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Chronic Disease Management

Care Coordinators assist you to maintain independence and improve your quality of life.

Care Coordination supports people with complex needs. This may help people with:

  • heart disease
  • arthritis
  • respiratory disease
  • diabetes
  • paediatric asthma
  • psychosocial needs
  • chronic health conditions

The Care Coordination service is provided to you free of charge.

Frequently asked questions

  • How will my Care Coordinator help?

    Together with your Care Coordinator a flexible program will be designed for you.

    This may include:

    • Goal directed care planning
    • Managing you appointments
    • Supporting you to talk to health professionals
    • Managing your ongoing care needs
    • Teaching you more about your health
  • What services do the Care Coordination team provide?

    Care Coordination services are provided by qualified health professionals and deliver a variety of services depending on your needs.

    These may include:

    • Education
    • Dietitian
    • Occupational therapy
    • Counselling
    • Exercise options
  • What are the benefits of Care Coordination?

    Care Coordination supports you to maximise your independence by providing person centred care.

    This care will be goal focused and time limited.

    In partnership with you and your family/carer we will assess and managed your complex, and often multiple, conditions and care needs.

    Care Coordination is about ensuring you receive the right care, in the right place at the right time.

Refer a patient

Referrals will be accepted from clinicians, self-referral, family and carers and specialists.
You can find the Community Health Referral form here.

Page last updated: 28 March 2023

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