 |
 |
 |
- Home
- About Us
- Programs & Services
- Community
- Events
- Resources
- Publications
- Secure Area
|
|||
|
|||
|
|
|
|
Chronic Disease Management
CDM Resource Manual version 4 available on-line NOW! Program Overview and RationaleThe Chronic Disease Management (CDM) program aims to develop a sustainable model of strengthening GP involvement in chronic care, promoting best practice diagnosis and management of chronic conditions, and improving referral pathways. Chronic disease is becoming one of the major burdens for general practice and the increase focus of CDM initiatives is vital in the primary care setting. According to the Central Coast Regional Health Profile 2004, area demographics indicate that the proportion of residents aged 65 years or more is considerably higher than that for NSW (17.5% v. 13.0%) and is predicted to increase. Many of this population have multiple chronic illnesses. GPs, as the primary care providers, have an important role in early detection and prevention of chronic disease as well as diagnosing, managing and treating existing chronic conditions. However, general practice is facing growing challenges such as workforce decline and increasing demands. This has the potential to result in reduced coordinated care and lack of awareness of current evidence based chronic disease programs. A recent study by the General Practice Integration Unit from the University of NSW identified that developing long-term capacity in general practice is crucial for chronic disease prevention and management. Duration of Program and how it OperatesThe CDM program focuses on both broad CDM issues and specific disease areas. The Integration Manager focuses on increasing support to GPs and general practice through the provision of relevant CDM related standards and guidelines, and through the promotion of relevant clinical pathways and referral mechanisms. Disease specific guidelines, such as Diabetes Management in General Practice, are also provided and the Division's Diabetes program and Respiratory program are readily promoted. More recently the CDM program has extended its focus to self management and prevention activities. This program works closely with the Division's Practice Support Program and local Area Health Ongoing & Complex Care Services. In February 2006, the Council of Australian Governments (COAG) announced a four-year national program called the Australian Better Health Initiative (ABHI) to strengthen the health system's focus on promoting good health and reducing the burden of chronic disease. ABHI's priority areas include:
Two ABHI related projects currently running at the Division under the CDM program umbrella are:
How the Program benefits GPs and their PatientsMost chronic care occurs in a community context. The program's objectives to improve Practice Support Programs to enhance general practice capacity to support CDM, and promote integrated approaches / best practice to chronic disease diagnosis and management in General Practice will benefit both GPs and patients to:
Current level of Program Participation / UtilisationThe progam has an established a CDM Advisory Committee with representation from general practice (including GPs and practice staff) and Northern Sydney Central Coast Health (Public Health Unit, GP Collaboration Unit, Community Nursing, and Manager, Ongoing & Complex Care Services). The program has also generated development of resources delivered through practice support, provision of evidenced based information through newsletters/fax outs and provision of ad-hoc practice visits on CDM related issues. Co-ordination of the ProgramJennie Sadler More InformationResources Links
|
|
|
