About Chronic Disease Management

Integrated Chronic Disease Management

The impacts of chronic disease?

  • Chronic disease affects 57% of women and 48% of men in Victoria
  • Chronic disease has significant, negative impacts on the health and quality of life of individuals and families
  • Chronic illness accounts for nearly 80% of the burden of disease and injury in Australia, and nearly 70% of all health expenditure (almost $34 billion)
  • Associated lost workforce participation, reduces productivity and increased absenteeism also significant costs to the economy
  • Hospital admissions in Victoria are rapidly increasing
  • Health expenditure in Victoria is increasing by 5.1% annually.

What is Integrated Chronic Disease Management?

People with chronic disease have a complex journey to manage. This journey can:

  • invlove accessing a range of health and community services
  • be long term
  • cross boundaries of agencies and services and
  • involve managing many symptoms

The aim of Integrated Chronic Disease Management (ICDM) is to improve the coordination of the health and community service system so that people with a chronic condition receive effective care that is responsive to their needs across the different stages of their disease.

SCPCP encourages an interdisciplinary and coordinated approach to chronic disease management and builds the capacity of organisations to ensure client and consumer empowerment through self management programs.

SCPCP aims to:

  • Support member agencies to meet the needs of clients with chronic disease through comprehensive assessment and care planning
  • Ensure options for self-management are available to people with chronic disease across the PCP catchment
  • Encourage partnership between health and community organisations for better integrated management of chronic disease across the catchment
  • Assist member agencies with workforce development in the area of chronic disease management

Integrated Chronic Disease Management Resources

Chronic Care Model

The Wagner Chronic Care Model, with its six interdependent elements, provides the framework for Primary Care Partnerships to devlop a service system for improving the care of clients with chronic and complex care needs.

Integrated Chronic Disease Management Clearinghouse

The ADMA Integrated Chronic Disease Management Online Clearinghouse stores practical resources and tools relevant to disease management service, plus brief explanations of their development and use, Tools have been uploaded by their authors where others can then search and access them. Authors are encouraged to submit resources to share.

Please find link below;

Chronic Illness Alliance

The Chronic Illness Alliance has 55 member organisations, both state and national. The aim of the Alliance is to build a better focus in health policy and health services for all people with chronic illnesses. It does this through education and research projects.

Please find link below;