CAOT Position Statement
Occupational Therapy and Primary Health Care (2006)

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The Canadian Association of Occupational Therapists (CAOT) believes that the people of Canada have a right to quality primary health care services available from collaborative interprofessional health teams that include occupational therapists. Occupational therapy contributes to primary health care by promoting health, preventing injury and by addressing occupational performance issues within different populations (MSOT, 2005).

Recommendations

1. Occupational therapists inform the public, other health professions and policy decision-makers about the role of occupation in promoting health and well-being.

2. Occupational therapists advocate for access to occupational therapy services in primary health care for individuals, groups and communities.

3. Occupational therapists develop partnerships with relevant organizations and stakeholders to assist advocacy efforts promoting access to occupational therapy in primary health care.

4. Occupational therapists advocate for the appropriate allocation of human, financial and material resources to provide quality occupational therapy services.

5. Occupational therapists promote the development of research among stakeholders that will advance best practices in occupational therapy in primary health care.

6. Occupational therapists engage in change management processes to facilitate the transition to collaborative interdisciplinary practice in primary health care services.

7. Occupational therapists use best practices based on research evidence to support the importance of occupation and occupational performance in primary health care.

CAOT Initiatives

To promote primary health care in occupational therapy, CAOT will:

1. Advocate for the integration of occupational therapists within interdisciplinary primary health care services to increase access to appropriate services for Canadians.

2. Promote the importance of occupation and occupational therapy in primary health care.

3. Advocate for funding models that allow health professionals to practice according to the principles of primary health care and interdisciplinary collaboration.

4. Work with coalitions to participate in advocacy initiatives related to interdisciplinary collaboration strategies or programs.

5. Promote and disseminate the principles, frameworks and toolkits to facilitate knowledge uptake of these important resources which were developed by the Canadian Collaborative Mental Health Initiative (CCMHI) and the Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative (EICP).

6. Support interdisciplinary education at the entry-level to the profession and in professional development initiatives to promote collaborative interdisciplinary practice.

7. Promote profession specific and interdisciplinary research studies that expand the knowledge base for interdisciplinary collaboration in primary health care in Canada.

8. Facilitate the development of change management resources to encourage the transition to collaborative interdisciplinary practice in primary health care services.

Background

Primary Health Care

Primary health care refers to an approach to health and a spectrum of services beyond the traditional health care system. It includes all services that play a part in health such as income, housing, education and environment. Primary care is the element within primary health care that focuses on health care services, including health promotion, illness and injury prevention and the diagnosis and treatment of illness and injury. (Health Canada, 2006)

The key feature of a primary health care approach is the shift to teams of providers who are accountable for providing comprehensive services to their clients. There is a growing consensus that interprofessional collaborative practice will result in better health, improved access to services, more efficient use of resources and better satisfaction for both clients and providers. Research evidence suggests that teams are well positioned to focus on health promotion and improving the management of chronic disease (EICP, 2006).

Primary health care was first defined by the World Health Organization in the 1978 Declaration of Alma Ata. Arising from this work, the Government of Canada established the $800M Primary Health Care Transition Fund (PHCTF) in 2000 in recognition of the need to reform Canada’s health system. They highlighted the importance of a primary health care approach with collaborative interdisciplinary teams. From 2000-2006, the PHCTF supported provinces and territories in their efforts to develop primary health care approaches as well as various pan-Canadian initiatives to address common barriers and offered opportunities for participation by health care system stakeholders.

The Canadian Collaborative Mental Health Initiative (CCMHI) and Enhancing Interdisciplinary Collaboration in Primary Health Care Initiative (EICP), both funded by PHCTH, are examples of projects that involved broad pan-Canadian stakeholders including CAOT. Both initiatives validated important hallmarks of a primary health care approach, including an integrated, population-needs based approach to service planning and delivery. Primary health care involves professionals working together and delivering services within the context of the broader determinants of health (e.g. employment, housing, literacy, income and social status, personal health practices and coping skills, etc). The determinants of health are interrelated and are known to impact upon the health status on individuals, families and communities. An effective primary health care system is integrated with other services and sectors (e.g. home care, tertiary care, housing, education, workplace and the justice system). Effective responses at the primary health care level reduce the need for services at other levels and in other sectors. A keystone of primary health care is interprofessional collaboration that involves the positive interaction of two or more health professionals to bring their unique skills and knowledge to assist clients, families and communities with their health decisions.

The CCMHI and EICP developed important resources to support collaborative interprofessional primary health care including principles, frameworks and toolkits which are intended to have a lasting and sustainable impact on the health system.

Public Policy Context

While the projects funded under the PHCTF have produced useful information outcomes on best practices, according to Health Canada (2006), relatively few Canadians have access to primary health care services in this way. All provinces and territories are implementing plans for primary health care reform. The range and configuration of services may vary from one community to another: there is no one size fits all model. Similarly, there may be various governance and funding models.

Canada lacks a national primary health care framework with equitable funding mechanisms for primary health care professions. Canada’s universal health insurance system was first implemented to provide hospital care and later was expanded to cover physician fees. As a result, public funding now covers almost all physician services, but less than half of the costs of services provided by other health professionals. Under the Canada Health Act, occupational therapy services are not covered outside of hospitals (Government of Canada, 1985). Under special circumstances, provincial or regional programs may fund primary health care occupational therapy services. At present, primary care services in Canada are delivered chiefly by medical practitioners who focus on the diagnosis and treatment of illness and injury.

Roles and Relationships among Primary Health Professionals

Defining roles and relationships among numerous practitioners in primary health care has been noted as one of the most significant and persistent challenges in creating a primary health care approach. These roles and relationships are affected by many factors, including:

• The predominant focus of the health care system on hospital and medical care and the consequent lack of value placed on chronic disease management, health promotion, illness and injury prevention.
• The lack of effective systems for transmitting health information to support continuity of services for consumers.
• Health care funding models that focus on fee-for-service reimbursement for physicians and reward acute episodic care rather than continuing care and health promotion and disease prevention (EICP, 2006).

Ongoing professional, interprofessional and consumer advocacy is required to inform federal and provincial public policy reform about these barriers to access.

Occupational Therapists

Occupational therapists are university-educated health professionals who are regulated in all 10 Canadian provinces. Their education is devoted to the study of occupation and occupational performance. Occupational therapists work with clients to achieve outcomes related to their participation in valued activities. As specialists in the area of occupation and occupational performance, they facilitate an interprofessional collaborative approach that puts clients and their occupational performance at the centre of all decision-making (MSOT, 2005).

Professional Education

Health Canada has made interdisciplinary education a major pillar in its Health Human Resources Strategy (Health Canada, 2005). Interprofessional education in primary health for students of occupational therapy and other health professionals should be addressed in entry-level professional programs and continuing professional education projects to promote interdisciplinary collaborative practices.

Evidence for Occupation and Health

The relationship between engagement in occupation and health has been examined by Law et al (1998). It is important for occupational therapists to communicate this relationship to the public and to policy and decision-makers. Research is needed to further the relationship between these themes.

Practice

Occupational therapists have demonstrated positive outcomes in primary health care roles with populations of seniors, children, youth, workers, homeless people and those with mental health problems (Klaiman, 2004; MSOT, 2005). CAOT membership statistics for 2004-2005 indicate that approximately one-third of members’ practice is in a setting that could be considered primary health care. The settings that were most highly represented included services provided in the client’s home (21.6%), community clinic (5.9%) and client’s worksite (1.8%).

To support the essential work of occupational therapists in primary health care, new public policies and funding structures that include occupational therapy services are required.

Advocacy

Occupational therapists have a critical role in advocating for access to occupational therapy as a primary health care service. The relationship of occupation and occupational performance to health makes occupational therapy a natural fit with the philosophy of primary health care. Both support the integration of primary health care, health promotion, preventative practices and management of health issues throughout a continuum of health and social services.

Strategic advocacy involving all members of the profession will ensure the development of sound public policy that supports a pan-Canadian framework as described in EICP 2006 and CCHMI 2006.

References

Canadian Association of Occupational Therapists (2002). Enabling occupation: An occupational therapy perspective. Ottawa, ON: CAOT Publication ACE.

Canadian Association of Occupational Therapists (2003). Position statement on everyday occupations and health. Retrieved November 2, 2005 from http://www.caot.ca/default.asp?ChangeID=164&pageID.

Canadian Collaborative Mental Health Initiative [CCMHI] (2006). The charter of principles and commitments. Retrieved October 25, 2006 from http://www.ccmhi.ca.

Enhancing Interdisciplinary Collaboration in Primary Health Care. [EICP] (2006). The principles and framework for interdisciplinary  collaboration in primary health care. Retrieved October 25, 2006 from www.eicp.ca.

Government of Canada. (1985). Canada Health Act. Retrieved October 25, 2006 from http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index_e.html.

Health Canada. (2006). Primary Health Care Retrieved on October 25, 2006 from http://www.hc-sc.gc.ca/hcs-sss/prim/phctf-fassp/index_e.html.

Law, M., Steinweinder, S., & Leclair, L. (1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65(2), 81-91.

Klaiman, D. (2004). Increasing access to occupational therapy in primary health care. OT Now, 6(1), 14-19.

Manitoba Society of Occupational Therapists. [MSOT](2005). Occupational therapists and primary health care. Winnipeg, MB: Author.

World Health Organization. (1978). Alma Ata Declaration (Article VI). Geneva: Author.

Position statements are statements on political, ethical and social issues that impact on client welfare or the role and practice of occupational therapy, or that affect the Association. They are frequently time-limited and persons wishing to use them more that two years after publication should confirm their current status by contacting the CAOT Director of Professional Practice by e-mail: practice@caot.ca

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