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Chronic Disease
Management
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HARP Chronic
Disease Management
The Hospital Admissions Risk Program (HARP), now known as
the HARP Chronic Disease Management Program, is designed to improve health
outcomes for people with chronic illness and reduce the need for emergency
department visits and hospital admissions.
HARP works with patients to improve their quality of life.
What is provided
HARP is a short term care coordination program where your
care coordinator provides information, support and education to you and your
family.
The staff are skilled in providing strategies to assist
your own self-management of your condition.
Your care coordinator can link you to community providers
and liaise with other health professionals such as your local doctor or
medical specialist, in establishing your management plan.
Care coordination
Patients with defined chronic diseases and complex needs
may be eligible to be enrolled in the HARP Chronic Disease Management
program.
If you wish to be involved in the program, you will be
allocated a care coordinator.
The HARP care coordinators are staff with a clinical
background (often nurses) with expertise in certain areas, for example
cardiac, respiratory, cancer, diabetes or other chronic diseases.
The staff are experienced in managing patients with complex
medical and social issues.
The care coordinator will contact and/or visit you at home,
usually following an admission to Latrobe Regional Hospital or presentation
to the Emergency Department.
They will conduct an assessment (physical and social) and
discuss with you and your family your condition and how you can best manage
the condition at home.
They are able to provide education about your medical
condition, how to recognise symptoms, and what actions to take in certain
situations.
They will develop a plan of care with you, and make any
appropriate referrals to other services you wish to receive.
If appropriate, the care coordinator may invite you to
attend an outpatient group exercise and education program run at the Hospital
(see below).
They will communicate with you and your treating team,
including your General Practitioner, and assist with coordinating your care
or any other issues that arise.
The care coordinator will monitor your progress for a few
months and ensure you have adequate knowledge and supports in place for you
to best manage your condition and optimise your quality of life.
Eligibility
The program is aimed at people with chronic diseases such
as respiratory or heart disease, as well as other complex medical and social
needs.
Referrals
Referral to HARP may be generated by any health
professional when you present to the Emergency Department or are admitted to
the hospital, or by your General Practitioner.
Services offered
Cost
Involvement with the HARP care coordination team is at no
charge.
Contact details
HARP Chronic Disease Management Program: (03) 5173 8571
Heart
Failure Rehabilitation Program
Cancer
Care Nurses
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