SO IT’S BEEN two weeks since school started! That aside…

The National Occupational Therapy Conference has just taken place this weekend at Concorde Hotel Singapore. The theme for this event: “Transcending Boundaries Towards Seamless Care”, tied in with the workshops and presentations focussing on services beyond that of the acute care setting.

Minister of  State for Health and Manpower, Dr. Amy Khor, was present to grace the event. In her opening address on Day 2, similar sentiments were echoed regarding the need for more Occupational Therapists (OTs) to deal with the challenges of an ageing population. Examples were cited – on how teams of OTs from acute hospitals are working with community partners on services to provide a smooth transition from acute to community care.

Taken from TODAYonline, 6th October 2012

But do services stop simply at community care level? Is there something missing in the equation?

Questions were triggered from my attendance at a workshop by Dr. Deirdre Connolly on Day 1. Dr. Connolly is the Head of  the Discipline of Occupational Therapy in Trinity College Dublin (TCD), Ireland.

Dr. Connolly’s research interest in the area of occupational therapy practice focuses mainly on the impact of occupation-based interventions in the management of multi-morbidity in primary care. And this was the central theme of discussions during the 4-hour workshop.

Primary care
is an approach to care that includes a range of services  designed to keep people well, from promotion of health and screening for disease  to assessment, diagnosis, treatment and rehabilitation as well as personal social services.  The services provide first-level contact that is fully accessible by self-referral  and have a strong emphasis on working with communities and individuals  to  improve their health and social well-being.
(Department of Health, 2011)

Primary care is very much like how clients can self-refer to see a General Practitioner (GP), only at a polyclinic level in Singapore. Can this same model be applied beyond GP services to include Allied Health? Whereby clients can self-refer to an Occupational Therapist, Physiotherapist, Speech & Language Therapist, and maybe even to a Psychologist for specific assessments and interventions.

The current situation in Singapore is that clients would need to have been admitted to the hospital before getting a doctor’s referral for Occupational Therapy services. And by admission, it would mean that the client would most probably have had some form of illness, disease or disability. Take for example an elderly who is admitted after having had a fall resulting in a hip fracture. He will most likely be receiving Occupational Therapy in the acute hospital before moving along the healthcare continuum of care – to a stepdown community hospital and eventually be discharged home with caregiver training or environmental modifications and education for future falls prevention.

Could the fall have been prevented?

What if such falls prevention education could have been conducted before the client has a fall?

Primary care services would provide the platform for such education programmes to be run, with the aim of health promotion as well as early prevention of illnesses  and disabilities. A client would not have to go full circle from acute to community healthcare to be a recipient of such service. Services can benefit both well clients and those with past diagnosis, all with the same objective of preventing future occurrence of illnesses and disabilities through lifestyle modification or other interventions.

The active discussions during the workshop gave me insight to the wide range of clients that can potentially benefit from primary care – from those who are at risk or cardiac diseases to caregivers of patients with chronic diseases to those who at at risk of a relapse of mental illness.

The unique contribution of Occupational Therapy in this area is our philosophy of client-centredness, enabling us to empower clients to self-manage in keeping healthy. Secondly, our profession’s beliefs are rooted in the use of occupations (leisure, work, daily activities) to improve participation and encourage well-being. Our models of practice guide us in understanding a person as a whole and the impact of our client’s environment on their participation in occupation.

As such, it is exciting to ponder whether Occupational Therapy in Singapore will be the followers or leaders in implementing primary care services to meet the growing demands of the population. Having taken a huge step towards becoming a licensed profession, I do not see why OTs cannot pioneer the primary care model and change the way healthcare is being delivered here in Singapore… for the better. 

But of course, we will meet challenges along the way. One of which is manpower. There is a definite need for more OTs as what Dr. Amy Khor suggests. However, this growing demand should not just focus on the ageing population, but also for diversifying healthcare delivery and expansion of services across the lifespan.

One of the solution is to learn from other countries who have pioneered primary care services in their healthcare setting. With that note, I hardly can wait for our trip to Dublin in January… and all the site visits we will be doing. Stay tune for more bright ideas!