Chronic Respiratory Disease

Clients referred to the Chronic Respiratory Disease stream are seen by a Respiratory Physician, Respiratory Nurse Consultant and a Physiotherapist as a means to supporting their GP to manage the client in the community.

Services include

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

Cost

There is NO cost for the Chronic Respiratory Disease service

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

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

Referrals

Clients can be referred by:

• clinical staff
• Respiratory Specialists
• GPs
• self

Referrals should be sent by eReferral through Healthlink, by email or by calling Community Access at (03) 8572 5631. Please include all patient demographic and clinical details as well as relevant investigation results.

Phone:  (03) 8572 5631
Email: icareaccess@monashhealth.org

For more information about access to community-based services

When

Monday to Friday from 8:30 am to 4:30 pm (except public holidays)

Help contacting us

For people who need help with English or an interpreter: : TIS: 131 450

For people with hearing or speech loss: TTY: 1800 555 677

Speak and Listen: 1800 555 727

Internet relay: National Relay Service: www.relayservice.gov.au