Exploring Reimbursement Pathways for Lifestyle Medicine and Health Promotion Services in Occupational Therapy.

Occupational therapy practitioners are uniquely qualified and positioned to offer both preventive and rehabilitative models of care. However, the status quo of current reimbursement models has created a barrier to occupational therapy practitioners receiving adequate reimbursement, if any, for doing health promotion and lifestyle-focused work. In this Health Policy Perspectives article, we emphasize the need for reimbursement and propose pathways for new and perhaps untapped or underutilized models of reimbursement for occupational therapy practitioners. These pathways require education and advocacy efforts to showcase our distinct value as key reimbursable and interdisciplinary players in lifestyle medicine and health promotion work.

Addressing Diabetes in Primary Care: Hybrid Effectiveness-Implementation Study of Lifestyle Redesign® Occupational Therapy.

IMPORTANCE: Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings. OBJECTIVE: To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic. DESIGN: Patients were randomized to be offered LR-OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods. SETTING: Safety-net primary care clinic. PARTICIPANTS: Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18-75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%. INTERVENTION: Eight 1-hr individual sessions of LR-OT focused on diabetes management. OUTCOMES AND MEASURES: Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR-OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations. RESULTS: Seventy-three patients were offered LR-OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation. CONCLUSIONS AND RELEVANCE: LR-OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care. WHAT THIS ARTICLE ADDS: This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy's effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.

Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team.

Reilly's (1962) now deeply cherished statement that "man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health" (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly's, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy's role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.

Effects of sodium caseinate on hindgut fermentation and fiber digestion in horses.

Eight cecally cannulated Quarter Horses were used in a replicated 4 × 4 Latin square experiment conducted in four 14-d periods to determine effects of sodium caseinate (casein) on hindgut fermentation and fiber digestion. During each period, horses were assigned to one of four treatments consisting of control (water; CON), 0.125 g casein/kg BW (LOW), 0.25 g casein/kg BW (MED), or 0.5 g casein/kg BW (HI). Casein was solubilized in 800 mL water and dosed directly into the cecum at 0700 and 1900 hours using a metal dosing syringe. Smooth Bromegrass hay (CP 8.50%), water, and salt were provided ad libitum. New hay was fed at 0700 and 1900 hours, and orts were recorded at 1900 daily. During the final 3 d of each period, cecal digesta were collected every 6 h, pH was measured, and samples were frozen for subsequent analyses of VFA and NH3 concentrations. Feed intake during the final 4 d of each period was recorded. Feces were collected during the 3-d sampling period, pooled, subsampled, and frozen. Fecal samples were analyzed for pH and used to determine digestibilities of DM, OM, NDF, and ADF. Statistical analyses were performed via the GLIMMIX procedure of SAS 9.4. Linear and quadratic effects of sodium caseinate on pH, VFA concentrations, and apparent digestibility were assessed by SAS. Digestibilities of DM, OM, ADF, and NDF were unaffected by treatment (P > 0.40). Horses dosed with CON and MED treatments had greater cecal pH than those fed LOW or HI treatments (P < 0.01). Cecal NH3 concentrations increased linearly in response to the amount of casein administered (P < 0.01). Cecal NH3 decreased 6 h after dosing and addition of new hay, regardless of treatment (P < 0.01). Total cecal VFA were unaffected by treatment (P > 0.10), but VFA changed over time with the greatest concentrations observed 6 h after treatments were administered and introduction of new hay (P < 0.01). Treatment did not affect DMI (P ≥ 0.17). In this experiment, cecal infusions of sodium caseinate had minimal to no effect on fermentation parameters or fiber degradation in the horse. A type II error may have occurred due to small population size or the medium quality hay fed to these horses provided sufficient N for microbial fermentation.

Assessment of student interprofessional education (IPE) training for team-based geriatric home care: does IPE training change students' knowledge and attitudes?

Our study assesses changes in students' knowledge and attitudes after participation in an interprofessional, team-based, geriatric home training program. Second-year medical, physician assistant, occupational therapy, social work, and physical therapy students; third-year pharmacy students; and fourth-year dental students were led by interprofessional faculty teams. Student participants were assessed before and after the curriculum using an interprofessional attitudes learning scale. Significant differences and positive data trends were noted at year-end. Our study suggests that early implementation, assessment, and standardization of years of student training is needed for optimal interprofessional geriatric learning. Additionally, alternative student assessment tools should be considered for future studies.

Decision-making, sensitivity to reward and attrition in weight management.

OBJECTIVE: Attrition is a common problem in weight management. Understanding the risk factors for attrition should enhance professionals' ability to increase completion rates and improve health outcomes for more individuals. A model that draws upon neuropsychological knowledge on reward-sensitivity in obesity and overeating to predict attrition is proposed. METHODS: A total of 52 participants in a weight-management program completed a complex decision-making task. Decision-making characteristics-including sensitivity to reward-were further estimated using a quantitative model. Impulsivity and risk-taking measures were also administered. RESULTS: Consistent with the hypothesis that sensitivity to reward predicted attrition, program dropouts had higher sensitivity to reward than completers (P < 0.03). No differences were observed between completers and dropouts in initial BMI, age, employment status, or the number of prior weight-loss attempts (P ≥ 0.07). Completers had a slightly higher education level than dropouts, but its inclusion in the model did not increase predictive power. Impulsivity, delay of gratification, and risk taking did not predict attrition, either. CONCLUSIONS: Findings link attrition in weight management to the neural mechanisms associated with reward-seeking and related influences on decision-making. Individual differences in the magnitude of response elicited by rewards may account for the relative difficulty experienced by dieters in adhering to treatment.