#1 - Referring to other health professions

​Author: Shane Pritchard BPhysio APAM
Director and Musculoskeletal Curriculum Lead

Many overseas-trained physiotherapists are well aware that it is appropriate to involve disciplines other than physiotherapy in patient care.

However, the disciplines of the Australian healthcare system might be very different to the disciplines from back home.

How do you know when it is appropriate to refer a patient to another healthcare discipline? And how do you know who is the most appropriate discipline to refer them to?

These questions have been asked many, many times in our Clinical Assessment Simulation Courses so far this year.
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In this blog we’ll provide a summary of the health professional disciplines who routinely make up the Allied Health Professions of the Australian healthcare system, and discuss some examples of when it would be appropriate to involve other disciplines.

Interprofessional collaborative practice (ICP) is extremely important

“Interprofessional collaborative practice” refers to the active participation of several healthcare disciplines in the care of a patient(1) .

ICP enables shared clinical decision making, continuous communication, and facilitates respect for the contributions of all providers. Practicing in this way benefits patients, family, and caregivers(2) .

However, we must remember that interprofessional collaboration is not doing another professional’s job.

It is about identifying areas that are outside your own skills and scope, and directing to the most appropriate practitioner.

What is required of me in my APC clinical exam?

The below table is taken from the Clinical Assessment Information Booklet for Simulation candidates, published by the APC.

Domain 2.5 of “interpret and analyse the assessment findings” outlines what you must demonstrate in your assessment (and, for that matter, in your physiotherapy work as a clinician also!)

When you're working with a patient, the “identifying” will happen either in the moment as you listen to your patient's concerns, or afterwards when you reflect on your assessment findings.

You might think to yourself "physiotherapy can't help with that, but a different discipline can". This would require a referral to another health profession. You could discuss this with your patient directly.

Alternatively, part of your exam involves "Oral Reporting Time", where your "assessors to seek clarification of the treatment plan and the rationale behind the intervention as some Candidates may not verbalise their actions during the assessment. Assessors can also use this time to ask the Candidate about their ongoing management plan of the patient." (Page 4). 

You might then discuss a referral to another health profession with your patient directly.

What allied health professions are there in Australia?

Here’s a summary of allied health professions who you may consider discussing a referral about, if areas are identified that are outside your own skills and expertise:

​Health profession	​What they do	​What services they provide	When should they be involved
Physiotherapy	​Experts in whole body movement and function, and optimising health through primarily physical means	Assessment, diagnosis, planning, treatment (manual therapy, exercise therapy, and education) and management of a broad range of health conditions, discharge planning and advocacy, health promotion and injury prevention ​	For chronic health conditions such as diabetes, COPD, chronic pain, stroke, neurological, cardiorespiratory, occupational health, musculoskeletal, sports injuries, when physical disorders are preventing activity and participation
Occupational Therapy ​	Modify activities or environments to enable participation in life activities (self-care, work, daily living, social participation) ​	Modification of environments, assessment and provision of equipment, coordination of care, driver rehabilitation, education and support, exercise or cognitive therapy ​	After someone sustains an injury, disability, physical or mental illness or condition, and restriction of activities or participation is identified, or cognition, executive processing or memory is limited
Social Work ​	Support people (with or without diagnosed health conditions) to improve personal and social well-being ​	Personal or family counselling, service information or referral, service coordination or care management, advocacy to those experiencing social disadvantage ​	When community service needs are identified (such as cooking or showering assistance) post injury or disability, for social dysfunction, mental health conditions, unstable accommodation, trauma, abuse or family dysfunction
Speech Pathology ​	Experts in communication disorders, including speech, listening, reading, writing, and swallowing disorders ​	Communication assessment and strategies (education, alternative devices), swallowing assessment and strategies to patients and carers	When difficulties swallowing or with any form of communication (speech, listening, reading, writing) are identified ​
​Podiatry	Experts in foot care ​	Callous treatment, bone joint or muscle conditions, prescription of orthoses, foot surgery ​	History or risk of foot conditions, including diabetes, peripheral vascular disease, foot or lower limb deformity, falls, arthritis, soft tissue or joint pathologies
Psychology ​	Experts in human behavior and mental health ​	Assessing and diagnosing problems related to behavior and mental health, and applying strategies to help improve the way people think, feel, behave and react	Childhood behavioural issues, learning difficulties, trauma or loss, relationship breakdown, mental illness, additions ​
Diabetic Educator ​	Specialists in diabetes, commonly with nursing background ​	Promote effective self-management of diabetes, assessment of diabetes management, referral to medical practitioners, education and health promotion	At diagnosis of diabetes, for periodic assessment and management of diabetes ​
Dietetics ​	Experts in food and nutrition ​	Medical nutrition therapy, food service management, community and public health nutrition advice and education ​	Newly diagnosed chronic disease, weight change, signs of poorly managed chronic disease, changes in medication, poor food intake or difficulty eating ​

Table adapted from Allied Health Professions Australia website(3)

Examples of referrals in practice

Cardiorespiratory practice
Our Cardiorespiratory 1 Simulation course requires participants to practice assessing and managing a person who is 68 years old, and was diagnosed with chronic obstructive pulmonary disease (COPD) 4 years ago. This patient has been in and out of hospital since her diagnosis. The scenario traverses three timepoints where she has another hospital admission for an exacerbation of her COPD, then day before discharge, and attending a pulmonary rehabilitation assessment appointment three weeks after getting home.

In this scenario, you might need to consider referrals to 

• occupational therapy (for home set-up assessment including modifications that might need to be made, or equipment to be provided on discharge)
• dietetics (for nutrition management), and 
• social work (for services that might need to be put in place to support the person post-discharge).

Musculoskeletal practice
Our Musculoskeletal 1 Simulation course requires participants to practice assessing and managing a person who is 41 years old, and has had back pain for many years. This scenario traverses three timepoints where this person experiences a significant flare up of her pain requiring an acute hospital admission, a stint in inpatient rehabilitation, and then follow up as an outpatient after discharge home.

In this scenario, you might need to consider referrals to:

• occupational therapy (for home set-up assessment including modifications that might need to be made, or equipment to be provided on discharge) 
• social work (for services that might need to be put in place to support Pauline post-discharge)
• psychology (depending how this person’s is coping with the stress and frustration associated with chronic pain)
• dietetics (if the person has weight loss goals to manage their back pain), and 
• podiatry (if the person has trouble bending forward to complete own foot care)

Neurological practice
Our Neurological 1 Simulation course requires participants to practice assessing and managing a person who is 63 years old, and is diagnosed as having a stroke. The scenario traverses three time points where this person is initially admitted to hospital with left-sided weakness, drooling, unable to stand, then transferred to an inpatient rehabilitation hospital and finally attending physiotherapy for outpatient rehabilitation. 

In this scenario, you might need to consider referrals to:

• speech pathology (to assist with communication and swallowing assessment and strategies) 
• social work (for services that might need to be put in place to support the person post-discharge)
• a diabetic educator (to assist with managing diabetes at home)
• occupational therapy (for home set-up assessment including modifications that might need to be made, or equipment to be provided on discharge), and
• dietetics (for nutrition management).​

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What questions do you have about referring to other health practitioners? 

We hope that has been a helpful summary for your understanding how different health professionals can be involved in patient care in Australia.
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Do you feel that you could confidently do this both in your APC exam, but also in day to day clinical practice?

Please comment below any questions or comments you have about referrals and other health professions.

Additionally, if you’d like to learn more about our Clinical Assessment Simulation Courses, where you can practice your skills with a simulated patient (actor) and receive feedback on your physiotherapy performance before your exam, please click here.
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References

1. Drynan D, Murphy S. (2013). Understanding and facilitating interprofessional education: A guide to incorporating interprofessional experiences into the practice education setting. 2nd ed. University of British Columbia.
2. Hammick M, Freeth D, Koppel I, Reeves S, Barr H. (2007). A Best Evidence Systematic Review of Interprofessional Education. Medical Teacher, 29(8):735-51. 
3. Allied Health Professions Australia (2019). Allied Health Professions. Available at: ahpa.com.au/allied-health-professions/ (accessed 12 September 2019)