A USC pilot study has indicated that an occupational therapy intervention can help diabetes patients make the kind of important and long-lasting lifestyle changes that have the potential to substantially improve their health and prevent serious health complications.
USC investigator Beth Pyatak, PhD, OTR/L, CDE, whose research interests include chronic care management and occupational therapy, tested the Lifestyle Redesign® (LR) occupational therapy intervention Resilient, Empowered, Active Living with Diabetes (REAL Diabetes), developed for adults with diabetes.
The study was as significant for the clinic where it was tested as much as for its findings. In 2016, the Southern California Clinical and Translational Science Institute (SC CTSI) along with its UCLA CTSI counterpart, and the Los Angeles County Department of Health Services (LAC DHS) launched a novel academic-government partnership. Their goal was to find ways that the clinical and translational researchers at the two universities could study and improve care provided by the LAC DHS for hundreds of thousands of Los Angeles County residents. With an annual budget of $5 billion, the LAC DHS is the country's second-largest public health system, and one of the most diverse.
A key element of the partnership is the Implementation Science Awards, which provides grants up to $75,000 for one year to pilot interventions to improve delivery of care to patients in the LAC DHS. Pyatak's study was the first to be awarded an Implementation Science grant through the partnership.
“Within the clinic where we implemented the study, we saw improvements in clinical outcomes such as A1C and blood pressure, and a trend toward decreased acute healthcare utilization, including emergency department visits and hospitalizations," said Pyatak, who is also an associate professor of occupational science and occupational therapy in the USC Chan Division of Occupational Science and Occupational Therapy.
The pilot study found that qualitative data from clinic stakeholders, including providers, patients, and administrative staff indicates that provider satisfaction and patient satisfaction increased. Additionally, the clinic's overall ability to address the needs of complex care patients increased, and providers started to learn strategies to be more effective in addressing health behavior with their patients, said Pyatak.
Diabetes is one of the top health concerns worldwide—as it is in the Los Angeles area, where it is a leading cause of death and serious health complications, including amputation, kidney failure and blindness. But the disease's many harms can be mitigated or even avoided through diet, medication, exercise, stress management and other lifestyle management measures.
However, most primary care physicians are ill-equipped to help their patients with diabetes make these vital but often difficult lifestyle changes. This has contributed to an increasing recognition of the potential for occupational therapists to play a greater role in care for patients with diabetes and other chronic conditions, by supporting holistic, long-term lifestyle changes.
"Doctors don't actually have the training to help people make lifestyle changes," said Pyatak. "Occupational therapists have the training and skills to support patients in the management of chronic health issues. They can work with the building blocks of daily life so patients can construct habits and routines to keep themselves healthier and enjoy a better quality of life."
Diabetes takes a disproportionately heavy toll among ethnically diverse and low-income populations, said Pyatak. Her pilot study also provides preliminary evidence of occupational therapy’s effectiveness in improving clinical outcomes among these diverse populations, in a safety-net primary care setting.
The study lends additional support for the incorporation of occupational therapy as a standard element of primary care for patients with chronic conditions. Pyatak has expanded the program to also treat patients with uncontrolled hypertension, and is currently readying a larger study of the OT-based intervention in expanded settings.
Working collaboratively with DHS investigators from primary care and occupational therapy, this study will lay the foundation for implementing an effective, scalable, and cost-effective service throughout LAC-DHS primary care settings that has the potential to improve the quality, efficiency, and patient-centeredness of care system-wide, said Pyatak.
The study, "Addressing Diabetes in Primary Care: Hybrid Effectiveness–Implementation Study of Lifestyle Redesign® Occupational Therapy," was recently published in the American Journal of Occupational Therapy. In addition to Pyatak, co-authors included Maggie King, Cheryl L. P. Vigen, Elia Salazar, Jesus Diaz, Stacey L. Schepens Niemiec, Jeanine Blanchard, Katie Jordan, Josh Banerjee, and Jagruti Shukla.
Pyatak is also an alum of the SC CTSI's Mentored Career Development in Clinical and Translational Science program. Previously called the KL2, the three-year program provides professional support and training for USC and CHLA researchers who aspire to careers in clinical and translational science.