Primary care and rehabilitation

Primary care is gaining currency internationally as the most effective treatment delivery system. There are parallels between the complex care needs of individuals with chronic or disabling conditions and treatment systems providing primary care including the need for comprehensive, continuous care. This chapter examines the intersections between primary care and rehabilitation and the opportunities for psychologists in these systems. Specifically, we examine if rehabilitation can be considered a version of primary care. Primary care is viewed as less expensive than specialty care systems such as the myriad of services involved in rehabilitation. A challenge for rehabilitation primary care models that do not reduce levels of care, is justifying costs. Most often, higher levels of care are justified by arguing that the higher cost is offset by better outcomes. In other words, improved quality of care or avoiding unnecessary treatment reduces secondary problems (such as depression associated with illness). Psychologists have a long history of invoking cost offsets to justify psychological care. In this chapter, rehabilitation primary care systems are considered as potential cost offset targets. Cost offsets are examined to understand if that model can be applied to rehabilitation primary care models and the implications for psychologists.