The Chronic Respiratory program works in partnership with GPs to support their clients within the community. The program aims to prevent hospital admissions and improve quality of life through self-management education and support delivered by clinical nurse consultants and nurse practitioners. Patients are supported short-term and then discharged to a GP and/or private Respiratory Physician.
- COPD and Asthma management
- signs and symptoms of exacerbation
- when to seek treatment and
- how to minimise exacerbations.
- self-management education
- respiratory Physician review at the Chronic Respiratory Disease Clinic if required
- referral to the Pulmonary Rehabilitation Program if required
- psychosocial needs assessments and referral to allied health or psychologist as appropriate
- medication optimisation
- medication review, understanding and adherence, and where appropriate a referral to HOMR is completed
Eligibility Criteria
This service is for clients who:
- are over 18 years old and reside in the Monash Health catchment
- have a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or asthma
- two Emergency Department presentations with respiratory disease in the past 6 months and is at risk of presentation at hospital.
- are at high risk of presenting with exacerbation of respiratory symptoms
This service is not for clients:
- whose primary condition is interstitial lung disease, cystic fibrosis or sarcoidosis
- whose primary condition is mental health, alcohol or drug dependence
- whose primary condition is cancer
- who are receiving palliative care
- who are pregnant or post-partum
Referral Method(s)
Referrals should be sent by eReferral through Healthlink or by email.
Phone:  03 8572 5631
Email:  icareaccess@monashhealth.org
Eligible Postcodes
- Cardinia:3781, 3782, 3783, 3807, 3808, 3809, 3810, 3812, 3813, 3814, 3815, 3981, 3981, 3984
- Casey: 3177, 3802, 3803, 3804, 3805, 3806, 3807, 3912, 3975, 3976, 3977, 3978, 3980, 3981
- Kingston: 3169, 3189, 3189, 3190, 3192, 3194, 3195, 3196, 3197, 3202
- Greater Dandenong: 3164, 3171, 3172, 3173, 3174, 3175, 3975
- Monash: 3125, 3147, 3148, 3149, 3150, 3164, 3166, 3167, 3168, 3170, 3800
Additional information required
Include all patient demographic and clinical details as well as relevant investigation results
Contact hours: 8.30am – 4.30pm, Monday to Friday (except public holidays)
Click here for more information about this service.
Please review the eligibility criteria before submitting a referral.