Chronic Conditions Care Coordination Service

Members of the community presenting with chronic conditions such as diabetes, asthma and chronic respiratory conditions are getting the support they need throughout the South West through our Chronic Conditions Care Coordination (CCCC) Service. 

The CCCC Service is spearheading the way to a more coordinated approach in providing needed services to members in the community.  We work with health care professionals to bring a coordinated method to optimising the health and wellbeing of people with a range of chronic conditions.  A key goal of the service is to give patients a wraparound service that ensures they are supported in a coordinated way. 
 
It is a bit of a mouthful, but the service provided is streamlined and efficient.  A client in the Warren Blackwood who had limited family support and difficulties with living independently has recently been assisted by the program.  ‘Mr R’ has chronic obstructive pulmonary disease and depends on oxygen 24/7.  He was struggling not only with breathing, but was trying to maintain his independence to stay in his own home.  With support from the CCCC service this was achieved. 

We worked with a range of service agencies, including My Aged Care to secure support for Mr R.  This resulted in the highest level of in-home support for him and access to local agencies such as Manjimup Home and Community Care.  For Mr R, one key to the success of the program was being at the centre of conversations and decisions when choosing who his provider would be.  The best outcome is that by getting help from the GP down south service Mr R is able to remain in his home and get subsidised services as well as improve his nutrition.  Mr R is now receiving supports from My Aged Care up to three times a week which allows him to continue living independently in a safe environment .
 
The CCCC is about bringing together all the services and support mechanisms for people living with Chronic Disease without them having to source each service individually.  You can get access to this service by getting your GP or other health professional to send GP down south the referral form from the website.
This service has been made possible through funding provided by the Australian Government under the PHN Program.