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A new way of managing your patients with a chronic disease Evidence has shown that people with a chronic illness who have a care plan to manage their condition have significantly improved health outcomes. cdmNet is a online health service that assists a GP in creating a care plan and sharing it securely with other members of the care team in a collaborative environment. All members of the care team are able to view or enter notes about the patient at any time during the cycle of the care plan using the secure cdmNet web portal. cdmNet provides the GP with the ability to create evidence based GP Management Plans and Team Care Arrangements quickly and co-ordinates the GPMP, TCA Reviews and Home Medicines Reviews. It creates an environment where collaboration is straightforward and easy - through the cdmNet web portal, SMS and email, and gives the care providers the ability to track their patients' progress at all stages to help with compliance with their goals and continuity of the care plans. Additionally, it gives the patients the option to view their own progress and provide reminders and alerts to assist adherence to the agreed goals of the care plan.
Monash University trials of cdmNet Trials in Barwon, Victoria and the WA goldfields showed practice increases in care planning Medicare items of:
Quality of care was also greatly improved. In addition to better sharing of data, use of guideline-based services increased substantially, such as Home Medicines Reviews (up 5 fold), podiatry services (up 2 fold) and dietician services (up 16 fold). Patients received automatic reminders of the need to make appointments by SMS and email, driving referrals and better adherence to best practice guidelines. Using cdmNet ensures that documentation is complete and satisfies Medicare compliance and reporting requirements as well as providing the practice with increased revenues through better use of chronic disease management Medical Benefits Schedule items. Precedence Health Care Precedence Health Care, a Melbourne based entity has developed cdmNet. Development started in 2007 as a result of Professor Michael Georgeff's desire to improve the management of, and subsequently, the care given to patients with chronic conditions. With funding from the Commonwealth Government under the Clever Networks scheme, he set about transforming the way chronic conditions are managed by utilising the internet and advanced information technologies to bring together the people providing care to a patient on a care plan that is created using current evidence based medicine and best practice guidelines. cdmNet in the Division cdmNet is now available to GPs, Specialists and Allied Health Professionals across the Division. The Division is offering to assist GPs and other members of the care team to implement cdmNet. Many GPs have taken up the RACGP early-bird membership offer which includes a trial of cdmNet, the Division can also help these GPs. The Evidence There is an ever-increasing number of people with chronic conditions that will need care plans and team care arrangements. This is across the spectrum of chronic disease - for those who are recently diagnosed with one chronic condition to those with many. To cope with the expected surge in patients with chronic disease, practices will need to have very efficient processes, communication and information. Two facts are:
More details: 1. Information on Chronic Diseases by the Australian Institute of Health and Welfare (AIHW): (http://www.aihw.gov.au/chronic-diseases/) highlight that nearly 20% of people under 25 years of age have 1 or more chronic conditions rising to over 80% of those over age 65 years. With an aging population and increasing number of the population with lifestyle risk factors like obesity, these numbers are predicted to increase.
2. AMA response to AIHW chronic disease report 16/02/2011 : (http://ama.com.au/node/6406) The recent AIHW Australia's Health 2010 report confirms that GPs are increasingly treating older patients with more complex care needs. The management of chronic and complex disease is a key part of general practice, with at least one chronic problem managed in 42 per cent of all visits to a GP. The report also highlights that the chronic problems most often managed by GPs are hypertension, depressive disorder, diabetes, cholesterol-related disorders, chronic arthritis, oesophageal disease and asthma. Many older patients are suffering from two or more chronic illnesses and these co-morbidities complicate diagnosis and management. Australia needs a comprehensive approach to the management of chronic and complex illness, not just a focus on single diseases as in the current Government's proposed plan for diabetes. Ref: http://www.aihw.gov.au/publication-detail/?id=6442468376 cdmNet can help practices to meet this increasing demand for managing patients with chronic conditions. Resources
Background Information - Understand more about cdmNet For the Patient How to use cdmNet Quick Start Guide for General Practitioner and Practice Nurse Setup Quick Start Guide for General Practice Setup General Practice Quick Guide Frequently Asked Questions Privacy, Terms of Use and Agreements For more information contact your Divisional cdmNet representatives: Brenda Fehring bfehring@mpdgp.com.au Judith Murray jmurray@mpdgp.com.au Ph 0354 811 300
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