The Murray PHN Needs Assessment identified chronic disease as a key priority for communities across the Murray PHN region. Evidence shows that service coordination and integration are vital to achieving positive health outcomes for people with chronic conditions, who often require healthcare from multiple providers. Challenges in navigating local and broader health systems have also been identified for consumers with complex care needs.
Chronic Disease Management funding focuses on two priority areas:
- Integrated Chronic Disease Management (CDM): supports the delivery and integration of evidence-based models of care for people with chronic obstructive pulmonary disease (COPD), chronic cardiovascular conditions (primarily chronic heart failure) and/or diabetes mellitus
- Health System Navigation: connects and assists local refugee communities to access the health services and supports needed for client-centred care of complex chronic diseases.
Integrated Chronic Disease Management (CDM)
Murray PHN currently funds 28 providers who deliver CDM primary care services including diabetes education, dietetics, podiatry, chronic disease nursing and community-based cardiopulmonary rehabilitation.
- Our current service provider details, via regions, can be found in HealthPathways. Type in the referral type (diabetes education, dietetics, podiatry, cardiac rehabilitation referral, pulmonary rehabilitation) in the search bar at the top of the page
- Click here for a summary of CDM MBS items
- Click here to register for HealthPathways and click here for more information about HealthPathways
- Click here for information on services for refugee communities with complex care needs
Chronic disease resources
- Best Practice Guidelines: Diabetes Australia
- Heart Failure Clinical Guidelines: Heart Foundation
- Australian guideline and calculator for assessing and managing cardiovascular disease risk: Australian Chronic Disease Prevention Alliance
- The COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD 2023: Lung Foundation Australia
Contact us
For more information, email info@murrayphn.org.au