Chronic Disease, ACTDGP, Australian Capital Territory Division of General Practice

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Chronic Disease Self-Management program
Chronic Disease Management

Chronic Disease Self-Management program

Chronic disease self-management (CDSM) is 'the active participation by people in their own health care. Self-management incorporates health promotion and risk reduction, informed decision making, care planning, medication management, and working effectively with health care providers to attain the best possible care and to effectively negotiate the often complex health system'*.

Five principles of Chronic Disease Self-Management

Self-management involves the person with the chronic disease working in partnership with their carers and health professionals so that they can:
1. Know their condition and various treatment options.
2. Negotiate a plan of care and review and monitor the plan.
3. Engage in activities that protect and promote health
4. Monitor and manage the symptoms and signs of the condition.
5. Manage the impact of the condition on physical functioning, emotions and interpersonal relationships.

*The National Chronic Disease Strategy policy

Aims

Provide and facilitate best practice Chronic Disease Self Management (CDSM) education and training for primary health care professionals in the ACT:
• The Flinders Program Chronic Disease Self Management
• Stanford “Living a Healthy Life with Chronic Conditions”
• Motivational Interviewing (MI) and
• Health Coaching education
Develop protocols and resources for health professionals to implement CDSM into their work practices
Develop and sustain partnerships with relevant government and NGO’s
Take a ‘whole of health system approach’ involving government, non-government and consumer/ community sectors, with patients/ clients, GPs, allied health and nurses as an essential part of a multidisciplinary approach to CDSM.
Integrate CDSM into existing chronic disease programs within the Division of general practice
Share CDSM resources and expertise and information across ACT Health and the Divisions Network
Provide ongoing support and promotion of chronic disease and health check Medicare items.

Funding

Australian Government Department of Health and Ageing

Who can help

Program Officer—Bev Hayhurst
Ph: 02 6287 8099
Fax: 02 6287 8055
GP Program Adviser—TBA

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Chronic Disease Management

Chronic Disease Management (CDM) is working to assist GPs manage the health care of patients with chronic medical conditions, including patients needing multidisciplinary care. The CDM MBS item numbers apply to the treatment of people with asthma, cancer, arthritis, diabetes, heart disease, mental illness and other chronic conditions.