Providing Health & Wellbeing Solutions


Integrated Chronic Disease Care


The aim of the Integrated Chronic Disease Care Program is to improve the health of vulnerable and or disadvantaged individuals in regional WA, who have or who are at high risk of developing diabetes, cardiovascular disease (some regions only), asthma and chronic obstructive pulmonary diseases.

The program works to reduce risks and improve the overall health and self-management of eligible individuals through a best practice, evidence based Integrated, coordinated chronic disease care service. This is achieved through the facilitation of effective access to and the delivery of a range of comprehensive allied health and Care Coordination services.

Services Available Include (Location Dependent)
• Dietetics
• Diabetes Education
• Exercise Physiology
• Physiotherapy (Respiratory and Exercise Prescription)
• Podiatry
• Care Coordination

Group Programs Include (Location Dependent)
• D.E.S.M.O.N.D. For newly Diagnosed Diabetics
• H.E.A.L. Healthy Eating , Activity and Lifestyle
• Better Breathers COPD Program

Eligibility for services and support from the Integrated Chronic Disease Care includes:
1. Financial Disadvantage, hardship or Health Care Card holder
2. Living in an area not adequately serviced by health providers
3. Social disadvantage
Patients are referred to the Integrated Chronic Disease Care Program preferably through their GP, referrals are however also accepted from specialists and other treating allied health professionals.

Once a referral is received one of our Care Coordinators will then talk to the client and their GP to discuss the best way to provide them with the allied health and other support services they may need to better manage their condition and feel more confident about their health.

Please click on the relevant region for location specific support and referral form.

Amity Health acknowledges WA Primary Health Alliance (WAPHA) for providing funding in its role as the operator of the Country WA PHN.