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Chronic Disease Management
Chronic diseases underline a group of diseases which are permanent. The main management is to keep the disease under good control and or in a long-term remission. The achievement of good control would stabilize the person’s condition and delays the complication due to the chronicity of the condition.
A multi-disciplinary team of doctors and allied health professionals would be able to assist the patient with their needs. The GP is the main coordinator of the person’s health, communication with the specialists and other health professionals. For instance, a pharmacist review of the patient’s medications is essential to avoid addition of medicines which is called polypharmacy.
The GP plan and the team care assessment are tools to assist those patients to access Medicare benefit to have five sessions with allied health practitioners such as podiatry, chiropractic, physiotherapy ect in one calendar year.
For patients living with one or more chronic diseases, our practitioners educate and empower the individual with a tailored lifestyle and treatment plan. This may include a General Practitioner Management Plan (GPMP) or a Team Care Arrangement (TCA).
Setting goals, learning about various treatment options and feeling supported will help patients be in control of their ongoing health challenges. We encourage our patients who require diagnosis or management of chronic illnesses to book in for a consultation.
What to expect...
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Our practitioners are experienced in dealing with common and complex chronic diseases, including but not limited to diabetes, hypertension, arthritis, cancer, COPD, asthma, ALS, obesity and heart disease. With empathy and expertise, patients who visit our clinic will get up-to-date information, support and treatment advice.
Will Jenkins : Dietitian
Dietitian | Nutritionist | Sport and Fitness Nutritionist | Weight Loss and Weight Management dietitian | Nutritionist for people with Chronic Disease |
Dr. Ghazal Monshipouri
Female General Practitioner | Special interest in Women's and Children’s health, Mental health, Skin Cancer medicine and Cosmetics.
Dr. Reza Sabry GP
Male Practitioner | General Practitioner | After-hours urgent Care | Men's and Mental Health | Child Health | Immunisation
Frequently asked questions...
There are some chronic diseases for which unhealthy lifestyle choices can be a contributor. By visiting your GP regularly, early warning signs may be identified. For some people, timely advice and guidance from their GP can steer them onto a healthier path to avoid obesity, diabetes, some cancer types, heart disease and other long term medical challenges.
It is recommended that CDM plans are reviewed at the end of 12 months. However, every patient is different and may need the plan to be tweaked and amended if their conditions change. Age and general wellbeing can impact a person’s responsiveness to the treatments and services. To avoid ad hoc visits to the doctors, a GP is likely to schedule periodic consultations.
When it comes to CDM, private health care can help to reduce costs for certain things. Whether you are eligible under private health for rebates will depend on when you began your policy and whether the additional services or costs you require are part of your policy. It is always advisable to discuss the offerings for your particular medical issues with an insurance consultant to be clear.
Medicare does cover many services associated with common chronic diseases, but these can have an annual limit. It is wise to discuss this with a representative from Medicare to be sure.
Management of a chronic disease or terminal disease or illness involves tailoring an ongoing plan to help a patient live with one or more medical problems. This includes, understanding the patients’ health care problems, setting goals, discussing and coordinating various services, working through treatment options, decision making and of course regular consultations to ensure the plan is relevant and beneficial. GPs often refer to the plan as a GPMP or for those who require multidisciplinary specialists it is called a TCA (Team Care Arrangement).
There are some overarching principles of CDM which GPs should try to cover with their patients. Understanding the disease and making informed decisions, understanding the health care system and the financial support that is available, self-management strategies and community support options. Mostly, the GP aims to empower and support the patient with a care plan.