Programs - Chronic Disease Management

Australian Better Health Initiative – Primary Care Integration Programs

Program Manager - Rob van Dartel - Phone: (02) 6884 0197 

In February 2006, the Council of Australian Governments (COAG) announced a four-year, national program called the Australian Better Health Initiative (ABHI) to strengthen the health system’s focus on promoting good health and reducing the burden of chronic disease. 

There are five priority areas identified under ABHI:

1. Promoting Healthy Lifestyles
2. Supporting Early Detection of Lifestyle risk factors and chronic disease 
3. Supporting lifestyle and risk factor modification 
4. Encouraging active patient self management 
5. Improving integration and coordination of care

The fifth priority area under ABHI is focused on improving integration so that people with chronic conditions can receive more flexible and innovative support. Both the NSW Government and Australian Commonwealth Government have dedicated funding to this component of ABHI.The Australian Government has provided $9 million over four years (2006/07 – 2009/10) through the NSW Divisions network to improve integration of state and commonwealth funded health services.

Program Aims

The program aims to promote solutions to primary care integration between general practice and other local health providers that will assist in delivery of more ‘seamless’ patient care. This is particularly important in the context of better managing patients with chronic or complex conditions who often receive care from multiple providers, funded by different sources, across different settings.

A successful Integrated Diabetes Service Model (IDSM) was piloted in Parkes and has been approved by the GWAHS executive to further roll out the model across our Divisional area.

The IDSM will deliver optimal use of all health professionals, including GWAHS employees, Dubbo/Plains Division of General Practice, GPs and Practice Nurses, by implementation of integrated health care and medical records for the management of Diabetes patients at selected practices. All care will be delivered at the GP surgery where possible, ensuring a patient centred approach and improved continuity of care across all sectors.