Managing chronic illness in the community

This is less about the community, GPs and EDs working together as opposed to the community, GPs and the specialsit teams who manage chronic illness.

The staff in the ED are less familiar with these patients then their GP and their specialist treating team and thus in many ways have very little to offer unless their acute deterioration / exacerbation requires resuscitation. ED's involvement may well invite unnecessary investigation and management as a result of this lack of familiarity.

Why the contribution is important

The growing number of patients with chronic illnesses as the community ages is becoming a signiifcant burden on the health system. Optimising the ability to manage these patients in the community with the support of GPs, specialist teams and case managers / nurse navigators is paramount.

A new approach to the role of the ED when such patients become unwell needs to be re-examined. The ED will always have a role when resuscitation is required. But many patients present to ED with acute exacerbations that could either be managed elsewhere in the community or if requiring admission could be managed by the specialist team within the ward environment; thus by-passing the ED.

by collierj on August 15, 2019 at 09:14AM

Current Rating

Average rating: 4.7
Based on: 4 votes


  • Posted by Mwann August 16, 2019 at 15:53

    hi there Collierj,

    i agree with your statement, however, i feel that this could be enhanced by looking at including specialist paramedic (LARU) to this formula. As this Pt journey typically starts in the pre-hospital arena. LARU officers are officers with a passion for the chronic health/sub-acute/acute on chronic/community health management of Pt. some of these officers (myself included) are starting down the masters level of education for this field. Other ambulance services both nationally and internationally, with a highly developed Etended Care Paramedic (ECP) program try to facilitate this very idea on a daily bases.

    i look forward to hearing your thoughs on this aspect.
    many thanks
  • Posted by Lili August 20, 2019 at 09:38

    A specialist chronic disease team to manage acute exacerbations in community health centres may reduce the number of hospital presentations and admissions. This needs to be explored further as currently the chronic disease services in place focus more on hospital avoidance through time-limited rehab programs and short-term follow-up post-hospital discharge.
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