Question 1

To practice in primary care, the occupational therapist must be a(n):&#10;A) Specialist&#10;B) Generalist&#10;C) Certified hand therapist&#10;D) Aging in place specialist

Accepted Answer

Primary health care is the "provision of integrated, accessible health-care services by clinicians who are accountable for addressing a large majority of personal health-care needs, developing a sustained partnership with patients, and practicing in the context of family and community" (Institute of Medicine [IOM], 1994, p. 1). According to the American Academy of Family Physicians (AAFP, 2011), primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health-care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals and utilizing consultation or referral as appropriate (AAFP, 2011, para. 3-4). This broader conceptualization provides opportunities for the infusion of occupational therapy services in primary health care. However, to be effective in this setting, "an occupational therapist must be a true generalist who is competent across all age spans and the entire domain of occupational therapy practice" (Muir, 2012, p. 509).

Question 2

Which of the following provide the majority of primary health-care services?&#10;A) Cardiologists&#10;B) Psychiatrists&#10;C) Family medicine physicians&#10;D) Nurse practitioners

Accepted Answer

Primary health care is continuous, comprehensive care designed to maximize health and prevent disease that is provided near where people live, work, and play (Edelman & Mandle, 2002). The term primary care physician "is used to describe all physicians whose practice includes the provision of medical care for well individuals and who act as 'gatekeepers' to specialist services" (Goel & McIsaac, 2000, p. 230). The physicians who today provide the bulk of primary health care are family and general practitioners, medical internists, and pediatricians. In addition, there are obstetrician-gynecologists for women's primary health care and psychiatrists for primary mental health services. Physician extenders, such as nurse practitioners and physician assistants, are also involved in the delivery of primary care services.

Question 3

In primary care, the patient hopefully engages with the physician's office as their:&#10;A) Medical home&#10;B) Pharmacy&#10;C) Durable medical equipment access&#10;D) Physician relationship

Accepted Answer

The long-term relationships that primary care physicians develop and share with those in their care make the primary physician the entry point in accessing the health-care system. Ideally, the primary physician's office is the patient's medical home. The primary care medical home "is accountable for meeting the large majority of each patient's physical and mental health-care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, counselors, educators, and care coordinators. Although some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities" (Agency for Healthcare Research and Quality [AHRQ], n.d., para. 2).

Question 4

Occupational therapy delivery in primary care is different from traditional models of OT delivery in which of the following ways?&#10;A) Patients are seen twice weekly&#10;B) Patients are seen once a year&#10;C) Patients are seen as needed over time&#10;D) OT is delivered at every primary care visit

Accepted Answer

The nature of primary care is such that practitioners follow a panel of patients intermittently over an extended period, providing health promotion, prevention, and treatment services at times of need. This is much different from typical occupational therapy services, which are often provided continuously and intensely over a short period. However, patients may need fewer visits for intervention because they are seen at an earlier stage of the health problem. Therefore, occupational therapists working in primary care settings must be flexible, adaptive, and readily available when the physician refers a person or family with a particular need.

Question 5

Mr. Janousek is a 67-year-old who presents to primary care with angina. The primary health-care team recognizes that this event has made Mr. Janousek concerned about his health and takes the opportunity to connect him with resources on weight management and smoking cessation. The primary health-care team is taking advantage of:

A) The primary care practice as the medical home
B) A weight-loss opportunity
C) Education on angina
D) A teachable moment

Accepted Answer

Primary care physicians' offices are ideal settings for disease prevention and health promotion. Physicians are generally viewed as authoritative and credible sources of information and advice on health and illness. A significant number of studies have demonstrated that physician advice is a strong determinant of adherence to preventive practices, such as mammograms. In addition, brief office interventions have demonstrated effectiveness for smoking cessation, reducing alcohol consumption, and other health-related behaviors. Teachable moments, when direct links can be made between symptoms, behavior, and outcome, occur routinely during office visits. For example, an office visit for angina is a teachable moment to address smoking cessation, nutrition, and weight loss with a patient. However, due to time constraints, physicians may not be able to utilize these opportunities effectively.

Question 6

An appropriate health promotion theoretical approach in primary care is which of the following?&#10;A) PRECEDE-PROCEED Model&#10;B) Model of Human Occupation&#10;C) Rogers Theory of Diffusion of Innovation&#10;D) Occupational Adaptation

Accepted Answer

The role of occupational therapy in health promotion has been conceptualized as having three critical functions: the promoting of healthy lifestyles for all clients, emphasizing occupational participation as an essential component of health promotion efforts, and providing interventions for populations, particularly those experiencing health disparities (AOTA, 2013). Occupational therapists providing services in primary care settings need to recognize that health promotion and prevention interventions do not immediately resolve health problems, and that individuals will progress in their own incremental and idiosyncratic ways. Appropriate health promotion theoretical approaches for use in primary care settings include the PRECEDE-PROCEED Model (Green & Kreuter, 2004) and the Transtheoretical (or Stages of Change) Model (TTM).

Question 7

In type 2 diabetes, a common psychosocial comorbidity is:&#10;A) Substance use disorder&#10;B) Bipolar disorder&#10;C) Body dysmorphia&#10;D) Depression

Accepted Answer

Depression and/or anxiety are frequently comorbid with diabetes. Persons with diabetes have a 60% higher rate of major depressive disorder and a 123% higher rate of generalized anxiety disorder than the general population (Fisher et al., 2008). The relationship between diabetes and depression is bidirectional. Individuals with depression are at higher risk for developing diabetes, and individuals with diabetes are at higher risk for developing depression, particularly if they are experiencing secondary complications. In addition, persons with diabetes and comorbid depression often have greater symptom severity and disease burden. This is likely due to the fact that depression often hinders a person's ability to initiate and maintain chronic disease self-management behaviors (Lin, et al., 2010). This highlights the need for mental health services in addition to medical care for the management of diabetes.

Question 8

Which of the following is a significant predictor of metabolic disturbances and disease risk?&#10;A) Obesity&#10;B) Abdominal obesity&#10;C) Body dysmorphia&#10;D) Underweight

Accepted Answer

The National Heart, Lung, and Blood Institute (NHLBI) guidelines for the prevention of cardiovascular disease recommend a target body mass index (BMI) between 18.5 and 24.9 regardless of age (NHLBI, 2018). Of the approximately 70% of adults who are overweight (BMI greater than or equal to 25), 36% are obese (BMI greater than or equal to 30), 15% are very obese (BMI greater than or equal to 35), and 6% are extremely obese (BMI greater than or equal to 40) (Flegal, Carroll, Kit, & Ogden, 2012). Several studies have indicated that abdominal obesity, regardless of overall weight, is a significant predictor of metabolic disturbances and disease risk. Even persons with a BMI in the normal range can be at higher risk if they have a large waist circumference. Therefore, waist circumference measurements are recommended as part of a routine physical examination (Dobbelsteyn, Joffres, Mac Lean, & Flowerdew, 2001). A waist circumference of more than 36 to 40 inches in men and more than 32 to 35 inches in women is highly correlated with obesity-related conditions, such as hypertension, sleep apnea, diabetes, and heart disease (Dobbelsteyn et al., 2001; Mosley, Jedlicka, LeQuieu, & Taylor, 2008).

Question 9

What is the most common musculoskeletal complaint seen in primary care medical practice and is a major source of activity limitation and disability?&#10;A) Carpal tunnel syndrome&#10;B) Arthritis&#10;C) Low-back pain&#10;D) Sprains

Accepted Answer

Low-back pain (LBP) is the most common musculoskeletal complaint seen in primary care medical practice and is a major source of activity limitation and disability. LBP is experienced by one in five adults each year and affects 60-80% of adults at some time in their lives. It is often persistent or recurrent and incurs a significant cost to individuals, businesses, and society. It is the fifth most common reason to seek health care. LBP can be due to a single event resulting in acute injury or to a cumulative process of stress and strain (Gaunt, Herring, & O'Connor, 2008; Rosenwax, Semmens, & Holman, 2001).

Question 10

Mental health conditions typically seen in primary care are reported by patients as:&#10;A) Physical complaints&#10;B) Depression&#10;C) Anxiety&#10;D) Chronic pain

Accepted Answer

Approximately 25% of patients seen by primary care providers present with physical and mental health comorbidities. According to the National Institute of Mental Health (NIMH, 2017), at least 50% of mental health care for common psychiatric disorders is provided in primary care settings. Mental health problems in primary health-care settings are frequently manifested by physical symptoms such as chronic pain, insomnia, gastrointestinal disturbance, headaches, and difficulty breathing, among others. In addition, addressing the emotional and psychological issues related to chronic medical conditions has been shown to improve overall health and is cost-effective (Dahl-Popolizio, Doyle, & Wade, 2018).

Question 11

Michael is a 47-year-old who visits his primary care provider to lose weight. He claims he has "no time to exercise" and works a sedentary job. The primary care provider refers him to occupational therapy to explore weight-loss options. The occupational therapist would:

A) Refer him a gym
B) Develop a home exercise program
C) Evaluate his daily routines and identify opportunities for physical activity
D) Encourage him to golf

Accepted Answer

The answer of Michael is a 47-year-old who visits his...

Question 12

George is a 42-year-old male with complaints of low-back pain to his primary care provider. He is having difficulty sitting at his computer to get work done. One strategy the OT might provide as intervention is:

A) A workstation evaluation
B) A home exercise program
C) An evaluation of his daily routines to identify opportunities for physical activity
D) Encouraging him to golf

Accepted Answer

The answer of George is a 42-year-old male with complaints...

Question 13

In order to meet the mental health needs of primary care patients, the collaborative care movement is developing and implementing models of care including:&#10;A) Population health&#10;B) Integrated care&#10;C) Medical home&#10;D) Nurse practitioners

Accepted Answer

The answer of In order to meet the mental health...

Question 14

Mr. Wu is 58-year-old Chinese immigrant who has lived in the United States for 10 years. He has recently had a stroke and needs some durable medical equipment. He speaks and reads English well but his wife does not. They have many questions about the shower chair provided to them from a recent hospitalization. When explaining the purpose of the shower chair, the occupational therapy practitioner should consider:

A) Health literacy levels
B) Cost of the shower chair
C) Placement of the shower chair in the home
D) Utilization of the shower chair

Accepted Answer

The answer of Mr. Wu is 58-year-old Chinese immigrant who...

Question 15

Which of the following could an occupational therapist working in primary care provide as a brief office intervention for the purpose of changing a health behavior?&#10;A) Depression screening&#10;B) An occupational profile&#10;C) A home exercise program&#10;D) Medication adherence

Accepted Answer

The answer of Which of the following could an occupational...

Question 16

Mr. Bruner is a 55-year-old male seen in primary care reporting depression due to a recent job loss. To understand the health needs of Mr. Bruner the occupational therapy practitioner could perform which of the following?

A) A health risk assessment
B) Health education and counseling
C) A home exercise program
D) A brief office intervention

Accepted Answer

The answer of Mr. Bruner is a 55-year-old male seen...

Question 17

In establishing occupational therapy in a primary care setting, which assessment tool provides an excellent opportunity for the occupational therapist to gain an understanding of the patient's needs, desires, and priorities as a basis for individualized health promotion planning?

A) Role checklist
B) Depression screening
C) Canadian Occupational Performance Measure
D) Occupational profile

Accepted Answer

The answer of In establishing occupational therapy in a primary...

Question 18

You are an occupational therapist meeting with a physician and a health-care administrator to advocate they add OT to the primary care team. What benefit can OT bring to the primary care team?&#10;A) Another team member for patients&#10;B) Depression screening&#10;C) Health risk assessment&#10;D) Better patient compliance with self-management regimens

Accepted Answer

The answer of You are an occupational therapist meeting with...

Deck 25: Occupational Therapy in Primary Health-Care Settings Introduction