title: Standardized referral form: Restricting client-centered practice?
abstract: BACKGROUND
  To increase homecare efficiency, the Ministry of Health and Social Services in Québec, Canada, encourages standardization of practices, including those of community occupational therapists (COTs). The impact of standardization is not known and might reduce client-centeredness. Aim/objectives. To explore the content and use of a referral form to standardize COTs' practice.
  
  
  METHODS
  An institutional ethnography inquiry was conducted through observations of work and interviews with 10 COTs working in three homecare programs. Secondary informants were also interviewed and documents collected. Data were analyzed using institutional ethnography procedures.
  
  
  RESULTS
  The referral form, completed by the COTs' colleagues, includes categories primarily related to safety or autonomy in personal care and mobility. The form organizes COTs' work, including information collection and interactions with clients and caregivers. Seen as consultants, COTs assess needs and make recommendations to keep clients at home safely for as long as possible, an important element of the homecare discourse.
  
  
  CONCLUSIONS
  The impact on COTs' potential to be truly client-centered revealed by these findings merits serious consideration by other health professionals. Concerted efforts by professionals to question and act upon contextual barriers to client-centeredness are needed.
authors.affiliation: School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke , Québec , Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Carrier
authors.forename: Andrew
authors.initials: A
authors.lastname: Freeman
authors.forename: Mélanie
authors.initials: M
authors.lastname: Levasseur
authors.forename: Johanne
authors.initials: J
authors.lastname: Desrosiers
mesh_terms: D006282:Health Personnel; D006699:Home Care Services / Q000592:standards; D006801:Humans; D020380:Needs Assessment / Q000592:standards; D009788:Occupational Therapy / Q000592:standards*; D018802:Patient-Centered Care / Q000379:methods*; D011792:Quebec; D011996:Records / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D012946:Social Welfare
keywords: community services; documentation; efficiency; home care services; institutional ethnography; needs assessment; occupational therapy; patient-centered practice; practice context; quality; standardization