T
he United Nations Interagency Taskforce (UNIATF) award recognises the Chronic Disease Management (CDM) programme’s work to develop the ‘GP Chronic Disease Contract and rolling it out despite the COVID-19 pandemic’. The Irish College of General Practitioners (ICGP) nominated the CDM programme for an award. Commenting on the award, HSE National Clinical Advisor and Programme Group Lead for Chronic Disease, Dr Orlaith O’Reilly said: “It’s an honour to see the CDM Programme recognised in this way. The CDM Programme works with GPs across Ireland to prevent and manage patient chronic diseases using a population approach. Before this Ireland had no formalised structure for Non Communicable Diseases (NCD) management in primary care. We remain committed to the roll-out of this programme. “The CDM programme provides a structured management programme for people with a history of cardiovascular disease, COPD, asthma and type 2 diabetes in general practice. It focuses on prevention, patient empowerment, early diagnosis and intervention, multi-morbidity and the provision of care as close to home as possible. “The programme emphasises lifestyle and medical risk factor control, disease management and the creation of a patient care plan. The GP in partnership with the patient works to develop this plan. We rolled out an ITissolution, embedded in What a chronic general practice, which provides decision disease? support for NCD management. It also gives A chronic disease is a long-term health real-timecondition returnthat of needs dataongoing to a central treatment data and management. repository. This supports service planning and quality improvement initiatives in Benefits of the primary care,” she added. programme The CDM programme supports GPs to is designed so thatwith you identify The andprogramme manage patients, a and your GP (family doctor) can work together monitor condition and medical card or toGP card,your who are at risk of identify the best way to treat it now. chronic disease or who have been diagnosed with one or more specified The Chronic Disease chronic diseases. Treatment Programme Pat Healy, National Director, HSE Clinical supports you by Programme Implementation and providing: Professional Development said: “I am set reviews of your chronic disease delighted• that the work of the HSE with your GP or practice nurse • Chronic a personalised care planManagement that you Structured Disease develop and agree with your GP Programme has been • reviews of your care plan recognised and medicine internationally. The development and • support you to manage your condition of implementation this programme • early detection of any new conditions happened you because groups and may developof • earlyworking detection of complications institutions collaboratively, in your condition including• the of Health and careDepartment in your community, to your home DPER, theclose IMO, the HSE (Clinical Programmes, Primary Care, ICT, Public
HSE WINS INTERNATIONAL UN AWARD FOR TACKLING CHRONIC DISEASE The HSE Chronic Disease Management (CDM) programme has scooped an international award for developing a structured illness and preventative care programme in general practice. The aim of the programme is to reduce morbidity and mortality from Non Communicable Diseases (NCDs). Health doctors and managers), the GPs, practice nurses and the wider practice teams. It was to launch in March 2020, just as the COVID-19 pandemic spread to Ireland. But rather than pause the programme, and recognising the syndemic of NCDs and COVID-19, we accelerated the roll-out of the programme. We expanded the initial age cohort. We also brought remote consultations on stream to protect our most vulnerable patients. “GPs have played a significant role in the role out of the CDM programme. Over 85% of GPs in Ireland have registered to provide
the programme to date. Between March and December 2020, GPs and practice nurses undertook over 119,000 consultations for people aged over 70 years. Programme data shows that 90% of people with these conditions are being managed solely in general practice for their NCDs.” A significant part of this programme is Making Every Contact Count. This focuses on interventions relating to tobacco, alcohol, sedentary behaviour and obesity or overweight. Year one data shows that smoking status, BMI and blood pressure were examined in over 90% of all consultations.
What is a chronic disease? A chronic disease is a long-term health condition that needs ongoing treatment and management.
Benefits of the programme The programme is designed so that you and your GP (family doctor) can work together to monitor your condition and identify the best way to treat it now.
Chronic Disease Treatment Programme
The Chronic Disease Treatment Programme supports you by providing: • • • • • • •
set reviews of your chronic disease with your GP or practice nurse a personalised care plan that you develop and agree with your GP reviews of your care plan and medicine support you to manage your condition early detection of any new conditions you may develop early detection of complications in your condition care in your community, close to your home
Order code: HPC01327
Order code: HPC01327
HEALTH MATTERS WINTER 2021 | 63
Chr Dise Trea Pro
