Chronic Disease Management

What is a Chronic Disease?

Chronic Disease is a long-lasting condition that can be controlled but not cured. Patients suffering with chronic disease illnesses (present for 6 months or more)  are managed closely at Clare Medical Centre to achieve the best health outcomes. 

GP Management Plans and Team Care Arrangements can be written for these patients. These documents are created to target a patients specific needs relating to current physical, mental health and support services.

A number of departments are involved in the writing and actioning of these plans, such as Doctor's, Nurses, Specialists, Allied Health Providers – Physiotherapist, Podiatrist, Pharmacist, Chiropractors, Community Nursing and local agencies like Meals on Wheels and SA Country Carers.

Patients who have a GP Management Plan and Team Care Arrangement can also access 5 visits in a 12 month period to an allied health provider.  This extra professional support may assist with acute situations such as joint issues or provide long term surveillance of potential complications such as provided by a podiatrist.

These plans assist the patients in understanding their care, managing referrals, and timing of visits and tests. This a chance for patients to be reminded of services or new treatments available to make sure they are receiving the best possible care.

Diabetes and Asthma can also be closely managed with yearly intensive reviews. Blood results and other investigations can be reviewed with the patient, with a focus on achieving the best possible health without disease complications.

Please speak to any of our CMC staff if you feel that you have a chronic disease and would benefit from any of these services.