I never thought we’d be discussing Albert Einstein’s theory of relativity and Chronic Disease Management but here we go…

Einstein’s equation e = mc² shows that energy and mass are different forms of the same thing.  I believe that Chronic Disease Management activities such as Care Plans and Health Assessments under the right conditions are also interchangeable like energy and mass.

Essentially, Care Plans and Health Assessments are the same.  We collect the same information to complete a Care Plan, Review or Health Assessment, the information just ends up in a different document.  The basic elements of Chronic Disease Management activities are:

💙 Checking patient eligibility: using MBS Online

💙 Using a progress note shortcut: these act as your prompt (there are 11 different types of health assessments and the requirements are different for each one)

💙 Before you see the patient: take some time before you call the patient in from the waiting room to review the clinical record

💙 Updating Patient Details: this is important and includes allergies, smoking, alcohol, family, social medical/surgical history

💙 Recording Observations: record relevant to patient age and condition

💙 Reviewing Medications: check Medications with patient and consider a Home Medicine Review referral

💙 Checking Bloods: look at the last bloods and when are the next bloods due

💙 Which Specialist, Allied Health & Other: who is involved in the patient’s care and when do they need to see them again

💙 Checking Prevention & Early Intervention: immunisations, cancer screening, osteoporosis, cardiovascular risk, emotional and social wellbeing, COPD screening, cognitive screening and sexual health

💙 Adding Patient needs & goals: don’t forget to ask the patient

💙 Listing Recommendations: risks and referrals

💙 Adding Recalls: always add a recall for the next CDM activity

💙 Finalising MBS Billing: know your billing

💙 Booking the Next Appointment: ALWAYS book the Next Appointment

We cover this and more in our Introduction to Chronic Disease Management Workshop, Online Module and Chronic Disease Management Manual (check them out here)

Jane Calligeros | Founder and CEO CDM Plus