Referral & Shared Care
Trainer Notes
& Activities
Overview
Referral and Shared Care comprise additional components of the range of strategies GPs may undertake in responding to the needs of patients with AOD-related issues.
Key Points
- Referral may be an intensive activity, as it requires accurate identification of a patient’s problems.
- Effective referral includes liaison, facilitation and follow-up.
- Ensure the colleague to whom you refer is competent in dealing with AOD issues and can meet the specific needs of the client.
- Increasing complexity and severity of AOD-related problems indicate the need for shared care; services need to coordinate shared care.
- There are systemic barriers to shared care that need to be identified and countered.
- Resources and training, including workplace development, must be available to GPs to ensure quality shared care arrangements.
Suggested Objectives
To enable GPs to:
- recognise the complexity of effective referral
- identify when referral can provide greatest benefit to the patient
- identify services available to people experiencing AOD-related problems
- articulate principles of good referral and a working definition of shared care
- articulate a strong rationale for GPs to engage in shared care
- identify the broad scope of shared care options and provide examples in the Australian context
- recognise factors required to establish and maintain shared care arrangements.
Topic Contents
Slides
The slides with slide notes cover:
- complexity of successful AOD referral
- reasons for referring and not referring
- types of available services and good referral practice
- definition and rationale of shared care
- examples of shared care, and mechanisms to ensure shared care arrangements are adopted and maintained.
The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of their participants.
Activities
The activities provide opportunities for GPs to:
- clarify referral objectives and decision-making using a flow-chart design activity
- provide contact details for local AOD support services
- rehearse skills required for successful referral
- apply the principles of shared care to their practices
- express a commitment to shared care
- develop skills, resources, protocols and infrastructure to ensure their shared care involvement is extended and maintained.
Handouts
- AOD Referral
Adapted from: Carmichael, C. 2001, The DISE Manual – A Resource for Directions in Illicit Substance Education, Queensland Alcohol and Drug Research and Education Centre (QADREC), University of Queensland, Brisbane, p.44.
- Shared Care in the AOD Management
Copeland, J. 1998, Shared Care in the Management of Alcohol and Other Drug-Related Disorders: A Review of the Literature, ISERU (Integration Support and Evaluation Resource Unit) and School of Community Medicine, University of New South Wales, Sydney.
- Models of Mental Health Shared Care
Holmwood,C., 2001, Models of Mental Health Shared Care and their Effectiveness, Primary Mental Health Care Australian Resource Centre (PARC) Available from
Please refer to the Resource Kit CDROM for a copy of handouts (PDF and Word).
Sources of Additional Information
Additional Resources
Copello, A., Templeton, L., Krishnan, M., Orford, J. & Velleman, R. 2000, ‘A Treatment Package to Improve Primary Health Care Services for Relatives of People with Alcohol and Drug Problems’ Addiction Research, vol. 8, issue 5, pp.471–484.
Meyers, R. & Miller, W. (eds) 2001, A Community Reinforcement Approach to Addiction,Cambridge University Press, Cambridge.
Penrose-Wall, J., Copeland, J. & Harris, M. 2000, Shared Care of Illicit Drug Problems by General Practitioners and Primary Health Care Providers: A Literature Review.Centre for General Practice Integration Studies and the National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney.
Referral & Shared Care
Activities
Activity 1: Referral Flow Chart
Purpose
To design a referral flow chart that reflects appropriate practice for the participants’ clinics.
Process
1.1Divide participants into small groups, according to similar practice characteristics (e.g., rural, small or large medical centres)
1.2Instruct groups to identify factors related to their practice and other factors that would lead them to refer
1.3Discuss with groups how they might represent the dynamics of referral (such as a flow chart) that shows the:
- factors
- objectives
- decisions associated with referral of patients with AOD related problems
1.4Each group presents their representation (flow chart) to the whole group
1.5Facilitate discussion of findings (i.e., what are the common factors, objectives and decisions?)
Activity 2: Identify Services
Purpose
To identify specific services and personnel with whom participants can liaise for efficient referral.
Process
2.1Give participants lists of State Government and local body resources and a phone book
2.2Instruct participants to identify services currently used with patients needing assistance for their AOD related problems
2.3Identify other services they believe would be useful for patients with AOD related problems but have not previously investigated (e.g., housing, welfare services)
2.4Ask participants to identify two services they are prepared to visit to discuss referral issues for patients with AOD issues
2.5Instruct participants to present their lists to the group for discussion
2.6Suggest that it may be useful for participants to arrange a group visit to relevant services.
Activity 3: Referral Discussion
Purpose
To rehearse a referral discussion with a ‘patient’ that includes appropriate encouragement, direction and support.
Process
3.1Arrange for a participant to role play a ‘patient’ who needs referral. Instruct the ‘patient’ to draw on a case known from personal experience
3.2Instruct participants to sit in a semicircle and take turns interacting with the patient about his/her referral options and preferences
3.3If necessary, provide a few prompts that assist in making the interview flow (i.e., what you say is interesting, can you tell me more about…?)
3.4At the end of the interview:
- ask the ‘patient’ to give their impression of the contact with the ‘doctors’
- ask the ‘doctors’ their impression of the contact
- provide your own impression of the session
3.5Facilitate group discussion including suggestions for improvement.
Activity 4: Analysis
Purpose
To determine and analyse the current nature of shared care arrangements among participants.
process
4.1Divide participants into small groups
4.2Instruct participants within each group to discuss shared care arrangements, determine what is working well, and identify areas for improvement
4.3Each group presents their response to the whole group for discussion.
Activity 5: Increase Involvement
Purpose
To identify potential for further shared care involvement and enhance motivation to become more involved.
process
5.1Conduct a ‘brainstorm’ session with the group to identify possible further shared care arrangements and participation
5.2Encourage creative ideas
5.3Work with the group to appraise options and promote (if needed) a commitment to explore several options.
Activity 6: Planning
Purpose
To plan protocols and support mechanisms to ensure shared care arrangements are implemented and sustained.
process
6.1Divide participants into small groups
6.2Instruct each group to develop a schema of the skills and mechanisms required to achieve shared care objectives, and to record the model on an overhead transparency or large piece of paper
6.3Each group presents the model to the whole group for discussion.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Complexity: Referral & Shared Care