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

• DOI: 10.5014/ajot.2019.037317
• Publication Date: 2019-08-19T17:30:31Z
• Authors: Elizabeth Pyatak; Maggie King; Cheryl L. P. Vigen; Elia Salazar; Jesus Diaz; Stacey L. Schepen...; Jeanine Blanchard; Katie Jordan; Josh Banerjee; Jagruti Shukla
• Keywords: Medical record

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