German Occupational Therapy Association (DVE)
Karlovy Vary (ots)
The term ‘responsible patient’ often creates ambivalent feelings and reactions – in some doctors, but also in one or the other patient himself. “It is important and timely that people behave more and more maturely and take responsibility for themselves ; also and especially in the health context,” explains Bettina Simon, occupational therapist and board member for care and cost bearers of the DVE (Deutscher Verband Ergotherapie eV). This also corresponds to the maxim of occupational therapists, who see their counterpart as an expert in their own life. The DVE has long been calling for the so-called extended care responsibility, known as a blank prescription, in which the prescribing doctors waive specifications such as the number of treatments or therapy frequency.
Occupational therapists work activity-oriented and client-, i.e. patient-centered. This means that after their anamnesis interview, which is part of the occupational therapy diagnosis, they analyze the everyday life of their patients with all their occupations and activities. From this, they develop an individual therapy concept together with their counterpart, which they check in the course of the treatment and adjust if necessary. So far, the legislature has stipulated that doctors make a diagnosis, select a diagnosis group and then prescribe occupational therapy with specifications such as the type of remedy, for example brain performance training or motor-functional or psychological-functional, as well as the number and frequency of occupational therapy treatment appointments. If there are deviations, the only option so far is to deal with the prescribers. Deviations can occur if the occupational therapist notices other things based on the detailed diagnostics and when checking the content of the medical indication or if the patient mentions them. This may require a different remedy – perhaps sensorimotor-perceptual instead of motor-functional – or even lead to a different diagnostic group. Consultation with the doctor usually works, but it takes more time for both sides and requires the prescription to be corrected. Nevertheless, after a change of direction that may be necessary, occupational therapists continue to have their hands tied: the legislature requires specific therapy instructions from doctors.
Occupational therapists want blank prescriptions instead of prescription corsets
“It is for the benefit of patients, therefore success-oriented and also much more economical to treat them in such a way that they receive the best possible care in their respective situation,” emphasizes occupational therapist Bettina Simon, which is why the DVE is the authoritative association of occupational therapists in Germany has long been demanding and persistently pursuing the introduction of the Blank Ordinance. What are the reasons against prescribing an occupational therapy intervention that is static and binding for a specific period of time? Occupational therapy treatment is always individual, a process that is based on treatment planning, but also adapts to the respective progress and other acute needs of the patient. The occupational therapist explains: “Depending on the illness and situation of a sick person, motor-functional treatment may be necessary and useful for the first two weeks, for example. However, neuropsychological aspects are then in the foreground – for example because cognitive deficits occur or the patients with their disease coping lag behind – occupational therapists could react flexibly with a blank prescription”. The same applies to the frequency of therapy previously also prescribed by doctors. “Every person has their own course of illness and recovery, which is not taken into account in such a rigid prescription corset,” Simon rightly criticizes the less patient-friendly and uneconomical procedure. It is an occupational therapy concern to enable patients to engage in everyday activities as quickly and as best as possible, while taking their overall situation into account. If, for example, it appears that “a window is open”, i.e. that the physical or psychological conditions of the person being treated are optimal, increasing the frequency of treatment could further promote recovery. This is often the case at the beginning of an acute illness or after an operation. If the development allows it – and occupational therapists check this regularly – the distance between the treatment appointments could increase over the course of the therapy. The cooperation of those affected also has an influence: do the patients do their own exercises at home continuously, reliably and correctly or are they less cooperative and self-motivated? The respective constitution also plays a role; in short: there are many aspects that affect the individual development process of patients. For example, a doctor’s prescription for 12 weeks simply cannot do justice to an optimal, flexible and, above all, patient-friendly occupational therapy intervention.
Benefits for everyone: patients, occupational therapists, doctors and insurance carriers
What advantages does Bettina Simon see from the blank ordinance? The ergotherapist on the board of the DVE mentions two decisive points: “The content-related participation and the flexibility”. The co-design of the content refers to the ergotherapeutic treatment and is not fundamentally new, but in certain places, namely in terms of remedies, decisive. It is already state of the art in occupational therapy to develop the treatment plan together with the patient. This already begins with the ergotherapeutic diagnosis, which queries all activities, the social environment, participation and also clarifies all aspects of work, school, leisure time and so on. Occupational therapists also shed light on the skills and resources that patients have, on the one hand, where they have limitations and in which areas they want to make improvements. All of this results in which goals and which remedy is most important and most effective for the respective person at the moment. With this approach, occupational therapists and patients could, for example, come to the conclusion: “Brain performance training is currently in the foreground, since cognitive difficulties impair everyday life more than, for example, limited mobility”. However, if the prescription is medically prescribed as a motor-functional remedy, the treating occupational therapist must also work motor-functionally, i.e. without considering the actual needs of patients. The current condition of the patient is therefore ignored, as is further development. The second advantage of the blank prescription is the flexibility, in addition to the choice of the remedy that is currently required, also the scheduling of the individual treatment units. Patients who are currently on sick leave can – if their health status allows it – make appointments at short intervals. For working people, therapy sessions that can be combined with their working hours are important. Additional stress due to frequent appointments in an occupational therapy practice tends to be counterproductive with regard to the healing process. “It is one of the tasks of occupational therapists to find out such subtleties and details in the initial and admission interview; doctors have neither time for this nor can they bill for such services,” Bettina Simon allows further insights that explain why the current form of regulations is not in line with reality.
The conclusion: As long as occupational therapists have to work with the previous form of prescriptions, they sometimes cannot achieve the optimal result. This can not only have a negative effect on the image of this professional group, it can above all mean that the course of the disease takes longer, patients do not recover as quickly or possibly not as completely and this results in more costs – nobody wants that. The patients do not and the occupational therapists themselves least of all.
Information material on the diverse topics of occupational therapy is available from the occupational therapists on site; Occupational therapists near your place of residence on the association’s homepage at https://dve.info/service/therapeutensuche
Press contact:
Angelika Reinecke, German Occupational Therapy Association (DVE),
[email protected]
Original content from: Deutscher Verband Ergotherapie eV (DVE), transmitted by news aktuell
