Purpose: Habits, roles, and routines are important behaviors that affect lifestyle and can lead to the development of chronic disease such as diabetes mellitus. Primary care physicians (PCPs) have limited time, suggesting an interprofessional team approach would be beneficial in helping patients modify behaviors for the prevention and treatment of chronic disease. Occupational therapists (OTs) specialize in addressing health behaviors, and literature supports including OTs on the primary care team to improve the self-management techniques of patients with chronic disease. This study was guided by Lifestyle Redesign®, an evidence-based program that addresses the health behaviors of patients with diabetes in primary care. We aimed to improve health outcomes by combining an OT-led lifestyle modification program with patient-centered treatment recommendations from an external interprofessional team. We hypothesized that the health outcomes of patients with diabetes in primary care would improve after participating in an OT-led interprofessional lifestyle modification program, and that reimbursement for services would be obtainable. Method: Two PCPs in community practice initially agreed to involve an OT on their primary care team. Due to reimbursement concerns, the PCPs later preferred to refer patients to receive the OT-led intervention at an offsite clinic, rather than onsite at the primary care practice. Health outcomes were measured pre- and post-intervention using industry standard assessments and biometrics. Descriptive and non-parametric statistics were used to evaluate change. Results: Thirty-one patients with diabetes were referred, and three (9.7%) participated in the offsite lifestyle modification program. While statistical significance was not achieved (p≥0.10), trends toward individual improvement were noted for occupational performance and satisfaction and empowerment, and reimbursement was received from the third-party payers. Conclusions: Patient participation in this study was consistent with participation rates for offsite behavioral health referrals. An offsite OT-led interprofessional lifestyle modification program demonstrated potential for meaningful change and services were reimbursed. These findings support practice redesign efforts to include OTs as part of an integrated primary care model. Offering onsite services will increase patient accessibility to care and improve referral completion rates, thus providing OTs the opportunity to further demonstrate the efficacy of delivering chronic disease management in primary care.

Author Bio(s)

Sue Dahl-Popolizio, DBH, OTR/L is a Clinical Associate Professor at Arizona State University (ASU), and a Program Coordinator of the Doctor of Behavioral Health Program in the College of Health Solutions at ASU. She is also a licensed occupational therapist.

Gretchen Roman, PT, DPT, PhD is an academic researcher affiliated with Arizona State University and a licensed physical therapist.

Felicia Trembath, PhD, MPH is an epidemiologist and Clinical Assistant Professor in the Public Health Department at Midwestern University.

Bradley Doebberling, MD, MSc. is professor of Science of Health Care Delivery and Biomedical Informatics in the College of Health Solutions at Arizona State University.

Alyssa Concha-Chavez, OTD is a Program Coordinator at Northern Arizona University and a licensed occupational therapist.


We would like to recognize the following collaborators who served as part of this study’s interprofessional team: Matthew Buman, PhD, Caitlin Cameron, PharmD, Melissa Coronado, OTS, Andrea Durand, DBH, LCSW, Jessica Lehmann, MS, RDN, Lesley Manson, PsyD, Miranda Materi, OTR/L, CHT, and Connor Swanson, OTS. Thank you for your time and consultation. Your contributions toward improving the health outcomes of patients with diabetes in primary care were greatly appreciated.





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