Introduction
Primary care has undergone significant transformation in the past 20 years. Around the globe, populations are ageing, and health care systems are shifting focus from acute care to chronic disease management (Public Health Agency of Canada, 2017; College of Family Physicians of Canada, 2019). There is a recognition that increasingly complex patients require the support of interprofessional primary care teams for the provision of comprehensive and coordinated care (Hutchison et al., Reference Hutchison, Levesque, Strumpf and Coyle2011; Somé et al., Reference Somé, Devlin, Mehta, Zaric and Sarma2020). Most notably during the pandemic, primary care teams have demonstrated an important role in supporting individuals to cope with the primary care secondary impacts of COVID-19 (Ashcroft, Donnelly, Dancey, et al., Reference Ashcroft, Donnelly, Dancey, Gill, Lam, Kourgiantakis and Brown2021; Ashcroft, Donnelly, Gill, et al., Reference Ashcroft, Donnelly, Gill, Dancey, Lam, Grill and Mehta2021; Donnelly et al, Reference Donnelly, Ashcroft, Bobbette, Mills, Mofina, Tran and Miller2021). As greater numbers of professions work in primary care settings, it is critical to articulate roles and identify evidence, or lack thereof, to support and ensure best practices in interprofessional primary care teams (Donnelly et al., Reference Donnelly, Brenchley, Crawford and Letts2013; Brown et al., Reference Brown, Leclair, Fricke and Wener2021).
The vast majority of individuals address their health care needs in primary care settings (Jaakkimainen et al., Reference Jaakkimainen, Upshur, Klein-Geltink, Leong, Maaten, Schultz and Wang2006; Kringos et al, Reference Kringos, Boerma, Hutchinson and Saltman2015), and as interprofessional primary care teams expand, opportunities for patients to access occupational therapy in primary care increase (Somé et al., Reference Somé, Devlin, Mehta, Zaric and Sarma2020). People with or at risk of impairment and disability are best supported in primary care, and growing evidence indicates that occupational therapy’s unique lens can support these individuals in a primary care setting (Richardson et al., Reference Richardson, Letts, Chan, Officer, Wojkowski, Oliver, Moore, McCarthy, Price and Kinzie2012; Garvey et al., Reference Garvey, Connolly, Boland and Smith2015; Bolt et al,. Reference Bolt, Ikking, Baaijen and Saenger2019; Brown et al, Reference Brown, Leclair, Fricke and Wener2021). Occupational therapists are educated as generalists bringing expertise to help individuals of all ages and develop, recover and improve as well as maintain function and skills needed for daily living. They promote engagement in occupations that influence an individual’s health and well-being (Law et al., Reference Law, Steinwender and Leclair1998). Occupations refer to the “everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do.” (World Federation of Occupational Therapists, n.d.).
Occupational therapy associations, including those in Canada, the United States, Australia and Europe, are recognizing the importance of articulating the profession’s role in primary care to support interprofessional primary care best practices (Bolt et al., Reference Bolt, Ikking, Baaijen and Saenger2019; Canadian Association of Occupational Therapists [CAOT], 2013; Muir, Reference Muir2012; American Occupational Therapy Association [AOTA], 2020). However, one of the biggest challenges to occupational therapy’s integration in primary care is the lack of understanding of their role by other primary care team members (Donnelly et al., Reference Donnelly, Brenchley, Crawford and Letts2013; Brown et al., Reference Brown, Leclair, Fricke and Wener2021). Historically, and most notably, occupational therapy has been considered synonymous with rehabilitation, facilitating recovery from and adaptation to any injury, illness or disease including chronic diseases. However, the scope of occupational therapy goes well beyond rehabilitation to include health promotion, disability and disease prevention and community development (Metzler et al., Reference Metzler, Hartmann and Lowenthal2012; AOTA, 2020); perspectives that are well aligned with primary care. A recent review paper examined occupational therapy interventions in primary care (Bolt et al., Reference Bolt, Ikking, Baaijen and Saenger2019); however, a broader review of the literature is needed to fully understand the role occupational therapists can play on primary care teams. The objective of this scoping review is to examine and describe the current evidence about occupational therapy services in primary care.
Methodology
The authors (CD, LL, CH, PW, LL) conducted a scoping review following Arksey and O’Malley’s (Reference Arksey and O’Malley2005) methodological framework with the modifications and enhancements suggested by Levac et al. (Reference Levac, Colquhoun and O’Brien2010). A scoping review provides an overview of the written evidence that is available on a particular topic and typically does not focus on the methodological quality of the existing evidence (Peters et al., Reference Peters, Godfrey, Khalil, McInerney, Parker and Soares2015). Not assessing for methodological quality of the evidence is appropriate when the topic of interest is emergent, and the desire is to include all of the relevant information. Scoping reviews are particularly useful for bringing together research and non-research information. Arksey and O’Malley’s (Reference Arksey and O’Malley2005) six-step process for a scoping review was as follows: 1. developing the purpose and review question(s); 2. identifying relevant studies; 3. selecting studies using an iterative team approach; 4. charting the data incorporating a numerical summary and thematic analysis; 5. collating, summarizing and reporting the results along with the implications for policy, practice or research; and 6. consulting with stakeholders to inform or validate study findings (Arksey & O’Malley, Reference Arksey and O’Malley2005). Arksey and O’Malley (Reference Arksey and O’Malley2005) stated that the sixth step is optional and this step was not included. No review protocol exists for this scoping review.
The following research question guided the search: What is the role of occupational therapy in primary care settings? A professional health sciences librarian performed a scoping review search of the literature across a number of relevant databases. While searches varied in keeping with the options available within each database, a combination of controlled vocabulary and keyword queries was used as available in each database. The title, abstract and subject heading (if applicable) fields were searched. The subject headings searched were occupational therapy, primary care physicians, family physicians, general practitioners, primary care nursing, community health centres/centres, outpatients, ambulatory care, general practice (exploded) and primary health care (exploded). A series of keyword strategies were created to access literature focussing on the concept of occupational therapy and therapists, family physicians and nurses, ambulatory healthcare and patient care, outpatients, community healthcare and health centers to ensure that all relevant studies were captured in the search (see the detailed OVID Medline search strategies Appendix A). The following databases were searched from their earliest date of coverage through August 31, 2021 Ovid Medline, Ovid EMBASE, SCOPUS, EBSCOhost CINAHL, Cochrane Library and Google Scholar. Guideline databases, NICE and National Guideline Clearinghouse were also searched. General searches on Google Scholar using terms such as “role of occupational therapy in primary care”, “occupational therapy” and “primary care” produced a list of articles that helped to inform the final choice of keywords for the search of the databases. The researchers also included websites of occupational therapy associations and manually searching the reference lists of the selected articles to identify any additional literature.
Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. Primary care and the structure of occupational therapy practice in this setting were understood based on the key feature described by Starfield (Reference Starfield1994), including care that is the first point of contact, comprehensive, coordinated and provided longitudinally over the lifespan. All existing literature including primary research studies, systematic reviews, scoping reviews, narrative reviews, opinion pieces, letters, guidelines, position papers, reports and service descriptions were included as sources for this scoping review.
There were 8280 documents identified in the initial searches. Documents were divided among the authors of the scoping review and each participated in the independent review of sources based on title and abstract. A team of two authors reviewed every source; in pairs, they compared and discussed the selected sources to ensure agreement. Four hundred and eighteen sources were identified for full-text review through this process. Of these sources, 102 met the selection criteria and were included, 18 were not available in English or French (the languages spoken by the authors) and 293 did not specify the role of occupational therapists and/or were not related to primary care. Twenty-two additional articles were identified by reviewing the reference lists of relevant articles and searching websites of occupational therapy associations for a total of 129 articles. See Figure 1 for the selection algorithm.
PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases, registers and other sources
Data were extracted using a charting table to ensure extraction consistency among team members (Levac et al., Reference Levac, Colquhoun and O’Brien2010). The data charting table (Appendix B) included headings based on Arksey and O’Malley’s (Reference Arksey and O’Malley2005) and Peters et al. (Reference Peters, Godfrey, Khalil, McInerney, Parker and Soares2015) data charting forms, which were expanded to include extraction of information on the role of occupational therapy in primary care. Health equity was also considered within the data charting table, a pertinent area to assess given the focus on health equity in many primary care settings. If a specific heading did not apply, as was often the case with grey literature, that column was left blank. Data charting was an iterative process in which all the authors of the scoping review (author initials here) participated and discussed throughout the data charting process to ensure that relevant information was being consistently captured for the review.
Levac et al. (Reference Levac, Colquhoun and O’Brien2010) identified three stages: analyzing the data, reporting the results and applying meaning to the results. Analyzing the data included completing a descriptive numerical analysis and a thematic analysis (Levac et al., Reference Levac, Colquhoun and O’Brien2010). The descriptive numerical analysis involved reporting the number of research and descriptive studies, study designs, publication year, study population and study location (Levac et al., Reference Levac, Colquhoun and O’Brien2010). A thematic analysis followed qualitative data analysis techniques in which two authors independently coded each article while considering the occupational therapy practice process to reflect whether the approach involved assessment or intervention and if these approaches were unique to the article. In addition, we coded using the Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, Reference Townsend and Polatajko2013). While this is a Canadian framework, it is widely used internationally to inform occupational therapy practice.
Using the Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, Reference Townsend and Polatajko2013), occupational therapists may address three domains including, aspects of the person (physical, cognitive, or affective components), environment (physical, social, cultural, institutional), occupation (self-care, productivity, or leisure) or all three, as they seek to optimize a patient’s ability to perform and engage in meaningful occupations. The Canadian Model of Occupational Performance and Engagement was used to classify assessment and intervention approaches that addressed: the person, occupation, environment or a comprehensive person–environment–occupation (PEO) approach. For example, a falls-prevention intervention that addresses balance (aspect of the person), simplifying activities (aspects of occupation) and falls hazards (aspects of the environment) would be classified as a comprehensive PEO approach. Additionally, we applied a lifespan lens and examined assessments and interventions that focussed on four age groups: children and youth; adults; older adults; adults and older adults.
Results
A total of 129 articles were included in the final sample. Table 1 provides a summary of the research literature. Just over half of the articles (n = 67) were researched. Of the sixty-seven research articles that were included, 18 applied a mixed or multiple methods design, 12 were qualitative designs, and 37 were quantitative designs. Of the mixed methods studies, seven involved feasibility studies that used a quasi-experimental design (n = 7) or randomized controlled trials (RCT) design (n = 1) to examine occupational therapy interventions in primary care. The qualitative component of these mixed methods studies primarily used interviews to examine the feasibility of the interventions. Fourteen of the quantitative studies were pilot RCTs or RCTs, nine were quasi-experimental with the remaining 14 being observational studies including retrospective chart review (n = 5) and survey studies (n = 4).
Summary of research articles
The majority of the publications were from five countries including the United States (n = 16), Canada (n = 14), Sweden (n = 12), Ireland (n = 10), England/UK (n = 6) and Australia (n = 5) with 42% articles published in the past five years and 78% in the past 10 years. Of note, 57% (n = 8) of the RCTs were published in the last five years. Included in the non-research publications are six occupational therapy professional bodies that have published descriptions of the role of occupational therapy in primary care (American Occupational Therapy Association [AOTA], 2014; AOTA, 2020; Baaiken et al., Reference Baaijen, Bolt, Ikking and Saenger2016; CAOT, 2013; Leclair et al., Reference Leclair, Restall, Edwards, Cooper, Stern, Soltys and Sapacz2005; Ontario Society of Occupational Therapists, n.d.; Society of Alberta Occupational Therapists, 2013). The research studies focussed heavily on individuals with chronic conditions, including both physical health and mental health conditions such as pain, diabetes, depression and anxiety. The focus of these studies was primarily on adults and older adults, with only two studies involving children or youth.
Across the research and non-research literature, 268 assessments were identified, of which 139 were unique assessments (i.e. mentioned in only one article) and 868 total interventions were identified, representing 324 unique interventions (i.e. mentioned in only one article) implemented in primary care settings. In the following sections, the assessment and intervention categories are further broken down to examine whether occupational therapy services provided directly in primary care settings focussed on aspects of the person, occupation, environment or all three comprehensively. Supplementary files display the role descriptions according to these categorizations based on non-research articles (position statements, practice guidelines, commentaries and programme descriptions) and research articles. Analysis of this literature shows that overall, occupational therapy in primary care works towards optimizing patient participation in daily occupations including care for self, employment, leisure and social and community activities.
Assessment
Across all articles, occupational therapy assessment in primary care focussed on the person (36%) with the most frequency, followed by occupation (32%), the environment (26%) and a combination of all three (6%). For those assessments focussed on aspects of the person, developmental screening was the primary assessment identified for children and youth (n = 12 unique articles). Person-focussed assessments for adults predominantly addressed physical health domains, including range of motion, strength and endurance, with assessments of mental health depression and anxiety described in six articles. For older adults, person-focussed assessments primarily targeted similar physical health domains as for adults, as well as cognitive screening (n = 13 articles).
Assessments of occupation included two specifically for children, one of which involved the observation of play (Dunbar & Reed, Reference Dunbar and Reed1999). For adults and older adults, the majority of the occupation-focussed assessments examined the analysis of everyday activities (n = 20 articles) and self-care (n = 19 articles), including both activities of daily living (n = 8 articles) and instrumental activities of daily living (n = 4 articles).
At the level of the environment, the majority of assessments in primary care targeted the general physical environment (n = 38 articles), with home safety assessment (n = 19 articles), ergonomic assessments (n = 7 articles) and home accessibility (n = 6 articles) being the most frequently identified assessments for adult and older adult populations. Falls screening/falls risk assessment (n = 9 articles) addressed all of the person–occupation–environment domains. Details of the assessments conducted in primary care can be found in Tables 2 and 3 and supplementary files.
Summary of assessments and interventions
PEO = Person–Environment–Occupation.
Summary of assessments by lifespan
Intervention
Occupational therapy interventions addressing occupations were identified with the most frequency (29%), including interventions supporting individuals to engage in self-care, work and leisure activities. Intervention focussing on the environment was the next most frequently reported intervention (28%), including facilitating home safety and accessibility, followed by comprehensive interventions that addressed the person–occupation–environment (24%). Interventions that targeted the person (e.g. exercise) were described with the least frequency (19%). Only 2% of all interventions targeted children and youth.
The majority of interventions in primary care to address aspects of the person for adults and older adults involved exercise, physical activity and movement (n = 34 unique articles). Interventions to support mental health were the next most frequently identified interventions and included counselling and psychotherapy (n = 10 articles) and anxiety management (n = 5 articles). Interventions focussing on cognition identified the use of cognitive behavioural techniques (n = 9 articles) and interventions that addressed all components of the person included promoting positive health behaviours (n = 8 articles). Only one person-level intervention was identified specifically for children and youth; this intervention was aimed at facilitating typical movement patterns.
Occupation-focussed interventions in primary care for adults most frequently targeted the worker role (n = 20 articles), seeking to support individuals to enter, remain or return to the workplace. For adults and older adults, interventions that sought to support functional and community mobility, including driving (n = 23 articles) were identified most frequently, followed by lifestyle interventions to modify lifestyles (n = 18 articles) and facilitate healthy habit, roles and routines. Occupation-based goal-oriented interventions (n = 19 articles) were used across the lifespan. Fewer occupation-level interventions focussed only on older adults, and those that did address supporting healthy eating and nutrition (n = 3 articles) and engaging in social activities (n = 2 articles).
At the environment, four unique interventions addressed children and youth including school accessibility (n = 1 articles), advocacy for inclusive education (n = 1 article), facilitating school board requirements and resources (n = 3 articles) and supporting parent–child interactions (n = 1 article). Interventions that focussed on the environment for adults included workplace ergonomics (n = 6 articles) and modifications (n = 2 articles). Facilitating home safety was the most frequent intervention for older adults (n = 15 articles). The majority of environment-focussed interventions (46%) were applied across all age groups, with the most frequent including referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), followed by supporting family and caregivers (n = 25 articles), and providing assistive technology and adaptive equipment (n = 19 articles).
The three most frequently identified interventions for adults and older adults targeted a combination of the PEO, including chronic disease management (n = 34 articles), self-management education (n = 28 articles) and pain management (n = 22 articles). Chronic disease management was the umbrella term used to capture occupational therapy interventions for both physical and mental health conditions and self-management was a more specific description used on its own or along with the description of chronic disease management. Falls prevention was the most frequently identified intervention for older adults and also focussed on the person, occupation and environment together (n = 27 articles). A number of other interventions were provided across the lifespan and included health promotion (n = 30 articles) and disability and disease prevention (n = 17 articles). It should be noted that health promotion and disability and disease prevention were general terms used in the literature and did not include specific details. Full details of the interventions can be found in Tables 2, 3 and 4 and supplementary files.
Summary of interventions by lifespan
Health equity and access
Access and equity are important issues to consider if our vision is to ensure patients and communities have access to occupational therapy in primary care settings. Two articles (Murphy et al., Reference Murphy, Griffith, Berkeridge, Mroz and Jirikowic2017; Marval, Reference Marval2018) focussed explicitly on health equity issues. Marval (Reference Marval2018) described specific strategies to reduce access barriers for persons who are street-involved, at risk of homelessness or experiencing homelessness in a Canadian context. Murphy and colleagues (Reference Murphy, Griffith, Berkeridge, Mroz and Jirikowic2017) explored how occupational therapists in the United States are well-positioned to work with Federally Qualified Health Centres to support access to medically underserved populations. Additionally, one article (Dunbar & Reed, Reference Dunbar and Reed1999) examined children living in poverty and another explored occupational therapy services to support older adults who were precariously housed (Merryman & Synovec, Reference Merryman and Synovec2020). Two articles focussed solely on woman and disability (Eklund & Erlandsson, Reference Eklund and Erlandsson2014; Gonzalez et al., Reference Gonzalez, del Teso Rubio, Paniagua, Criado-Alvarez and Holgado2015), and one article (Naidoo et al., Reference Naidoo, Van Wyk and Joubert2017) identified the need for occupational therapists in South Africa to take on advocacy roles that facilitate social inclusion and enhance access to resources for persons with a disability. Oliveira and Ferigato (Reference Oliveira and Ferigato2019) sought to understand how Brazilian occupational therapists working in primary care can support women who have experienced domestic and family violence.
A number of articles published in the United States discussed issues of access, which were linked to the broader health system and the current lack of funding mechanisms to support occupational therapy in primary care (Dahl-Popolzio et al., Reference Dahl-Popolizio2017; Jordan, Reference Jordan2019; AOTA, 2020). One article in the Canadian context (Donnelly et al., Reference Donnelly, Brenchley, Crawford and Letts2014) highlighted issues related to access and occupational therapy in primary care.
Discussion
This paper is the first to provide a review of the role of occupational therapy in primary care including assessment and interventions in both research and non-research literature. The scoping review highlights that primary care is a relatively new practice setting for occupational therapy, with just under half of the papers being non-research and largely offering a visionary description of the potential roles of occupational therapy in primary care. However, the evidence specific to occupational therapy in primary care has doubled in the past five years with 8 of the 14 RCT’s published since 2018. The increasing attention demonstrates the expansion of this role in Canada, the United States, Europe, and Australia. Primary care occupational therapy is an area of tremendous research and practice opportunity.
The review emphasizes that occupational therapists working in primary care provide services aimed at promoting patients’ engagement in occupations, by addressing the person, the occupations in which they engage, and the home and community environments for individuals of all ages. Although occupational therapy may provide assessment and interventions to children and youth in primary care, the predominant focus in the literature is on adult and older adult populations, largely due to the emphasis on managing chronic conditions in adults and supporting older adults to live independently in their homes. Occupational therapists assessed and treated physical, cognitive and affective components of patients presenting to primary care settings. We identified a total of 181 unique interventions in the research literature highlighting both the depth and the breadth of the profession in primary care. This comprehensive approach to patient care is in keeping with generalist primary care practice, which has been described elsewhere in the literature (Devereaux & Walker,Reference Devereaux and Walker1995; Donnelly et al., Reference Donnelly, Brenchley, Crawford and Letts2014, Reference Donnelly, Leclair, Wener, Hand and Letts2016).
The most frequently identified primary care occupational therapy interventions were chronic disease management (n = 34)/self-management (n = 28), referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), health promotion (n = 30) and falls prevention (n = 27). Health promotion is not so much a specific role, but rather a framework that identifies different levels at which occupational therapists can intervene to support patients in primary care. Wilcock (Reference Wilcock2006: 313) statds that “an occupation-focussed approach to health promotion involves enabling people to increase control over, and to improve, their health and that this can be attained through doing (occupations)”. Wilcock and Hocking (Reference Wilcock and Hocking2015) present four levels of health-promoting occupational therapy that are reflective of the assessments and interventions identified in this scoping review. Level one is directed to the general public, focussing on preventing health-damaging behaviours and illness. The results at this level would include such roles as developmental screening, falls risk assessments and prevention, injury prevention, driver screening, healthy eating and weight management. Level two includes individuals who currently experience health issues to influence behaviour change and to slow down or prevent further disease and disability. A large number of the roles identified in this review fall into this level. Included here are lifestyle modifications, promotion of healthy habits and routines, chronic disease self-management activities including joint protection, energy conservation, home exercises, counselling, pain management and ergonomics. The third level addresses those individuals with chronic disease and disability and aims to maintain health and well-being. Occupational therapists most often work with this population and a range of roles fit here including prescription of assistive technology, home modifications, supporting access to disability supports and benefits, transportation, mobility interventions, caregiver support and education, facilitating return to work and supporting children’s performance at school. The final level is directed towards end-of-life care and supporting quality of life. While there were fewer roles identified for this final level, there was a clear identification of the role for occupational therapy to offer end-of-life care and support families and caregivers, particularly in the non-research literature.
Occupation-focussed interventions were the most frequently identified overall, which highlights the strong emphasis placed on supporting healthy daily activities and routines. In primary care, there is a growing focus on lifestyle medicine, whose aim is to support individuals to adopt behaviours to improve health and quality of life (Bourbeau et al., Reference Bourbeau, Lavoie, Sedeno, De Sousa, Erzen, Hamilton, Maltais, Troosters and Leidy2016; Rash et al., Reference Rash, Lavoie, Sigal, Campbell, Manns, Tonelli and Campbell2016). A number of barriers have been reported that limit primary care in providing lifestyle intervention including low confidence of providers, lack of time, belief about and knowledge of lifestyle interventions (Lianov & Johnston, Reference Lianov and Johnson2010; Bouma et al., Reference Bouma, van Wilgen, Baarveld, Lemmink, Diercks and Dijkstra2019). An interprofessional team has been recommended to enhance lifestyle medicine and a strong argument could be made that occupational therapy is ideally suited to support lifestyle medicine; focussing on occupation and understanding the impact of person-level factors on activities and routines within the context of their environments (Moll et al., Reference Moll, Gewurtz, Krupa, Law, Lariviere and Levasseur2015; AOTA, 2020).
This scoping review shed some light on occupational therapists’ work with at risk populations in primary care and health equity issues. Occupational therapists’ have a long history of working with underserved populations to redress inequities in health, valuing equity principles as part of their practice and seeking to enable a just society (Townsend & Wilcock, Reference Townsend and Wilcock2004; Restall et al., Reference Restall, MacLeod Schroeder and Dubé2018). Occupational therapist, however, have also experienced challenges applying these principles across the health care system (Gerlach, Reference Gerlach2015;Restall et al., Reference Restall, MacLeod Schroeder and Dubé2018). The results of this review point to the fact occupational therapists in primary care are working to connect people to services across health and social systems and are well-placed to address social determinants of health and health inequities. Moving forward occupational therapists need to consider how they can and moving beyond traditional individual interventions in primary care settings and consider adopting human right approaches as suggested by Restall and colleagues (Reference Restall, MacLeod Schroeder and Dubé2018) to support people and communities.
Much of the early literature used to support the role of occupational therapy in primary care drew on occupational therapy research that could inform the role, with relevant populations, but was not directly studied in a primary care context. Many recent non-research papers that call for occupational therapy in primary care still largely rely on evidence gathered in non-primary care settings. For those people, who have disability and multiple conditions, the evidence about the effectiveness of occupational therapy interventions may be transferable to delivery in a primary care context, because the interventions themselves may be very similar regardless of the delivery site. However, it must be understood that primary care is a unique setting and what might work in other practice settings may not work in primary care.
One of the key limitations of the scoping review is the discrepancy in how primary care is defined and understood in occupational therapy, making it difficult, at times, to determine the specific setting in which the study was conducted. This lack of clarity within the profession could have led to missed research. Moving forward, researchers need to be clear in the description of the primary care setting and provide context regarding the health care models or services. The authors of this scoping review did not evaluate the strength of the research evidence in relation to the role and contributions of occupational therapists in primary care. While these are not part of the original scoping review methodology, they could have provided additional insights into the findings.
In conclusion, our review has demonstrated a breadth of contributions that occupational therapists are making in primary care with a role that is focussed on understanding how individuals are engaging in everyday activities and supporting them to participate in their communities through interventions targeted at building or adapting individual capacity, engaging in occupations and ensuring safe and accessible environments. Primary care is a relatively new practice setting for occupational therapists and offers a unique opportunity for the profession to draw on a health promotion lens, which the scoping review has demonstrated.
Primary care has almost exclusively been physician-based, where a biomedical model is the dominant practice framework. With the changing practice demographics, occupational therapists can bring their health promotion lens and unique understanding of everyday activities and function to primary care teams to support physicians and the broader team meet the more complex health and social needs seen in primary care. As the World Health Organization’s ‘Rehabilitation 2030 Initiative’ draws attention to the need to strengthen access to rehabilitation across health system, it is clear there is a need across the globe for ongoing efforts to ensure solidification and further integration of occupational therapy in primary care contexts.
Supplementary material
To view supplementary material for this article, please visit https://doi.org/10.1017/S1463423622000123
Acknowledgements
We would like to acknowledge the following occupational therapy students who assisted in this scoping review: Ashley Yussiem, Monica Kapac, Danielle Degagane, Anna Tjaden- Clemens, Swanti Duet, Amanda Mofina and Ashley Williams.
Financial support
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Conflict of interest
None.
Ethical standards
No human participants were involved in this scoping review.
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