Canadian Occupational Performance Measure (COPM) in
Primary Care: A Profile of Practice
Catherine Donnelly, PhD, OT Reg (Ont.), is
Associate Professor, School of Rehabilitation Therapy,
Queen’s University, Kingston, Ontario, Canada; Catherine.
donnelly@queensu.ca
Colleen O’Neill, BSc (OT), OT Reg (Ont.), is
Occupational Therapist, McMaster Family Health Team,
McMaster University, Hamilton, Ontario, Canada.
Martha Bauer, BSc (OT), OT Reg (Ont.), is
Occupational Therapist, McMaster Family Health Team,
McMaster University, Hamilton, Ontario, Canada.
Lori Letts, PhD, OT Reg (Ont.), is Associate Dean,
Occupational Therapy Program, and Professor, School of
Rehabilitation Sciences, McMaster University, Hamilton,
Ontario, Canada.
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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
ith the increasing emphasis on interprofessional primary care, it is critical
to understand occupational therapy’s role in this setting and the client
issues that arise (Donnelly, Brenchley, Crawford, & Letts, 2014; Letts, 2011;
Mackenzie, Clemson, & Roberts, 2013; Metzler, Hartmann, & Lowenthal,
2012; Muir, 2012). Primary care should have certain core features; most im-
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, &
Macinko, 2005). Primary care is also characterized by comprehensive services
that are delivered longitudinally, and it should be person centered (Starfield
et al., 2005). Primary care increasingly has a population orientation and in-
cludes health promotion, illness and injury prevention, and community de-
velopment (Aggarwal & Hutchison, 2012; Health Canada, 2012).
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,
November/December 2017, Volume 71, Number 6
 approximately 40 occupational therapists work on pri-
mary care teams (Donnelly et al., 2014). These positions
have offered a tremendous opportunity to understand the
role of occupational therapy in primary care. Occupa-
tional therapists working on primary care teams have
provided services across the full life course and spectrum
of disease conditions (Donnelly et al., 2014). Although
occupational therapists are known to be working as
generalists in primary care, no demographic data have
been published examining the exact nature of the disease
conditions or the frequency with which specific condi-
tions are being seen in primary care. A national survey of
occupational therapists working on primary care teams
found that the most frequent services being provided
were health promotion and prevention activities (71%),
including falls prevention (71%) and home safety as-
sessment (69%; Donnelly, LeClair, Wener, Hand, &
Letts, 2016).
Although early research has offered an important
glimpse into the roles of occupational therapists, it is also
critical to understand the occupational issues being
identified by clients in primary care and determine out-
come measures to evaluate the effectiveness of occupa-
tional therapy services in this setting. To date, there has
been no published research on occupational therapy
outcomes in primary care.
Because of the generalist nature of occupational
therapy practice in primary care, measures need to be able
to capture outcomes from services that address the ex-
tensive physical and mental health issues identified by
clients in this practice setting (Donnelly et al., 2014).
Occupational therapists have been shown to primarily
rely on nonstandardized measures (Colquhoun, Letts,
Law, MacDermid, & Edwards, 2010); with primary
care’s strong emphasis on outcomes, it is critical to iden-
tify standardized outcome measures that are meaning-
ful to both clients and therapists and feasible to use in a
diverse primary care environment. Ultimately, a generic
occupation-focused outcome measure would be ideal to
demonstrate the unique contribution of occupational
therapy to primary care.
The Canadian Occupational Performance Measure
(COPM; Law et al., 2014) is an individualized outcome
measure designed to assess clients’ perception of their
occupational performance and satisfaction with that
performance. The COPM is consistent with the Cana-
dian Model of Occupation Performance and Enablement
(Townsend & Polatajko, 2013) and congruent with the
client-centered philosophies of both occupational therapy
and primary care. A systematic review of 64 articles across
nine clinical and nonclinical settings and practice areas
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examined the impact of the COPM in clinical practice
(Parker & Sykes, 2006). The review found that the COPM
enables clients to identify goals for occupational therapy
and engage in the therapy process. From a therapist per-
spective, the COPM supports a collaborative partnership
and focuses intervention on occupations. The COPM’s
broad applicability makes it an ideal outcome measure for
use in primary care. Despite its distribution in 21 countries,
its translation into 30 languages, and countless publica-
tions, no known research has focused on its use in primary
care. Because the COPM is a general occupation-focused
measure, has been recommended for use across many areas
of occupational therapy practice, and has established strong
measurement properties, it is ideally suited for adoption in
primary care.
The purpose of this study was to examine the use of
the COPM in a primary care setting. We sought to answer
two questions: (1) What client issues are being identified
through administration of the COPM? and (2) What is
the feasibility of using the COPM as an outcome measure
in primary care? Results of the study will provide further
insights into the use of the COPM in primary care and
into the nature of occupational performance issues so that
occupational therapy interventions tailored to the primary
care setting can be developed or refined.
Method
Design
A sequential mixed-methods design was used. Mixed
methods are ideally suited to understanding complex issues
because they integrate both qualitative and quantitative data
(Creswell, 2009). For this study, we wanted not only to
know the nature of occupational issues identified by the
COPM (Law et al., 2014) but also to understand the
experience of using the measure in a novel practice setting.
The study was implemented in two phases. Phase 1
occurred over a 10-mo period during which the COPM
was administered to all clients seen by the occupational
therapists at each of the three study sites. Phase 2 involved
a focus group, conducted by a research assistant, consisting
of the participating occupational therapists. The goal of
the focus group was to explore the use of the COPM as a
routine outcome measure in primary care.
Focus groups provide an opportunity for discussion
among participants and work well when participants have
common experiences and backgrounds (Kreuger & Casey,
2000). Focus group questions focused on the COPM’s fit
with primary care, its challenges and strengths in this
setting, and feasibility issues.
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 Participants
The study was conducted at three interprofessional pri-
mary care clinics in Ontario, Canada. All three sites
were academic primary care clinics and included a range
of interprofessional team members, including phar-
macy, dietetics, social work, and psychology. Occupa-
tional therapists each had assigned clinical rooms in which
to complete their assessments and interventions; depending
on clients’ needs, community and home visits may also have
occurred. The study initially included a fourth site, but
because of staffing changes that site was required to with-
draw from participating. Three occupational therapists at
the three interprofessional primary care clinics participated
in the study. The occupational therapists collected COPM
data during all routine clinical service delivery and partici-
pated in the focus group.
Clients were referred to occupational therapy in
several ways, including physician referral, referral by an-
other interprofessional team member, or self-referral. No
specific occupational therapy screening processes occurred,
and as a result all individuals who were referred were seen
by an occupational therapist. Clients were included in the
study if they met the following inclusion criteria: (1) able
to understand and communicate in English and (2)
expected occupational therapy intervention of more than
two visits. Clients were excluded from the study if they did
not have the cognitive ability to independently identify
occupational issues (i.e., advanced dementia). No formal
cognitive screen was used, and the client’s ability to
complete the COPM was based on the individual ther-
apists’ clinical judgment.
A study by Colquhoun et al. (2010) found that one
of the key barriers to COPM completion is cognitive is-
sues as perceived by occupational therapists; therefore,
we included it as an exclusion criterion. A data extraction
program was written to directly export deidentified elec-
tronic COPM (e-COPM) data from the electronic med-
ical record (EMR) on completion of Phase 1. Ethics approval
was received by the university’s Health Sciences Research
Ethics Board.
Canadian Occupational Performance Measure
The COPM is an individualized, client-centered outcome
measure. A semistructured interview enables the client to
identify areas of difficulty in the areas of self-care, pro-
ductivity, and leisure (Law et al., 2014). The client rates
the importance of each identified issue on a scale ranging
from 1 to 10 (1 5 with great difficulty or not satisfied, 10 5
with no difficulties or completely satisfied). Clients subse-
quently rate as many as five identified problems on their
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perceived level of performance and satisfaction with their
performance on each of the five identified issues. On re-
assessment, clients rate their performance and satisfaction
on the issues identified in the initial assessment. A change
score is obtained by subtracting the posttreatment score
from the initial score. The COPM has been found to be
both a reliable and a valid measure across diagnostic cat-
egories and treatment settings (Parker & Sykes, 2006).
To facilitate both the administration of the COPM
and the extraction of data, an e-COPM was developed.
The e-COPM was embedded within each of the sites’
EMR systems. The development of an e-COPM al-
lowed occupational therapists to directly enter data into
the e-COPM, and the completed record was immedi-
ately available for the primary care team to review on
each patient’s chart. Mary Law, one of the authors of the
COPM, provided approval to use the e-COPM for the
duration of the study.
In preparation for the study, occupational therapists
at each of the sites attended a half-day COPM work-
shop facilitated by one of the authors of the COPM
(S. Baptiste) to ensure a common knowledge base and to
clarify any questions regarding COPM administration;
the lead investigators ensured that the study protocol was
explained.
Data Analyses
Quantitative COPM data were analyzed using descrip-
tive statistics, including frequencies, means, and standard
deviations. Patient age, COPM issues, and COPM scores
were extracted from the EMR directly into a Microsoft
Excel spreadsheet (Microsoft, Inc., Redmond, WA). All
calculations were completed using Excel formulas. Occu-
pational issues were categorized into self-care, produc-
tivity, and leisure, and frequency of issues was determined
for the total sample. Mean change scores for both satis-
faction and performance were calculated when available.
The focus group was recorded and transcribed ver-
batim. The principal investigator (Catherine Donnelly)
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
the COPM. Preliminary codes were identified, and quotes
associated with the codes were indexed and organized
in ATLAS.ti (Version 7; ATLAS.ti Scientific Software
Development, Berlin, Germany), a qualitative software
program. Preliminary codes were provided to all members
of the focus group for review. A review and discussion of
the preliminary coding structure resulted in full consensus
among participants. As a result, no further changes or
additions were made to the coding structure.
November/December 2017, Volume 71, Number 6
 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
more of a challenge” (S2O2). “That’s probably another
challenge that I’ve faced with, sort of, getting people in
for a follow-up measure . . . [in rehab] there’s a date
they’re going home so you do your measures beforehand”
(S2O2).
A further challenge with reassessment was the focus
on screening and assessment, which created short-term
interactions with little or no opportunity for follow-
up. “There’s a lot of people I’m seeing within a 1-hour
confined [appointment]; giving them strategies, tips, re-
ferring to some community programs. Then I won’t see
them again” (S1O3). As a result, therapists felt the
COPM had the best fit with client and situations in
which they were going to engage in multiple interactions
over time, as in the case with people with complex
multiple chronic conditions. For program-based services,
such as a chronic pain program or healthy living group,
the COPM offered a way to measure change over time.
“It’s the more complex clients [with whom] you’re going
to engage in a more long-term relationship” (S1O3).
I don’t know that I would use it as a routine outcome
measure. I think that I would say that there are patients
where it’s a good measure and I think my sort of gut
[feeling] is that it is more complex people [with whom]
you know you’re going to be spending a fair bit of time
working on perhaps a number of different issues. Or
maybe not, maybe just one issue but it’s going to take
time to progress with. (S2O1)
Generalist Role. The generalist focus of primary care
was also seen as influencing the nature of the occupational
performance problems identified with the COPM (Law
et al., 2014). Although the problems of emphasis in re-
habilitation settings are self-care in nature, in primary
care the issues that were identified spanned self-care, pro-
ductivity, and leisure.
I’ve just started thinking about my rehab experience
and you know it was typically ADLs, mobility . . .
getting out in the community. They were a bit more
focused and specific. Here it’s a broad range. It could
be anything. (S2O2)
Overall, the COPM was seen as a good philosophical fit
with primary care, framing medical issues in a functional
way and highlighting the broad issues that clients are
identifying in occupational therapy.
Discussion
This is the first known study to examine the use of the
COPM in a primary care setting. The study focused on
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occupational performance issues identified by clients in
primary care and the overall feasibility of the COPM as an
outcome measure. Participants referred to occupational
therapy reported a relatively equal distribution of prob-
lems among self-care, productivity, and leisure. In con-
trast, the literature has largely shown that in acute and
rehabilitation settings, the greatest emphasis has been on
issues related to self-care, with less emphasis on leisure and
minimal emphasis on productivity (Chen, Rodger, &
Polatajko, 2002; Colquhoun et al., 2010; Cup, Scholte
op Reimer, Thijssen, & van Kuyk-Minis, 2003; Donnelly
et al., 2004). Clients receiving services in other commu-
nity settings, including home-based rehabilitation services
or outpatient clinics, have identified COPM occupational
performance issues similar to those found in primary
care, with a more equal distribution among issues in self-
care, productivity, and leisure. This finding suggests that
opportunities exist for therapists in community-based
settings to address broad occupational performance issues
(Appelin, Lexell, & Månsson-Lexell, 2014; Persson,
Lexell, Rivano-Fischer, & Eklund, 2013).
This study provides further confirmation that oc-
cupational therapists in primary care are very much
generalists (Donnelly et al., 2014, 2016). Not only do
occupational therapists provide a broad range of services,
but the client issues are also wide ranging, suggesting that
the primary care setting provides an incredible opportu-
nity to work to the full scope of occupational therapy
practice.
This study found that home management (n 5 101),
functional mobility (n 5 91), and active leisure (n 5 83)
were the top three issues reported, which highlights the
fact that clients being seen in primary care are concerned
about maintaining their independence within the home
and community. Occupational therapists in primary care
should consider emphasizing interventions that maintain
and promote home- and community-based function or
prevent further decline.
A survey examining the role of occupational therapy
in primary care found the top three practice areas were the
provision of equipment, fall prevention, and chronic
disease management (Donnelly et al., 2016). In Australia,
Mackenzie et al. (2013) urged occupational therapists to
seize the day and develop a fall prevention role in primary
care. In Canada, Richardson et al. (2010) examined the
impact of occupational therapy and physical therapy
among adults with chronic illness in interprofessional
primary care clinics. It is interesting that both of these
practice areas (falls and chronic disease management)
map closely onto the problem areas identified in this
study through administration of the COPM and again
November/December 2017, Volume 71, Number 6
 highlights the focus of primary care on prevention and
management of disease and disability. Although neither
Mackenzie et al. nor Richardson et al. (2010, 2012) used
the COPM, this study suggests that it could be a positive
addition to any research or clinical practice in a primary
care setting.
The major strength of the COPM in a primary care
setting is its focus on function and occupation. Function
transcends any specific medical diagnosis, which is par-
ticularly important in primary care, in which the focus
is traditionally on medical symptoms. Broad applicability
of the COPM to a range of clients is congruent with the
generalist role of the occupational therapist in primary
care. Bringing a functional or activity focus to the inter-
professional primary care team provides a unique lens and
fits with the increasing emphasis on and importance of
activity and balance, particularly in relation to both
chronic disease management and healthy aging.
Law et al. (2014) have reported that change scores >2
represent minimal clinically important change. In this
study, the COPM Performance and Satisfaction change
scores both exceeded this benchmark (at 2.1 and 2.6,
respectively), suggesting that the services provided be-
tween the baseline and follow-up COPM resulted in an
important change in clients’ perception of occupational
performance in primary care.
However, despite the number of initial assessments
completed, relatively few were readministered, and the
focus group data supported the notion that readminis-
tration of the COPM is a challenge in primary care set-
tings. Colquhoun et al. (2010) administered the COPM
on a routine basis in a hospital rehabilitation setting and
had an 82% completion rate. The primary reasons for
lack of completion related to challenges due to cognitive
issues as perceived by the occupational therapists. How-
ever, in this study, the context of the primary care setting
appears to be the biggest factor in the COPM readmini-
stration rate. An interesting finding relates to the number
of COPMs that were completed. In this study, 161 initial
COPMs were completed versus Colquhoun et al.’s 45
COPM initial attempts in a rehabilitation setting. Al-
though the duration of data collection was double that of
Colquhoun et al. (10 mo vs. 5 mo), the rate of COPM
administration in primary care was almost 4 times as
great, highlighting the emphasis on screening and as-
sessment in primary care versus ongoing intervention.
In this study, no data were collected on the number of
occupational therapy visits per client or the duration
between visits, and further descriptive research is required
to better understand how exactly occupational therapy is
being delivered in primary care. Unlike traditional settings
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that have a starting point and an endpoint to interven-
tions, clients in primary care have a lifelong relationship
with providers. Thus, there is seldom a discharge meeting
or specific point in time for follow-up assessment; instead,
the patient returns again when the next health issue arises.
This study also highlights the need for occupational
therapists to consciously build outcome measurement
into this setting, because this appears to be a challenge. As
the role of occupational therapy in primary care settings
continues to develop, therapists may become more adept
at integrating formal follow-up. Strategies to support
outcome measurement could involve booking routine
follow-up appointments or incorporating telehealth tech-
nology. With an increasing emphasis on patient-centered
care and patient-centered research in primary care, the
individualized nature of the COPM is philosophically
aligned with these approaches; given this, it is important to
examine how best to support regular use of the COPM for
both initial assessment and follow-up.
An interesting finding was that participants who re-
ceived a follow-up COPM had initial scores that were
lower than the sample as a whole (Performance, 3.4 vs. 3.8;
Satisfaction, 2.4 vs. 3.0). This result suggests that occu-
pational therapists provide more intensive and longer term
interventions to those with lower perceived function.
Although this may be an intuitive conclusion, the COPM
scores provide an opportunity to consider how they might
be used to predict which clients are in need of more in-
tensive occupational therapy services and which are more
appropriate for a short-term consultation. Although the
study did not specifically explore these issues, the results
raise some important questions and highlight the need for
further research to explore how the COPM could be used
in primary care to identify and prioritize clients who
would benefit from occupational therapy intervention. In
a primary care setting, in which caseloads are large and
formal discharge does not occur, identifying who could
most benefit from occupational therapy services is very
important.
An e-COPM template embedded within the EMR
offered an opportunity to integrate occupational therapy
reporting directly with other medically based reports and
clinical examinations (i.e., X-rays, computed tomography,
bloodwork, specialist reports). This has potential benefits,
including the ability to easily extract data for reporting and
quality assurance and more visible access to occupational
therapy data in the EMR. Although the e-COPM was
developed for the duration of the project, it provided an
easy-to-use format and is well-suited for the paperless
charting found in many primary care settings. Offering
easy access to outcome measures may facilitate regular use
7106265010p6
 and integration into practice and is something occupa-
tional therapy as a profession must consider with the
increasing push for mechanisms to support continuous
quality improvement. In a study of the routine use of the
COPM in a rehabilitation unit, however, Colquhoun
et al. (2010) found that despite organizational support
and the perceived benefit of the COPM by clinicians,
the measure was not consistently used. Given that the
COPM will now be available in electronic form, it would
be valuable to understand what impact this format may
have on routine use.
Primary care has a strong emphasis on outcomes and
indicators and, to date, primary care research and policy
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
identify primary care indicators and outcomes relevant to
nonphysician primary care providers (Jaakkimainen et al.,
2006). This study offers the first look at occupational
therapy outcomes in primary care and lays the foundation
for further work in this area.
The study has limitations that must be acknowledged.
It was conducted at three primary care sites in Canada,
which may not broadly reflect the occupational issues in
primary care or the experiences of occupational therapists
working in this type of setting both within and outside of
Canada. Clients with cognitive issues were not formally
screened, which could have led to errors in the application
of the inclusion and exclusion criteria. The study focused
on occupational performance issues generally and did not
link them to specific conditions or diagnoses, something
that could be included in a future study.
Implications for Occupational
Therapy Practice
The results of this study have the following implications
for occupational therapy practice:
• The major strength of the COPM in a primary care
setting is its focus on function and occupation.
• The COPM is broadly applicable to a range of clients,
which is congruent with the generalist role of the oc-
cupational therapist in primary care.
• Clients referred to occupational therapy reported a
relatively equal distribution of problems among self-
care, productivity, and leisure.
Conclusion
This study supports the generalist nature of the occupa-
tional therapist in primary care and reinforces that primary
7106265010p7
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care is an ideal setting for occupational therapists to offer
comprehensive client-centered services. The strength of
the COPM in a primary care setting was its focus on
occupation and function rather than medical symptoms.
Given the lifespan approach and emphasis on screening
and assessment in primary care, the challenge was finding
an opportunity for readministration, but the COPM was
seen as an invaluable tool to guide initial assessments and
offer an occupation-focused lens. s
Acknowledgments
Project funding was provided by the Ontario Society of
Occupational Therapists.
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