RESEARCH REPORT PLATFORM PRESENTATION

THE INTEGRATION OF REHABILITATION INTO PRIMARY HEALTH CARE: RESULTS OF A RANDOMIZED TRIAL. Richardson J¹, Letts L^1,, Chan D^2,3, Stratford P¹, Baptiste S¹, Edwards M¹, Coman L¹, Price D^2,3, Hilts L^3,4, Law M¹; ¹School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. ²Dept of Family Medicine, McMaster University, Hamilton, Ontario, Canada. ³Stonechurch Family Health Centre,McMaster University, Hamilton, Ontario, Canada. ⁴School of Nursing, McMaster University, Hamilton, Ontario

PURPOSE: The objectives were to determine whether adults with a chronic illness receiving care in a Primary Care(PC)setting as a result of a rehabilitation intervention, compared with adults in the PC setting who do not receive the intervention:1.show greater improvement in health status 2.have fewer hospital admissions and emergency room visits 3.show greater improvement in physical functional status,and decreased falls 4.show greater satisfaction. RELEVANCE: The future of Primary Care lies in its ability to meet the needs of persons who are chronically ill (Anderson & Wagner, 2003).Persons with chronic illness, especially older persons who are most at risk for functional decline, are currently not receiving effective management(Grumbach & Bodenheimer, 2002).This project introduced Physical Therapy and Occupational Therapy into a PC setting to address this need. PARTICIPANTS: Adults 44 years or older with one or more chronic conditions who had 4 or more physician visits in the previous year were selected from the Stonechurch family practice database and invited to participate. Mean age was 64 years, 56% 46-64 years, 63% were women. METHODS: Blind assessors (PTs and OTs) assessed patients in their homes on four occasions. The outcomes used were the SF-36, the Late-Life Function and Disability Index,ER visits and hospitalizations and caregiver strain index. Semi-structured qualitative interviews were undertaken with patients and staff. Rehabilitation services offered through the project involved:screening and prioritizing individuals in both the intervention and the control groups at risk for functional decline,a recent fall and the probability of hospitalization; assessment by a PT or an OT for persons in the intervention group to establish treatment goals;home, clinic or community visits; group or individual intervention directed at chronic disease self-management(CDSMP) based on the CDSMP from Stanford and adapted to focus on rehabilitation-related strategies;collaborative goal setting; an Activity and Wellness Group that provides opportunities to explore healthy lifestyles PT Individual services included individualized exercise programs using motor learning principles, modalities, acupuncture, manual therapy; consultation regarding mobility devices and funding, home safety and falls prevention and posture and positioning.A website I Am Able Website (www.iamable.ca)was developed with information regarding rehabilitation and community resources. ANALYSIS: An analysis of covariance was used to analyze the continuous variables, logistic regression for dichotomous variables and Mann-Whitney U-test for ordinal variables. RESULTS: The intervention group had fewer planned hospital days,adjusted difference=0.60 p < 0.01, a cost saving $490/day with an overall saving of $65,700. There was greater satisfaction with rehabilitation services for the intervention group p < 0.001. Other trends in favour of the intervention group were fewer falls,less caregiver strain, better communication with physician and fewer home hazards. There were no significant group differences on the SF-36. CONCLUSIONS: Physical therapy services can be effectively delivered by condition based clinics, education, triaging and interdisciplinary formats in a primary care setting and with associated cost savings. IMPLICATIONS: The project integrated physical therapy and occupational therapy into the primary care team and enabled opportunities for the appropriate team member to provide care. This allowed physicians and nurses to focus on expert-specific roles. Chronic disease self-management programs that incorporate rehabilitation principles are effectively delivered by physical therapists. KEYWORDS: primary care, randomized controlled trial, physical therapy. FUNDING ACKNOWLEDGEMENTS: This study was funded through the primary health care transition fund through the Ministry of Health. CONTACT: jrichard@mcmaster.ca

ETHICS COMMITTEE: Hamilton Health Sciences/McMaster University Ethics Board