Chronic diseases are prolonged conditions that often do not improve and are rarely cured completely. Diabetes, dementia, congestive heart failure and asthma are examples of chronic diseases. The increasing incidence of chronic disease is a challenge facing health services in Australia and around the world.

 

By 2020 it is expected that 80 per cent of the disease burden in Australia will be due to chronic disease.

 

Chronic illness has a profound effect on the physical, emotional and mental well-being of individuals, often making it difficult to carry on with normal daily activities and relationships. However, in many cases, health outcomes can be improved by good care. This often depends upon access to appropriate medical supervision and informed individual choices.

Chronic Disease Management (CDM) is a systematic, coordinated approach to improving health care for people with chronic disease across the healthcare system. The approach aims to improve the quality of life and health outcomes of those already diagnosed with one or more chronic diseases and reduce the progression and complications of their illness.

 

The CDM approach is underpinned by several key principals that involve coordinating care through a comprehensive health assessment, the use of multidisciplinary shared care plans, the application of evidence-based treatment protocols and the promotion of person centred care with active self management support where possible.

In response to the Garling Report 2008, the NSW Ministry of Health is implementing the NSW Chronic Disease Management Program (Connecting Care in the Community). This Program is being overseen by the Chronic Disease Management Office to improve the quality of life of older people with chronic and complex conditions, their carers and families and to prevent unplanned and avoidable hospital admissions. It achieves this by coordinating a statewide chronic disease management approach.

 

The NSW Chronic Disease Management Program (Connecting Care in the Community) is focused on five major chronic diseases of interest that are recognised as having a major impact on the burden of disease in NSW. Furthermore, these conditions have been demonstrated to have improved outcomes through CDM approaches. The diseases of interest are listed below. People who are diagnosed with these diseases and who are experiencing repeated episodes in hospital will be offered enrolment to the Program. In the future the Program will expand and be offered to people with these conditions even if they are not being admitted to hospital frequently to prevent their deterioration.

 

 

The NSW Chronic Disease Management Program (Connecting Care in the Community) builds on the NSW Chronic Care Program established in 2000.