If you have not already heard the phrase ‘chronic conditions’, you will – a lot. In 2015 over 11 million Australians (50%) reported having at least one of the 8 chronic conditions - arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental health conditions – and chronic disease among our population is on the rise.
Health professionals acknowledge that effective care coordination is key in reducing the amount of time spent in hospital as well as the number of admissions. Whilst care coordination already exists within the hospital setting, a new and innovative model has been developed by GP down south in conjunction with our funder WAPHA, to provide seamless care coordination for patients post hospital discharge, providing support to facilitate links to appropriate services as well linking care at the primary level ensuring GPs get the information they need.
Our new Clinical Care Coordinator, Lynn Douglas, will be the bridge between the hospital and home and everything in between with a view to encouraging self-management. GP down south are working in partnership with WA Country Health Service to deliver this service which will be available to eligible patients from the Bunbury Regional Hospital.