Indigenous Chronic Disease Package
Step 1. Register the practice/service with Medicare as a participant in the Practice Incentives Program Indigenous Health Incentive
Table of contents
- Improve your Aboriginal and Torres Strait Islander patients’ health
- GP and Patient Journey flowchart
How to participate in this program- Step 1. Register the practice/service with Medicare as a participant in the Practice Incentives Program Indigenous Health Incentive
- Step 2. Offer health checks to the Aboriginal and Torres Strait Islander patients in your care
- Step 3. Develop a care plan for patients with a chronic disease
- Step 4. Provide ongoing monitoring of ‘at risk of chronic disease’ patients
- Step 5. Re-register patients annually for the PIP Indigenous Health Incentive
- Registering your practice/service for the PIP Indigenous Health Incentive
- Registering your eligible patients for the PBS Co-payment measure
- Cultural awareness training: who needs it?
- Defining ‘chronic disease’ and ‘at risk’
Identifying and signing up eligible patients- Specialist Outreach Programs and Care Coordination
- Indigenous Health Project Officers: A resource for General Practices and Indigenous Health Services
- Aboriginal and Torres Strait Islander Outreach Workers
- Chronic disease self-management accredited training for staff
- National Tackling Smoking Workforce
- Healthy Lifestyle Workers
- MBS Item numbers for Aboriginal and Torres Strait Islander health services
- General restrictions
To gain registration the practice/ service will need to:
- Be accredited against the Royal Australian College of General Practitioners (RACGP) Standards for general practices, or be registered for accreditation; and
- Have at least one GP and one other staff member undertake cultural awareness training within 12 months of registration (see exemptions on page 12 of this booklet).
In addition, your practice would benefit from:
- Understanding how ‘chronic disease’ and ‘at risk’ are defined for the purposes of this program;
- Developing a process to ask all patients whether they are of Aboriginal and/or Torres Strait Islander origin, consistent with accreditation requirements under RACGP Standards for general practices (3rd Ed); and
- Establishing a recall and reminder system for Aboriginal and/or Torres Strait Islander patients: annual recalls for a health assessment, review of risk factors and care plan reviews at clinically indicated intervals.