The team at offers care and support to ease the effects of your chronic disease and improve the quality of your health outcomes
The number one priority for Her Medical is to assist patients to live longer and healthier lives. Chronic disease management plans are an integral part of Her Medical’s commitment to achieving better health outcomes for patients.
Her Medical utilises Chronic Disease Management Plans as an effective strategy to assist in providing the best care to patients suffering from chronic medical conditions. Experiencing chronic conditions can affect the quality of life on many levels. Her Medical’s goal is to help manage health with team support to optimise overall health and wellbeing.
Chronic Disease Management Plan eligibility
A GP Managment Plan aims to create a structured and personalised approach to healthcare for a chronic disease to enable coordination of complex chronic conditions requiring ongoing care from a multidisciplinary.
*Chronic disease is defined as a condition that has been present or is likely to be present for 6 months or longer.
A chronic medical condition is one that has been present for at least six months or longer, such as:
- Asthma
- Cancer
- Cardiovascular disease
- Diabetes
- Musculoskeletal conditions
- Stroke
General Practitioner Management Plan (GPMP)
General Practitioner Management Plan (GPMP)
If a patient has a chronic (or terminal) medical condition, a General Practitioner may suggest a General Practitioner Management Plan (GPMP)
A GPMP can help individuals with chronic medical conditions by providing an organised approach to care. A GPMP is a plan of action agreed upon with the GP and may include the following:
- Identifies health and care needs
- Sets out the services to be provided
- Lists the actions required to help manage the condition
Dr. Donna Tanchev
Dr Paula Hade
Dr. Chris Briggs
Dr Isabella Panettiere
Dr Rachel Wyndham
Team Care Arrangements (TCAs)
Team Care Arrangements (TCAs)
Chronic medical conditions and complex care needs may require multidisciplinary care. General Practitioners may also develop a Team Care Arrangements (TCAs). This will help coordinate the care required more efficiently.
TCAs require GPs to collaborate with at least two other healthcare providers who will give ongoing treatment and services.
Dr. Donna Tanchev
Dr Paula Hade
Dr. Chris Briggs
Dr Isabella Panettiere
Dr Rachel Wyndham
Review of GPMPs and TCAs
Review of GPMPs and TCAs
Once a plan is in place, regular reviews are important for the planning cycle of care, where goals are set and met and whether should be considered.
The review also offers the opportunity to further discuss any general issues and concerns.
Referrals for allied health services
Referrals for allied health services
If both the GPMP and TCAs are prepared for by a General Practioner, patients may be eligible for Medicare rebates for specific individuals and Allied health services that have been identified as part of the care plan. The need for these services must be directly related to the chronic medical (or terminal) condition.
Mental Health Treatment Plan
Mental Health Treatment Plan
A Mental Health Treatment Plan is a plan for people with a mental health disorder.
The plan identifies what type of health care is needed and spells out what has been agreed upon and aims to achieve.
If a patient has a Mental Health Treatment Plan, they are entitled to Medicare rebates. This gives the patient access — subsidised by Medicare — to certain psychologists, occupational therapists, and social workers.
After the first 6 appointments, doctors need to you need to review the mental health plan and will decide if further sessions are required and need to be referred.
Diabetes Annual Cycle of Care
Diabetes Annual Cycle of Care
The Annual Cycle of Care is a checklist designed to help patients and the healthcare team keep diabetes care on track.
Diabetes can lead to complications that affect the kidneys, eyes, feet and heart. The Annual Cycle of Care can help identify further health concerns early and allow for the best treatment with the healthcare team.
Plans involve:
Every 6 months:
- Measure weight and height and calculate body mass index
- Measure blood pressure, for someone with diabetes, the target BP is 130/80 to 140/90 or less.
- Examine feet to assess blood supply and sensation
Once a year:
- Assess diabetes control by measuring HbA1c which shows an average of your blood glucose level over the past 10-12 weeks, and where the general target level is 7% (53 mmol/mol) or lower.
- Measure total cholesterol, triglycerides and HDL cholesterol
- Test for microalbuminuria
Once every 2 years:
- Ensure that a comprehensive eye examination is carried out
- Review diet
- Review levels of physical activity
- Check smoking status
- Review medication
Asthma Cycle of Care including review
Asthma Cycle of Care including review
The Asthma Cycle of Care involves at least two asthma related consultations within 12 months for a patient with moderate to severe asthma.
The Asthma Cycle of Care includes:
- Document diagnosis and assessment of the severity and the level of control needed for asthma
- Review the patient’s use of, and access to, asthma-related medication and devices
- Provide a written asthma action plan
- Provide asthma self-management education
- Review the written or documented asthma action plan
Additional Assessment Plans targeting specific demographics include:
45–49-Year Old Health Assessment
Staying healthy is especially important once the 40s are reached. Her Medical recommends that most healthy people in their 40s should get health checks at regular intervals.
Every 2 years:
- Heart disease risk assessment
- Blood pressure check
- Eye test
Every 3 years:
- Blood glucose test
Every 5 years:
- Cholesterol and lipids tested
- Cervical screening test
Regularly:
- Skin cancer checks
- Dental check-ups
75 Years and Older Health Assessment
A health assessment of an elderly person (75 years and over) is an in-depth review of their health status. This assessment enables doctors to identify health issues and conditions that are potentially preventable or responsive to interventions in order to improve health and overall quality of life.
Specific components of the health assessment for the elderly include:
- Measurement of blood pressure, pulse rate and rhythm
- Assessment of medication
- Assessment of continence
- Assessment of immunisation status for influenza, tetanus and pneumococcus
- Assessment of physical function, including activities of daily living
- Assessment of psychological function, including cognitive and mood
- Assessment of social function
The health professional undertaking the health assessment may also consider:
- Any need for community services
- Social isolation
- Oral health and dentition
- Nutrition status