Chronic Disease Management
An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, and patient education.
What is a chronic disease?
A chronic disease is a medical condition that has been present for an extended period or is likely to be present for a minimum of six months. These diseases often require ongoing medical attention or may limit daily activities. Some common chronic diseases that affect many individuals include:
asthma
diabetes
cancer
osteoporosis
arthritis
back problems
cardiovascular disease
chronic obstructive pulmonary disease (COPD)
dementia
chronic kidney disease
endometriosis
Chronic conditions can affect people of all ages but they tend to become more common as we get older.
GP Management Plan (GPMP)
A GPMP helps patients with chronic health issues by organising their care with a structured approach. It consists of a GP and practice nurse getting a detailed review of a patient’s lifestyle and insight into what could potentially impact their quality of life. The GP will set goals and targets for the patient’s health.
Team Care Arrangements (TCA)
Sometimes patients with chronic disease require a collaborative approach towards their healthcare. This is where a team care arrangement (TCA) plan can be useful to support patients. TCAs involve your GP working with at least two other providers who will continue your treatment. These providers may include a specialist or allied health provider.
Regular Reviews
Once a plan is set, your GP should review it regularly. This step ensures your goals are being met and any necessary changes are made. We provide care plans at little or no cost for eligible patients with chronic illnesses. Patients should schedule an appointment with their GP to check eligibility. Our practice nurse will support and monitor you between GP visits.
Ehanced Primary Care Plan (EPC)
An EPC is a type of referral that a GP can offer to patients with a chronic disease. This referral system allows patients to see healthcare providers without having to pay the full fee. Instead, the Australian Government subsidises a portion of the cost, making it more affordable for everyone involved. Under an EPC referral, patients are entitled to 5 Medicare rebated consultations with an allied health provider such as:
physiotherapist
chiropractor
audiologist
psychologist
dietitian
If you have any questions, please speak to one of our friendly receptionists who will be happy to assist you.
