebecca S
Jodi M. Winship, MS, OTR/L, is PhD Candidate, Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond;
Carole K. Ivey, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond.
Am J Occup Ther. 2019 Sep/Oct;73(5):7305185010p1-7305185010p10. doi: 10.5014/ajot.2019.030841.
Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting.
To explore the need for and potential role of occupational therapy in a team-based primary care clinic.
A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes.
Outpatient complex care clinic of an urban academic medical center.
The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid.
Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving.
The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address.
This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.
职业治疗领域的领导者呼吁将职业治疗纳入初级保健，但对于该环境下患者的职业需求了解甚少。
探讨职业治疗在团队式初级保健诊所中的需求及潜在作用。
一项定性描述性研究，采用临床医生和患者的便利样本。会议和半结构化访谈进行了记录、转录，并由多名编码员使用一般沉浸式结晶法进行编码，以确定相关主题。
一家城市学术医疗中心的门诊综合护理诊所。
该研究纳入了综合护理诊所的临床医生和患者的自愿样本。患者从工作人员提供的名单中招募；符合条件的患者在该诊所就诊至少1年。所有患者都患有多种慢性病，且未参保或接受医疗补助。
研究人员参加了10次临床医生团队会议，进行了13次患者访谈和10次临床医生访谈。患者和临床医生都确定了患者需求的四个领域：复杂的医疗管理、患者资源有限、心理健康需求以及职业挑战。临床医生还确定了影响护理的认知行为挑战，包括缺乏参与度和解决问题能力差。
诊所团队的构成反映了他们解决医疗、社会经济和心理健康领域问题的意图。然而，认知行为挑战和患者的职业限制并未得到持续解决。因此，患者存在职业治疗从业者有资格解决的未满足需求。
本研究补充了现有文献中关于初级保健诊所患者需求和临床医生挑战的内容。患者的职业需求在初级保健中未得到解决，表明该环境下需要职业治疗。
