Organised by:

Malaysian Healthy Ageing Society

Co-Sponsored:

Bridging The Gap Between Primary

And Secondary Care

-Occupational Therapy (OT)

Perspective

20 March 2012

(1st World Congress On Healthy ageing)

Thillainathan Krishnan • BSc. (Hons) Applied Rehabilitation (Occupational Therapy) UK,

• Dip. In Occupational Therapy (Mal),

• Post Basic in Occupational Health and Safety (MOH, MAL),

• Cert. in CBR (JICA/JIMTEF)]

• Head of Occupational Therapy department

• SELAYANG HOSPITAL

Multi-Discipline Collaboration

Secondary Care (Hospital)

Primary Health Care facility (Health Clinic)

Overview Of The Presentation

• OT History • Current Concepts of Healthy

Ageing / Scenario • OT’s Role in primary and

Secondary care

• Efforts to Bridging The Gap • Challenges and possible solutions

THE CULTURE OF HEALTHY AGING:

• Healthy aging has been a very important

agenda for many health care providers as

much as there is an enormous demand from

Clients (as the service user) worldwide. The

main aims of promoting healthy aging are to

keep people more active and function

independently

(Kyriakidou 1992).

Definition of Healthy Ageing:

• “Healthy ageing is the process of

optimizing opportunities for physical,

social and mental health to enable older

people to take an active part in society

without discrimination and to enjoy an

independent and good quality of life”

• many research activities about maintaining

general health and well-being throughout the

aging process have proved that people who

are concerned about their aging have

better life satisfaction towards the end-of-

life phase.

• The same pattern can also be seen in other

nations of the world and this is inclusive

Malaysia.

OBJECTIVE

• Malaysian Health Policy:

-Nation of healthy individuals, families &

community.

-Through equitable, affordable, efficient,

technologically appropriate, environmentally

adaptable & consumer friendly health system.

-Emphasis on quality, innovation, health

promotion & respect for human dignity.

-Promotes individual responsibility & community

participation.

GOALS OF HEALTH CARE

SYSTEM • Wellness Focus

• Person Focus

• Informed Person

• Self Help

• Care Provided At Home Or Close To Home

• Seamless, Continuous Care

• Services Tailored To Individual Or Group

Need

• Effective, Efficient And Affordable Services

Current Statistics (MOH):

• 135 - Hospitals

• 50 - 1 Malaysia clinics

• 2815 health clinics

• >800 OT’s in Hospitals (Health)

• 52 OT’s in KK (Health)

• OT’s in Community- 12(welfare)

(Source: Portal MyHealth)

OCCUPATIONAL THERAPY:

• Rehabilitating a person to a total / maximum well being through selected functional activity to enable the person to be independent & return back to his/her community

OCCUPATIONAL THERAPY

CONTRIBUTION TO HEALTH CARE :

(Primary and secondary Care)

- To prevent disability, to improve health, achieve optimum function and independence & enhancing quality of of life.

(minimize the effect of losses & compensate the deficits, support their competencies & maintain self esteem)

ROLES OF OCCUPATIONAL THERAPY :

• Prevention of disease or illness

• To assess & rehabilitate functional disability

• To assess needs of aids / gadgets and modifications

• To improve the quality of life

OCCUPATIONAL THERAPIST

• One of the Most important Health

Care Professional in Multi-

Disciplinary Team collaboration to

rehabilitate a person to optimal

wellbeing health status.

Conditions :

•Pediatrics

•Palliative

•Oncology

•Hand and

Microsurgery

•Child Psychiatry

•Medical •Neurology •Orthopedic •Surgical •Psychiatric •Spinal

Common Problems In Primary Care:

(Health Profile) • Diabetis

• Central nervous system:

-Dementia,depression,

cerebrovascular disorder,

parkinson,

• Cataract

• Hypertension

• Delirium

• Incontinence

• Edema

• Vertigo

• Anemia

• Hypo tension

• Metabolic disturbances

-electrolite disturbances,

hypoglycemia

• Musculosceletal

disorders

-Arthritis, muscle weakness

• Occupational Therapist have a great deal to

offer to ageing person because we belief

that everyone, in spite of illness or

disability, can be helped through their

own action to reach the highest level of

independence and ability that is possible

for them

Why Occupational Therapist?

• We assess each individual, thinking always

towards recovery not only physical but

also aware of the psychosocial problems

they have

OT Competencies

SCOPES OF OT INTERVENTION

• Conditions and interventions in care of an

ageing person quite unique considering humans

operate as occupational beings who deal

with major changes in various aspects of

biological/physical, emotional, social,

psychological, cognitive and perceptual,

psychosocial in their daily living (ADL),

work/productivity and leisure activities

(Crepeau et al. 2003)

scopes of interventions by OT’s can be split into

two big groups of domains:

i) Physical – mainly covers areas concerned with

physical dysfunction that forbid clients from

being independent in previous routine/function.

ii) Mental Health – mainly covers areas

concerned with mental disability of both

neurosis and psychosis which prevents clients

from engaging independently in areas of

previous level of performance.

Functional Domain:

• Physical ADL / Everyday ADL: - Self care & personal hygiene(Bathing,

dressing, using toilet, eating, drinking, walking, transfer)

• Instrumental ADL: - Related to home management( Shopping,

prepare meal, money management, using phone)

History of OT in Malaysia: • 1st OT working in Sungai Buloh Leprosy Center

(in late 1950’s)

• Pioneer OT’s working in mental Institutions

(1960’s).

• More OT’s Working in General Hospitals

(1970’s)

• OT’s working in Community and OT training

started locally (1980’s)

• OT’s working in district Hospitals and

specialized areas and Private practice(1990’s)

• OT’s working in health clinics (20th Century)

Advantages:

• OT training (Education Program) includes

community placement.

• OT’s work in terms of context where the client

lives (environment and culture)

• OT’s are ‘enablers’ -creative and flexible with

critical and analytical thinking.

• OT scope includes home/environmental

assessment and modification

recommendation.

Principle Of Rehabilitation:

• Activity : The performance of a task by an individual

• Participation : An individual’s involvement in life situations in relation to health conditions, body functions and structure , activities and contextual factors

ICF(2001)

• Health condition : A

disorder or disease

affecting the individual

• Body function/structure

: The physiological or

psychological functions

of body systems

Types Of Rehabilitation:

• Preventive Rehab.

• Educational Rehab.

• Vocational Rehab.

• Social Rehab.-ability of a person to function in various social

situations towards the satisfaction of his/her needs & the right to achieve

maximum richness in his/her participation in the society.

• Acute Rehab.

• Medical Rehab.

Rehabilitation In Health Centers:

• Primary Rehab.

• Concept Of Community Based Rehabilitation (CBR):

-Community & client centered

-Focused on prevention & early detection

-Promotes consumer participation

-transparent & information sharing

-Consistent & flexible

-Rehab. Carried out in clients on surrounding

MDT

Health Clinics

HOSPITAL

Family Communit

y

Instituitions

NGO

SELF

REFERRAL

OT’S

Referral System in Health Clinics:

Global direction:

• Internationally, nations has been urged to

develop, implement and evaluate policies

and programs to promote healthy and active

ageing.

• It suggests for new multi-sectoral

partnerships with intergovernmental, private

sector and voluntary organizations.

• Occupational Therapy in ‘new Direction’

According to the WHO: • Chronic diseases (Lifestyle issues /

noncommunicable diseases) is by far the leading

cause of mortality in the world, representing

over 60 % of all deaths

-(By2030, deaths from chronic diseases are

expected to increase to 52 million per year)

• Deaths caused by infectious diseases, maternal

and perinatal conditions and nutritional

deficiencies are expected to decline by seven

million per year during the same period

A HOLISTIC VIEW OF WELLNESS: • Holistic concept of Wellness includes the

involvement of one’s “Physical, Social,

Emotional, Occupational, Spiritual and

Intellectual”

• “the state of being healthy” and as “…an

active process by which an individual

progresses towards maximum potential

possible, regardless of current state of

health”

-Travis and Ryan (1988), Hornby (2005), Anon (2006)

Good news!

• It is interesting to note that risk factors such

as a person’s background, lifestyle and

environment are known to increase the

likelihood of chronic diseases, which means

we have an opportunity to intervene by

treating the cause and not the illness

exclusively.

Unfortunately!

• Roles of OT in different set-up not efficiently

coordinated

• OT’s role in Health Clinics mainly on

preventive medicine only

• Majority of the OT’s in Primary Care are

rendering their services to Community based

rehabilitation which comes under Social

Welfare ministry

Current issues:

• Clients problems should be addressed more in

the community – Home Based Healthcare

(Home visits and modification

recommendations, working with family,

trainings)

• Clients discharged from hospitals without input

from Occupational Therapy.

• OT’s working under different system / ministries

with no proper step down / seamless care.

Current issues: (cont.)

• Assessments/interventions should be

communicated to OT in primary health so that

there is continuity in effort to integrate client

into community.

• Junior OT’s posted in primary Healthcare.

• Limited number of OT’s in Health Clinics.

• Clients trained in hospital setting in a

simulated environment which does not

portray their real context.

Current issues: (cont.)

• Clients not integrated in community because

their functional ability is not been addressed-

role must be taken over by primary health

care personnel.

• Community centers(NGO- ‘PDK’) visited by

OT’s from nearest hospitals or health Clinics.

• OT’s not efficiently promoting / marketing

their contributions to other MDT members.

Focus of Health: The way forward

• There is increasing evidence that healthy

and active ageing can be achieved by

promoting health that focuses on

prevention and focus on optimizing

health to ensure that a person with

chronic conditions and disabilities can

remain active and independent, thus

avoiding institutionalization.

Possible solutions: • To coordinate OT’s working in different

Health Care settings, Agencies/Ministries.

• Proper assessments/interventions carried out

before client been referred to/from different

Health care systems.

• More OT’s in Community/Primary Health

Care with proper training.

• Holistic approach in Healthcare through

seamless services- more definite continuous

provision of occupational Therapy

Challenges:

• How to effectively deliver lifestyle changes

that are safe effectual for individuals with

chronic conditions who may experience

potential complications.

• Providing holistic healthcare taking into

consideration client’s own individual needs

and their environment and a clear

understanding of clinical needs.

• Multi-sectoral model:

The manner in which such integrated healthcare

and wellness program is delivered is a vital

consideration - implementing the necessary

supportive services and moulding the environment

to promote healthy lifestyle habits should be

advocated in the community where they live.

This is no easy……..but possible with

combined efforts

Foreign Initiatives: • Japan – Proper step down care is in place post

discharge from hospital. Apartments that

comes with its own health and wellness

centre.

• Singapore – Case manager system to ensure

proper and holistic health care delivery. City

for All Ages project that aims to enhance the

livability of the environment, develop age-

friendly solutions and services, and enhance

the integration of services with the built

environment.

“ We can’t solve problems by using

the same kind of thinking we used

when we created them.”

the future is defined by what we

do today.

-Albert Einstein

OCCUPATIONAL THERAPY TOWARDS

INDEPENDENT LIVING