Canadian Occupational Performance Measure (COPM) in

Primary Care: A Profile of Practice

Catherine Donnelly, Colleen O’Neill, Martha Bauer, Lori Letts

OBJECTIVE. This study aimed to understand how the Canadian Occupational Performance Measure
(COPM) can be used as an outcome measure in primary care and to identify the occupational performance
profiles in this setting.
METHOD. First, the COPM was administered to all eligible clients at two sites. Second, a focus group with
participating occupational therapists explored the feasibility of using the COPM in primary care.
RESULTS. A total of 161 COPMs were initially administered. Self-care goals were identified most frequently
(n 5 248), followed by productivity (n 5 229) and leisure (n 5 179) goals (total goals 5 656). Mean initial
performance and satisfactions scores were 3.2 and 2.8, respectively. The average change (n 5 22) scores
were 2.1 and 2.6, respectively.
CONCLUSION. The COPM is an invaluable tool to guide initial assessments and offer an occupation-
focused lens. Given the lifespan approach and an emphasis on screening and assessment, the challenge was
finding the opportunity for readministration.

Donnelly, C., O’Neill, C., Bauer, M., & Letts, L. (2017). Canadian Occupational Performance Measure (COPM) in pri-
mary care: A profile of practice. American Journal of Occupational Therapy, 71, 7106265010. https://doi.org/
10.5014/ajot.2017.020008

W
Catherine Donnelly, PhD, OT Reg (Ont.), is ith the increasing emphasis on interprofessional primary care, it is critical
Associate Professor, School of Rehabilitation Therapy,
Queen’s University, Kingston, Ontario, Canada; Catherine.
to understand occupational therapy’s role in this setting and the client
donnelly@queensu.ca issues that arise (Donnelly, Brenchley, Crawford, & Letts, 2014; Letts, 2011;
Mackenzie, Clemson, & Roberts, 2013; Metzler, Hartmann, & Lowenthal,
Colleen O’Neill, BSc (OT), OT Reg (Ont.), is 2012; Muir, 2012). Primary care should have certain core features; most im-
Occupational Therapist, McMaster Family Health Team,
McMaster University, Hamilton, Ontario, Canada.
portant is that it is a client’s first contact with the health care system and in-
volves the coordination and integration of all aspects of care (Starfield, Shi, &
Martha Bauer, BSc (OT), OT Reg (Ont.), is Macinko, 2005). Primary care is also characterized by comprehensive services
Occupational Therapist, McMaster Family Health Team,
that are delivered longitudinally, and it should be person centered (Starfield
McMaster University, Hamilton, Ontario, Canada.
et al., 2005). Primary care increasingly has a population orientation and in-
Lori Letts, PhD, OT Reg (Ont.), is Associate Dean, cludes health promotion, illness and injury prevention, and community de-
Occupational Therapy Program, and Professor, School of velopment (Aggarwal & Hutchison, 2012; Health Canada, 2012).
Rehabilitation Sciences, McMaster University, Hamilton,
Ontario, Canada.
Recent articles have urged occupational therapists to consider their role in
primary care (Mackenzie et al., 2013; Metzler et al., 2012; Muir, 2012). Muir
(2012) stated that in the primary care setting, occupational therapists “could
truly provide patient-centered and comprehensive intervention plans” (p. 508).
Given the longitudinal nature of primary care, occupational therapists are
ideally suited to support people’s health and participation over the life course.
However, despite the clear fit between the domain of occupational therapy
practice and primary care, there is relatively little research on the role of oc-
cupational therapy in primary care and few practice examples (Donnelly et al.,
2014).
In 2009, in the province of Ontario, Canada, occupational therapy became
a funded profession within interprofessional primary care teams. To date,

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 approximately 40 occupational therapists work on pri- examined the impact of the COPM in clinical practice
mary care teams (Donnelly et al., 2014). These positions (Parker & Sykes, 2006). The review found that the COPM
have offered a tremendous opportunity to understand the enables clients to identify goals for occupational therapy
role of occupational therapy in primary care. Occupa- and engage in the therapy process. From a therapist per-
tional therapists working on primary care teams have spective, the COPM supports a collaborative partnership
provided services across the full life course and spectrum and focuses intervention on occupations. The COPM’s
of disease conditions (Donnelly et al., 2014). Although broad applicability makes it an ideal outcome measure for
occupational therapists are known to be working as use in primary care. Despite its distribution in 21 countries,
generalists in primary care, no demographic data have its translation into 30 languages, and countless publica-
been published examining the exact nature of the disease tions, no known research has focused on its use in primary
conditions or the frequency with which specific condi- care. Because the COPM is a general occupation-focused
tions are being seen in primary care. A national survey of measure, has been recommended for use across many areas
occupational therapists working on primary care teams of occupational therapy practice, and has established strong
found that the most frequent services being provided measurement properties, it is ideally suited for adoption in
were health promotion and prevention activities (71%), primary care.
including falls prevention (71%) and home safety as- The purpose of this study was to examine the use of
sessment (69%; Donnelly, LeClair, Wener, Hand, & the COPM in a primary care setting. We sought to answer
Letts, 2016). two questions: (1) What client issues are being identified
Although early research has offered an important through administration of the COPM? and (2) What is
glimpse into the roles of occupational therapists, it is also the feasibility of using the COPM as an outcome measure
critical to understand the occupational issues being in primary care? Results of the study will provide further
identified by clients in primary care and determine out- insights into the use of the COPM in primary care and
come measures to evaluate the effectiveness of occupa- into the nature of occupational performance issues so that
tional therapy services in this setting. To date, there has occupational therapy interventions tailored to the primary
been no published research on occupational therapy care setting can be developed or refined.
outcomes in primary care.
Because of the generalist nature of occupational
therapy practice in primary care, measures need to be able Method
to capture outcomes from services that address the ex-
tensive physical and mental health issues identified by Design
clients in this practice setting (Donnelly et al., 2014). A sequential mixed-methods design was used. Mixed
Occupational therapists have been shown to primarily methods are ideally suited to understanding complex issues
rely on nonstandardized measures (Colquhoun, Letts, because they integrate both qualitative and quantitative data
Law, MacDermid, & Edwards, 2010); with primary (Creswell, 2009). For this study, we wanted not only to
care’s strong emphasis on outcomes, it is critical to iden- know the nature of occupational issues identified by the
tify standardized outcome measures that are meaning- COPM (Law et al., 2014) but also to understand the
ful to both clients and therapists and feasible to use in a experience of using the measure in a novel practice setting.
diverse primary care environment. Ultimately, a generic The study was implemented in two phases. Phase 1
occupation-focused outcome measure would be ideal to occurred over a 10-mo period during which the COPM
demonstrate the unique contribution of occupational was administered to all clients seen by the occupational
therapy to primary care. therapists at each of the three study sites. Phase 2 involved
The Canadian Occupational Performance Measure a focus group, conducted by a research assistant, consisting
(COPM; Law et al., 2014) is an individualized outcome of the participating occupational therapists. The goal of
measure designed to assess clients’ perception of their the focus group was to explore the use of the COPM as a
occupational performance and satisfaction with that routine outcome measure in primary care.
performance. The COPM is consistent with the Cana- Focus groups provide an opportunity for discussion
dian Model of Occupation Performance and Enablement among participants and work well when participants have
(Townsend & Polatajko, 2013) and congruent with the common experiences and backgrounds (Kreuger & Casey,
client-centered philosophies of both occupational therapy 2000). Focus group questions focused on the COPM’s fit
and primary care. A systematic review of 64 articles across with primary care, its challenges and strengths in this
nine clinical and nonclinical settings and practice areas setting, and feasibility issues.

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 Participants perceived level of performance and satisfaction with their
The study was conducted at three interprofessional pri- performance on each of the five identified issues. On re-
mary care clinics in Ontario, Canada. All three sites assessment, clients rate their performance and satisfaction
were academic primary care clinics and included a range on the issues identified in the initial assessment. A change
of interprofessional team members, including phar- score is obtained by subtracting the posttreatment score
macy, dietetics, social work, and psychology. Occupa- from the initial score. The COPM has been found to be
tional therapists each had assigned clinical rooms in which both a reliable and a valid measure across diagnostic cat-
to complete their assessments and interventions; depending egories and treatment settings (Parker & Sykes, 2006).
on clients’ needs, community and home visits may also have To facilitate both the administration of the COPM
occurred. The study initially included a fourth site, but and the extraction of data, an e-COPM was developed.
because of staffing changes that site was required to with- The e-COPM was embedded within each of the sites’
draw from participating. Three occupational therapists at EMR systems. The development of an e-COPM al-
the three interprofessional primary care clinics participated lowed occupational therapists to directly enter data into
in the study. The occupational therapists collected COPM the e-COPM, and the completed record was immedi-
data during all routine clinical service delivery and partici- ately available for the primary care team to review on
pated in the focus group. each patient’s chart. Mary Law, one of the authors of the
Clients were referred to occupational therapy in COPM, provided approval to use the e-COPM for the
several ways, including physician referral, referral by an- duration of the study.
other interprofessional team member, or self-referral. No In preparation for the study, occupational therapists
specific occupational therapy screening processes occurred, at each of the sites attended a half-day COPM work-
and as a result all individuals who were referred were seen shop facilitated by one of the authors of the COPM
by an occupational therapist. Clients were included in the (S. Baptiste) to ensure a common knowledge base and to
study if they met the following inclusion criteria: (1) able clarify any questions regarding COPM administration;
to understand and communicate in English and (2) the lead investigators ensured that the study protocol was
expected occupational therapy intervention of more than explained.
two visits. Clients were excluded from the study if they did Data Analyses
not have the cognitive ability to independently identify
occupational issues (i.e., advanced dementia). No formal Quantitative COPM data were analyzed using descrip-
cognitive screen was used, and the client’s ability to tive statistics, including frequencies, means, and standard
complete the COPM was based on the individual ther- deviations. Patient age, COPM issues, and COPM scores
apists’ clinical judgment. were extracted from the EMR directly into a Microsoft
A study by Colquhoun et al. (2010) found that one Excel spreadsheet (Microsoft, Inc., Redmond, WA). All
of the key barriers to COPM completion is cognitive is- calculations were completed using Excel formulas. Occu-
sues as perceived by occupational therapists; therefore, pational issues were categorized into self-care, produc-
we included it as an exclusion criterion. A data extraction tivity, and leisure, and frequency of issues was determined
program was written to directly export deidentified elec- for the total sample. Mean change scores for both satis-
tronic COPM (e-COPM) data from the electronic med- faction and performance were calculated when available.
ical record (EMR) on completion of Phase 1. Ethics approval The focus group was recorded and transcribed ver-
was received by the university’s Health Sciences Research batim. The principal investigator (Catherine Donnelly)
Ethics Board. and the research assistant read and reread the transcript to
become familiar with the data and begin to identify
portions of the transcript related to the clinical utility of
Canadian Occupational Performance Measure the COPM. Preliminary codes were identified, and quotes
The COPM is an individualized, client-centered outcome associated with the codes were indexed and organized
measure. A semistructured interview enables the client to in ATLAS.ti (Version 7; ATLAS.ti Scientific Software
identify areas of difficulty in the areas of self-care, pro- Development, Berlin, Germany), a qualitative software
ductivity, and leisure (Law et al., 2014). The client rates program. Preliminary codes were provided to all members
the importance of each identified issue on a scale ranging of the focus group for review. A review and discussion of
from 1 to 10 (1 5 with great difficulty or not satisfied, 10 5 the preliminary coding structure resulted in full consensus
with no difficulties or completely satisfied). Clients subse- among participants. As a result, no further changes or
quently rate as many as five identified problems on their additions were made to the coding structure.

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 Results Table 2. Top Three Most Frequently Reported Occupational
Performance Issues
A total of 161 initial COPMs were administered, and 22
Self-Care (n 5 248) Productivity (n 5 229) Leisure (n 5 179)
were readministered. Thus, change scores could be cal-
Issue n (%) Issue n (%) Issue n (%)
culated for 14% of the COPM data (see Table 1). The
Functional 91 (37) Home management 101 (44) Active 83 (46)
average age of participants was 56.7 yr (standard de- mobility
viation [SD] 5 17, range 5 23–91; 122 women and Sleep 36 (15) Employment 58 (25) Social 53 (30)
39 men). Forty-eight participants (29%) were older than Dressing 26 (10) Meal preparation 28 (12) Quiet 43 (24)
age 65 (mean age 5 77.2, SD 5 7.0). Participants ini-
tially identified a total of 656 issues; self-care goals were
traditionally on medical symptoms. “It’s a really nice way
identified most frequently (n 5 248; 38%), followed by
to move from symptom focus to a focus on occupation”
productivity (n 5 229; 35%) and leisure (n 5 179;
(Site 2, Occupational Therapist 1 [S2O1]).
27%). The subset of participants who were older than age
The COPM supported therapists in ensuring a unique
65 identified a total of 167 goals; self-care goals were
lens within primary care:
identified most frequently (n 5 82; 49%), followed by
leisure (n 5 47; 28%) and productivity (n 5 38; 23%). I think [the COPM] forces us as clinicians to ensure that
The average initial COPM Performance score was 3.8 [focus on function] because it’s really easy to focus on
(SD 5 1.5), and the average initial COPM Satisfaction the things [the patients] are telling us that are more
score was 3.0 (SD 5 1.6). An average of 4.1 issues (SD 5 impairment based because that fits the model of pri-
1.3) were identified per client, with adults older than age mary care. (S1O3)
65 identifying an average of 3.6 issues (SD 5 1.4). The Changing people from symptom focus to function
five most frequently reported problems by occupational focus. (S2O1)
performance category are presented in Table 2.
Just as the COPM supports occupational therapists in
The focus group provides further insight into both
ensuring an occupational lens, it also helped patients to
the COPM results and the process of COPM adminis-
view their own problems from a different perspective.
tration. Analysis of the focus group data resulted in the
identification of a total of 14 codes. Sample codes included People can get very mired down in their symptoms . . .
longitudinally, rapidly evolving practice; scoring; patient and life gets put on hold, but [when] we start looking at
priorities; reframing change in primary care; one-time what they can do and how they are changing from a
functional perspective it helps them to reframe their
interaction; shift from symptoms to occupation; and the
perception of how this [has] affected their life. (S2O2)
unique occupation lens. From these codes, two broad
themes and two subthemes were identified that addressed The COPM enabled patients to see meaningful, positive
issues of the COPM’s feasibility and overall fit with a changes when changes in their medical symptoms may
primary care setting. The themes were (1) supporting not have been easily identified. Sometimes what people
occupational therapy practice: focusing on function and deem as important in their lives are not things that we
(2) the unique environment of primary care. can easily measure . . . but being able to measure
something that actually changed for them because that
Supporting Occupational Therapy Practice: Focusing was important and not just the range of motion in their
on Function shoulder. (S2O2)

The major strength of the COPM in primary care was its Unique Environment of Primary Care
focus on function or occupation. This was seen as par-
Challenge of Reassessment. The primary care envi-
ticularly important in this setting, in which the focus is
ronment provided some unique challenges that have not
been previously presented in the literature. Primary care
Table 1. COPM Change Scores for Participants Who Had a
Follow-Up Assessment
provides health care to patients across the life course. In
interprofessional primary care clinics, patients are rostered
M (SD)
or signed up with a team that provides them with con-
Initial Assessment Reassessment Change
COPM (n 5 22) (n 5 22) (n 5 22)
tinuous support and services over time, as needed. As a
Performance 3.4 (1.2) 5.6 (2.0) 2.1 (1.5)
result, there is no natural start or endpoint, as is the case in
Satisfaction 2.4 (1.3) 5.1 (2.5) 2.6 (2.0) traditional settings in which occupational therapists are
Note. COPM 5 Canadian Occupational Performance Measure; M 5 mean; employed. “We don’t actually discharge” (S2O1). With-
SD 5 standard deviation. out a set discharge date, readministration was a challenge.

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 “I think knowing when to rescore in primary health is occupational performance issues identified by clients in
more of a challenge” (S2O2). “That’s probably another primary care and the overall feasibility of the COPM as an
challenge that I’ve faced with, sort of, getting people in outcome measure. Participants referred to occupational
for a follow-up measure . . . [in rehab] there’s a date therapy reported a relatively equal distribution of prob-
they’re going home so you do your measures beforehand” lems among self-care, productivity, and leisure. In con-
(S2O2). trast, the literature has largely shown that in acute and
A further challenge with reassessment was the focus rehabilitation settings, the greatest emphasis has been on
on screening and assessment, which created short-term issues related to self-care, with less emphasis on leisure and
interactions with little or no opportunity for follow- minimal emphasis on productivity (Chen, Rodger, &
up. “There’s a lot of people I’m seeing within a 1-hour Polatajko, 2002; Colquhoun et al., 2010; Cup, Scholte
confined [appointment]; giving them strategies, tips, re- op Reimer, Thijssen, & van Kuyk-Minis, 2003; Donnelly
ferring to some community programs. Then I won’t see et al., 2004). Clients receiving services in other commu-
them again” (S1O3). As a result, therapists felt the nity settings, including home-based rehabilitation services
COPM had the best fit with client and situations in or outpatient clinics, have identified COPM occupational
which they were going to engage in multiple interactions performance issues similar to those found in primary
over time, as in the case with people with complex care, with a more equal distribution among issues in self-
multiple chronic conditions. For program-based services, care, productivity, and leisure. This finding suggests that
such as a chronic pain program or healthy living group, opportunities exist for therapists in community-based
the COPM offered a way to measure change over time. settings to address broad occupational performance issues
“It’s the more complex clients [with whom] you’re going (Appelin, Lexell, & Månsson-Lexell, 2014; Persson,
to engage in a more long-term relationship” (S1O3). Lexell, Rivano-Fischer, & Eklund, 2013).
This study provides further confirmation that oc-
I don’t know that I would use it as a routine outcome
measure. I think that I would say that there are patients cupational therapists in primary care are very much
where it’s a good measure and I think my sort of gut generalists (Donnelly et al., 2014, 2016). Not only do
[feeling] is that it is more complex people [with whom] occupational therapists provide a broad range of services,
you know you’re going to be spending a fair bit of time but the client issues are also wide ranging, suggesting that
working on perhaps a number of different issues. Or the primary care setting provides an incredible opportu-
maybe not, maybe just one issue but it’s going to take nity to work to the full scope of occupational therapy
time to progress with. (S2O1) practice.
Generalist Role. The generalist focus of primary care
This study found that home management (n 5 101),
was also seen as influencing the nature of the occupational functional mobility (n 5 91), and active leisure (n 5 83)
performance problems identified with the COPM (Law were the top three issues reported, which highlights the
et al., 2014). Although the problems of emphasis in re- fact that clients being seen in primary care are concerned
habilitation settings are self-care in nature, in primary about maintaining their independence within the home
care the issues that were identified spanned self-care, pro- and community. Occupational therapists in primary care
ductivity, and leisure. should consider emphasizing interventions that maintain
and promote home- and community-based function or
I’ve just started thinking about my rehab experience prevent further decline.
and you know it was typically ADLs, mobility . . . A survey examining the role of occupational therapy
getting out in the community. They were a bit more
in primary care found the top three practice areas were the
focused and specific. Here it’s a broad range. It could
provision of equipment, fall prevention, and chronic
be anything. (S2O2)
disease management (Donnelly et al., 2016). In Australia,
Overall, the COPM was seen as a good philosophical fit Mackenzie et al. (2013) urged occupational therapists to
with primary care, framing medical issues in a functional seize the day and develop a fall prevention role in primary
way and highlighting the broad issues that clients are care. In Canada, Richardson et al. (2010) examined the
identifying in occupational therapy. impact of occupational therapy and physical therapy
among adults with chronic illness in interprofessional
primary care clinics. It is interesting that both of these
Discussion practice areas (falls and chronic disease management)
This is the first known study to examine the use of the map closely onto the problem areas identified in this
COPM in a primary care setting. The study focused on study through administration of the COPM and again

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 highlights the focus of primary care on prevention and that have a starting point and an endpoint to interven-
management of disease and disability. Although neither tions, clients in primary care have a lifelong relationship
Mackenzie et al. nor Richardson et al. (2010, 2012) used with providers. Thus, there is seldom a discharge meeting
the COPM, this study suggests that it could be a positive or specific point in time for follow-up assessment; instead,
addition to any research or clinical practice in a primary the patient returns again when the next health issue arises.
care setting. This study also highlights the need for occupational
The major strength of the COPM in a primary care therapists to consciously build outcome measurement
setting is its focus on function and occupation. Function into this setting, because this appears to be a challenge. As
transcends any specific medical diagnosis, which is par- the role of occupational therapy in primary care settings
ticularly important in primary care, in which the focus continues to develop, therapists may become more adept
is traditionally on medical symptoms. Broad applicability at integrating formal follow-up. Strategies to support
of the COPM to a range of clients is congruent with the outcome measurement could involve booking routine
generalist role of the occupational therapist in primary follow-up appointments or incorporating telehealth tech-
care. Bringing a functional or activity focus to the inter- nology. With an increasing emphasis on patient-centered
professional primary care team provides a unique lens and care and patient-centered research in primary care, the
fits with the increasing emphasis on and importance of individualized nature of the COPM is philosophically
activity and balance, particularly in relation to both aligned with these approaches; given this, it is important to
chronic disease management and healthy aging. examine how best to support regular use of the COPM for
Law et al. (2014) have reported that change scores >2 both initial assessment and follow-up.
represent minimal clinically important change. In this An interesting finding was that participants who re-
study, the COPM Performance and Satisfaction change ceived a follow-up COPM had initial scores that were
scores both exceeded this benchmark (at 2.1 and 2.6, lower than the sample as a whole (Performance, 3.4 vs. 3.8;
respectively), suggesting that the services provided be- Satisfaction, 2.4 vs. 3.0). This result suggests that occu-
tween the baseline and follow-up COPM resulted in an pational therapists provide more intensive and longer term
important change in clients’ perception of occupational interventions to those with lower perceived function.
performance in primary care. Although this may be an intuitive conclusion, the COPM
However, despite the number of initial assessments scores provide an opportunity to consider how they might
completed, relatively few were readministered, and the be used to predict which clients are in need of more in-
focus group data supported the notion that readminis- tensive occupational therapy services and which are more
tration of the COPM is a challenge in primary care set- appropriate for a short-term consultation. Although the
tings. Colquhoun et al. (2010) administered the COPM study did not specifically explore these issues, the results
on a routine basis in a hospital rehabilitation setting and raise some important questions and highlight the need for
had an 82% completion rate. The primary reasons for further research to explore how the COPM could be used
lack of completion related to challenges due to cognitive in primary care to identify and prioritize clients who
issues as perceived by the occupational therapists. How- would benefit from occupational therapy intervention. In
ever, in this study, the context of the primary care setting a primary care setting, in which caseloads are large and
appears to be the biggest factor in the COPM readmini- formal discharge does not occur, identifying who could
stration rate. An interesting finding relates to the number most benefit from occupational therapy services is very
of COPMs that were completed. In this study, 161 initial important.
COPMs were completed versus Colquhoun et al.’s 45 An e-COPM template embedded within the EMR
COPM initial attempts in a rehabilitation setting. Al- offered an opportunity to integrate occupational therapy
though the duration of data collection was double that of reporting directly with other medically based reports and
Colquhoun et al. (10 mo vs. 5 mo), the rate of COPM clinical examinations (i.e., X-rays, computed tomography,
administration in primary care was almost 4 times as bloodwork, specialist reports). This has potential benefits,
great, highlighting the emphasis on screening and as- including the ability to easily extract data for reporting and
sessment in primary care versus ongoing intervention. quality assurance and more visible access to occupational
In this study, no data were collected on the number of therapy data in the EMR. Although the e-COPM was
occupational therapy visits per client or the duration developed for the duration of the project, it provided an
between visits, and further descriptive research is required easy-to-use format and is well-suited for the paperless
to better understand how exactly occupational therapy is charting found in many primary care settings. Offering
being delivered in primary care. Unlike traditional settings easy access to outcome measures may facilitate regular use

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 and integration into practice and is something occupa- care is an ideal setting for occupational therapists to offer
tional therapy as a profession must consider with the comprehensive client-centered services. The strength of
increasing push for mechanisms to support continuous the COPM in a primary care setting was its focus on
quality improvement. In a study of the routine use of the occupation and function rather than medical symptoms.
COPM in a rehabilitation unit, however, Colquhoun Given the lifespan approach and emphasis on screening
et al. (2010) found that despite organizational support and assessment in primary care, the challenge was finding
and the perceived benefit of the COPM by clinicians, an opportunity for readministration, but the COPM was
the measure was not consistently used. Given that the seen as an invaluable tool to guide initial assessments and
COPM will now be available in electronic form, it would offer an occupation-focused lens. s
be valuable to understand what impact this format may
have on routine use. Acknowledgments
Primary care has a strong emphasis on outcomes and
Project funding was provided by the Ontario Society of
indicators and, to date, primary care research and policy
Occupational Therapists.
have focused on physician-based indicators (Jaakkimainen
et al., 2006). Given the growing focus on interprofes-
sional primary care teams, there is an urgent need to
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