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Background Incorporating occupational therapists (OTs) into primary care requires adapting services to patient needs and depends on how colleagues within the multidisciplinary team perceive the OT roles and collaborate in daily practice. This study explored the feasibility, impact on the care team, and challenges of incorporating an OT into the home-based care service of a Spanish primary healthcare center. Methods A two-phase sequential exploratory mixed-methods study was conducted. First, structured interviews and a stakeholder focus group were conducted over the six months following the introduction of the OT. Thematic analysis identified factors that hindered or supported integration. Second, a cross-sectional study described patients who received OT care within 12 months of service implementation. The electronic health records provided patient profiles and OT interventions. Descriptive statistics and the Kruskal–Wallis tests were used to examine the associations between the study and patient characteristics. Results Six themes emerged: introduction of the OT role, team coordination, impact on team functioning, impact on patient and caregiver, contributions of the OT, and structural limitations and challenges. OT integration improved interdisciplinary collaboration and patient-centered care; however, initial role ambiguity and a lack of referral criteria were challenges. Over 12 months, 248 patients were visited (mean age, 88.2 years; 70.9% women), with an average of 11.1 chronic conditions. Overall, 45.6% had severe or total dependency in activities of daily living, and 43.2% reported at least one fall in the past year. OT interventions focused on risk assessment (65.6%) and home adaptation (52.5%). Patients with moderate-to-severe functional dependency received more risk assessment activities (median: 2; p  = 0.005). No significant associations were found between intervention frequency and fall history or other functional domains. Conclusions Integrating an OT into a primary health care team appears feasible and valuable. Sustainable implementation may require clear patient profiles, defined professional roles, structured integration processes, robust evaluation frameworks, and service standardization-based workforce planning.

Background Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences and goals, which is the core of the motivational interview. The objective of this study was to evaluate the efficacy of a cardiac rehabilitation program with a motivational interview in patients discharged from hospital after acute myocardial infarction. Methods/design A randomized, non-pharmacological clinical trial in six primary healthcare centers in Barcelona (Spain) will assess whether a tailored cardiac rehabilitation program consisting of four motivational interviews and visits with family physicians, primary healthcare nurses and a cardiologist, coordinated with the reference hospital, results in better cardiac rehabilitation than standard care. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction will be randomized to a cardiac rehabilitation group with a motivational interview program or to standard primary healthcare. The main outcome will be physical function measured by the six-minute walk test, and the secondary outcome will be the effectiveness of secondary prevention: a composite outcome comprising control of blood pressure, cholesterol, diabetes mellitus, smoking and body weight. Results will be evaluated at 1,3 and 6 months. Discussion This is the first clinical trial to study the impact of a new primary healthcare cardiac rehabilitation program with motivational interviews for patients discharged from hospital after myocardial infarction. Changes in lifestyles and habits after myocardial infarction are a core element of secondary prevention and require patient-centered care strategies such as motivational interviews. Therefore, this study could clarify the impact of this approach on health indicators, such as functional capacity. Trial registration ClinicalTriasl.gov NCT05285969 registered on March 18, 2022.