Chronic Conditions

Effective management of chronic conditions requires a multidisciplinary approach. Each client is supported with a tailored care plan including: 

• GP Management Plan 
• Specialist outreach services 
• Diabetes Educator 
• Nutritionist 
• Physiotherapy 

We provide holistic, coordinated care for community members with a chronic condition including Kidney; Heart; Lung; Liver; thyroid disease; diabetes; cancer; multiple conditions; infectious diseases such as TB and Hepatitis B; and chronic wound management.

We support our clients to manage their conditions, encouraging two-way learning to ensure the partnerships we develop are culturally sensitive and meaningful.

Our Aboriginal workforce is key to this process, providing cultural, community and language support. We engage family and community through education and support as requested by our clients.

Our services include: 

• Weekly Multidisciplinary Complex Care meetings
• One on one Insulin injection education
• Palliative care / home care
• Advanced care planning with family, GP and nurse
• Care in the home where required including blood tests and special medications
• Community vaccination drives eg over 65 influenza
  

We also run additional activities, such as:

• One on one Insulin injection education
• Quarterly community outreach BBQ