Occupational Therapy in LGBTQ + Affirming Primary Care: Referral, Intervention, and Outcomes

ImportanceLGBTQ + clients experience healthcare barriers that may shape daily routines, health management, and participation. Little is known about occupational therapy referral pathways and outcomes in LGBTQ + affirming primary care.ObjectiveTo describe referral characteristics, occupational performance concerns, intervention focus, and client-reported outcomes among LGBTQ + clients referred to occupational therapy.DesignRetrospective pilot program evaluation using clinical documentation and outcome data from July 2025 through March 2026, with a June 2026 analysis cutoff.SettingTwo Midwestern primary care settings where occupational therapy screening and referral processes were developed; ongoing intervention occurred through outpatient occupational therapy.ParticipantsThirty-nine referred clients were included in descriptive analyses; 38 received intervention beyond evaluation; 21 had complete baseline and follow-up Canadian Occupational Performance Measure data.InterventionIndividualized outpatient occupational therapy focused on client-identified concerns.Outcomes and MeasuresReferral and treatment characteristics, occupational performance concerns, coded occupational focus, and Canadian Occupational Performance Measure Performance and Satisfaction ratings.ResultsCommon concerns included instrumental activities of daily living (94.9%), health management/self-management (92.3%), activities of daily living (82.1%), and work or school participation (82.1%). The most common primary intervention focus was health management and chronic condition self-management (65.8%). Among participants with outcome data, COPM Performance scores improved by 2.29 points and Satisfaction scores improved by 2.58 points.Conclusions and RelevanceOccupational therapy may support LGBTQ + clients referred from primary care by addressing needs related to health management, routines, self-care, and participation through individualized outpatient intervention. Prospective multisite research is needed.