Referral Prioritization in Home Care Occupational Therapy: A Matter of Perspective.
Marie-Hélène Raymond, Debbie Ehrmann Feldman, Louise Demers
PMID 32292056WHAT IT FOUND
Home care OTs prioritized falls and safety, while older people and adults with disabilities valued getting out and showering for independence, dignity and participation.
OTs said this safety focus clashed with client-centered practice.
Key findings
01OTs prioritized falls because they saw them as the strongest safety threat, and they often gave lower priority to problems exiting the home or showering.
02OTs described a conflict between prioritizing safety and client-centered practice, because they could not always prioritize what was meaningful to the client.
03Older participants focused on independence, while adults with disabilities made exiting the home their highest priority for social participation.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The older participants had few functional limitations and little experience with occupational therapy services, so their views may reflect the public more than actual clients. The referral scenarios used only four factors, so other priorities may not have emerged. The study was qualitative and purposive, so it cannot show how common these views are or that changing prioritization improves care. The interviewer was an OT and used a reflexivity journal to reduce bias.
Declared interests
Marie-Hélène Raymond was employed part-time as a home care occupational therapist at the time of the study and worked mainly with older persons. She did not know any of the study participants personally. She was a supporting member of Ex aequo, an advocacy group for persons with physical disabilities from 2014 to 2017. Debbie Feldman and Louise Demers declared no conflicts of interest.
The easy way to misread this
Do not treat these findings as evidence that changing prioritization rules improves health outcomes or access. The study reports perspectives from OTs, older persons and adults with disabilities in fictional referral scenarios, and older participants had few functional limitations and little experience with home care occupational therapy.