Shared-care planning across primary, secondary and tertiary care — formative SAQs

SAQ 1 — Open-loop multi-level care (10 marks)

An 8-year-old with epilepsy sees a tertiary neurologist, a local paediatrician and a GP. Medicines were changed at tertiary clinic. The letter has not reached primary care. Mother carries both plans. The child is currently well. [1] [2]

Questions

1. Define shared care and contrast it with one-way referral and transfer of care. (3 marks) [2] [3]
2. Explain why relying on the parent as information intermediary is unsafe. (3 marks) [1]
3. Outline the essential elements of a shared-care plan and loop-closure actions you would implement now. (4 marks) [7] [8]

Model answer

Define (3). Shared care is deliberate co-management across levels with named owners and one coherent plan. One-way referral asks specialty for opinion or procedure without automatic co-management. Transfer of care moves responsibility to a new team with handover. This scenario is multi-level involvement without closed shared care. [2] [3]

Parent intermediary (3). Stille’s work shows parents often ferry information between primary and specialty care when clinician-to-clinician communication fails. This creates missed updates, wrong doses and delayed recognition. Families should receive plain-language copies, but must not be the default clinical messaging system. [1] [2]

Plan and loops (4). Write problems, goals, owners, emergency thresholds and review date. Reconcile the current medicine. Ensure tertiary advice reaches GP and local paediatrician. Assign owners and times for outstanding results. Teach after-hours pathway. Confirm the medical home remains whole-child owner for non-epilepsy care. [7] [8] [14]