Discussion 

The limited understanding of occupational therapy’s full scope of practice is one the most significant barriers to integrating occupational therapy into primary care (Andreae et al., 2021; Halle et al., 2018; Dahl-Popolizio et al., 2017a; Donnelly et al., 2013). This doctoral capstone project addressed that barrier by educating pediatric primary care providers and parents/guardians on OT’s scope of practice and role in the primary care setting. The findings of this project suggest that educating pediatric primary care providers on OT’s scope of practice and role in primary care increases their familiarity of occupational therapy’s scope of practice and increases their interest in working with an OTP as part of their interprofessional primary care team. These findings are consistent with previous research in which PCPs reported increased support and receptiveness to the inclusion of OTPs on a primary care team for adult populations following education via presentations, educational rounds, meet and greets, brochures, and information letters (Andreae et al., 2021; Halle et al., 2018; Dahl-Popolizio et al., 2017a; Donnelly et al., 2013).

While previous research quantitatively assessed PCP understanding of OT’s scope of practice (Brenner et al., 2020), this capstone project utilized an open-ended response component to qualitatively assess their understanding. As evident in the post-test responses, all participants demonstrated a broader understanding of the occupational therapy profession in comparison to their pre-test responses. For instance, Participant One initially stated that OTPs “educate families.” In the post-test, Participant One added that OTPs help educate parents on ways to work with their children “at home” to develop skills which demonstrates a broader understanding of OTP’s ability to teach skills that can be carried over into an individual's daily life. Participant Two initially described OT’s role in primary care using the language of performance skills by stating that OTPs work to “tune fine motor skills.” In the post-test, Participant Two described OTs role in primary care by stating an area of occupation (“feeding”). This demonstrates an understanding of OT’s role in supporting engagement in occupation, rather than solely improving performance skills. 

Parents/guardians reported an increase in their understanding of occupational therapy and were interested in receiving occupational therapy services within their pediatric primary care setting. Specifically, the majority of parents/guardians reported a preference for receiving occupational therapy services onsite at their primary care practice rather than at a different location. This preference is consistent with previous research that indicates referrals to outside sources can cause increased health care costs, a delay in receiving services, and fragmentation of healthcare delivery (Dahl-Popolizio et al., 2017; Muir, 2012). 

Norlin et al. (2011) observed well-child visits and found that the most common concerns raised by parents were related to nutrition/diet, growth, sleep, and toileting. Similarly, in this doctoral capstone project, parents/guardians chose sleep, toileting, and feeding/eating/swallowing as some of the areas they would like to receive an OTP’s support for. This suggests that many concerns that parents/guardians consistently raise during well-child visits are within occupational therapy’s domain of practice and, therefore, could be more fully addressed through an interprofessional primary care team approach. 

Limitations 

Due to time constraints and the widespread geographical location of participants, the education was delivered virtually. The use of an asynchronous and virtual education approach allowed the doctoral candidate to access providers from across the country. However, the virtual format may have impacted the learning experience for participants who may have had a preference for in-person instruction. This potential limitation is supported by previous literature that suggests in-person interactions or co-location (OTPs and PCPs working together in the same facility) is beneficial for educating PCPs on occupational therapy’s scope of practice and role in the primary care setting (Foxhoven, 2020; Pyatak et al., 2019; Donnelly et al., 2013). 

Of notable mention and further consideration is the small number of PCPs who participated in the educational opportunity. Additionally, there were no existing outcome measures that fit the needs of this project, therefore, the doctoral candidate created an outcome measure which was reviewed by a content expert. 

Implications for Future Practice, Research, Education, and Advocacy 

This doctoral capstone project has implications for occupational therapy practitioners, educators, and students who wish to contribute to the integration of occupational therapy in primary care. Occupational therapy practitioners are urged to establish relationships with local primary care providers and begin collaborating under the "coordinated off-site" model with the intention of moving towards "co-located" or "integrated” (Dahl-Popolizio et al., 2023). 

Occupational therapy educators should consider including primary care occupational therapy throughout their curriculum. Curriculum changes and additions may include introducing assessments and interventions suitable for primary care, incorporating case studies describing typical primary care visits and challenging students to identify OT’s role, including guest lectures from OTPs with primary care experience or from other professions who provide primary care services, assignments such as literature reviews to expose students to the current literature related to OT in primary care, and discussions of the challenges and opportunities for OTPs in this setting to support and strengthen students’ advocacy and leadership skills. Fieldwork coordinators may explore forming relationships with local primary care clinics for student fieldwork experiences and community-based service learning projects (AOTA, 2018).

Doctoral level occupational therapy students are urged to design capstone projects that contribute to the advancement and integration of OT into primary care via several focus areas such as research, education, advocacy, and program development (DeIuliis & Bednarski, 2020; Andreae et al., 2021). To expand upon this capstone project, students may consider a research-based capstone project focused on formally piloting the outcome measure designed for this project and establishing the psychometric properties of the measure to support future research in the area. Projects focusing on education and advocacy may consider primary care provider recruitment through national or state professional associations which may reach a larger audience and, thereby, increase participation.  

Further research is necessary to explore the breadth of services that OTP’s can provide within primary care settings. Further investigation is also needed to explore the funding and reimbursement mechanisms for primary care occupational therapy services. Although the provision of occupational therapy services was beyond the scope of this project, it is crucial that OTP’s demonstrate the effectiveness of interventions in order to provide more evidence-based support for OT’s role in the primary care setting.