Abstract
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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13679-5.