Chronic Disease Management and Allied Health Referral

 

Surfers Day & Night Medical Centre has highly experienced vocationally registered GPs who have all completed extra training for general practice. They manage patients with chronic diseases such as asthma, coronary heart disease, chronic obstructive pulmonary disease, diabetes and renal impairment.

We work with our patients on prevention of chronic diseases and provide regular checks on cholesterol, glucose and blood pressure and help patients improve these. GPs use the Diabetic risk assessment tool and Australian Cardiovascular Risk Predictor to target those at moderate to high risk and also factor in family history and smoking status.

Surfers Day & Night Medical Centre has an excellent referral network of specialists and Allied Health professionals to help with chronic disease management and provide Life referrals, and referrals to the Diabetes Association for those at moderate to high risk of diabetes.

All GPs provide GP Management Plans and Team Care Arrangements for patients with chronic medical conditions. They form a framework for agreeing on management goals with individual patients and identifying actions to be taken by patients. These goals are then reviewed with the patient each 3 to 6 months.

When a GP Management Plan and Team Care Arrangement is in place, patients with chronic diseases can then be referred to Allied Health Providers.

These Enhanced Primary Care (EPC) referrals entitle patients to five Medicare subsidised sessions per calendar year. They facilitate communication between GPs, specialists and Allied Health professionals, including Physiotherapist, dietician, podiatrist, chiropractor, diabetic educator, occupational therapist etc, which enhances patient care.