What is the Chronic Disease Management Programme?

If you have a chronic illness, your doctor can help you manage it better through long-term,
structured monitoring, available free from your GP. 

What is the Chronic Disease Management Programme? 
Our Structured Chronic Disease Management (CDM) Programme aims to improve the health and wellbeing of patients living with certain chronic diseases. On this HSE-managed scheme, patients are actively monitored to improve management of their conditions, free of charge.

The benefits include:
-   structured reviews of your chronic disease with both your GP and your practice nurse
twice a year, for free. That’s four visits in total;
-   a personalised care plan developed and agreed with your medical team;
-   regular reviews of your care plan and medication;
-   opportunities for structured education and self-management support;
-   early detection of any new conditions, or complications;
-   care in your community, close to your home.
Am I eligible for Chronic Disease Management? 
You can join this programme, free of charge, if you:
-   have specific chronic disease/s, namely type 2 diabetes, asthma, chronic obstructive
pulmonary disease (COPD), or cardiovascular disease, including heart failure, heart
attack (angina), stroke, and irregular heartbeat (atrial fibrillation);
-   have a medical card or a GP visit card;
-   are aged 18 years or over;
-   are able to take a call from your nurse or GP, or attend your GP surgery.

If you’re eligible, your surgery should contact you to register. If this hasn’t happened yet, do get in touch by phone or email and we will register you.

Initially, we will talk you through the programme, and help you enrol. Together, we will discuss your general wellbeing, and focus on your specific chronic condition and health issues. You may also need to visit the surgery in person, for blood work and other tests.

Following review, we will issue you with a written care plan.
Your information counts 
Once you are on the CDM Programme, you allow certain information to be collected at each review as part of the programme. Your GP will record your name, age, chronic disease diagnoses, medical history, and details of any symptoms or investigations you have had since your last visit.

The information gathered will play a vital role in helping to improve our understanding of chronic disease. It will improve the health service’s ability to detect, treat and prevent chronic illness, as well as to deliver a better service.