Chronic conditions

Chronic conditions are the leading cause of illness, premature mortality and health system utilisation in the South Eastern NSW region. Improving care for people with chronic conditions can make a real difference to the long term health and wellbeing of local residents and communities.

Chronic conditions occur across the life cycle, becoming more prevalent with age. It is estimated that nearly 40 per cent of Australians aged 45 and over have two or more chronic diseases that compromise quality of life. Aboriginal people, people with a mental illness diagnosis and people with issues related to drug and/or alcohol misuse tend to be more at risk of developing chronic conditions.

Prevention is important in reducing the impact, complications and suffering caused by chronic conditions. Building consumer health literacy and awareness is fundamental in the prevention and management of chronic conditions; particularly among disadvantaged communities. End-of-life care must also be integrated into chronic conditions management.

 Our strategic priorities

 As the South Eastern NSW PHN, COORDINARE has a key role to play in improving coordinated and comprehensive care for the prevention and management of chronic conditions in the region.

Working with general practice and primary care providers, COORDINARE aims to build more integrated models of care for consumers, increasing consumer capacity for self-management and prevention. 

Our goals for chronic conditions are:

  • potentially preventable hospitalisations are avoided due to timely and effective health care, usually delivered in primary care and community-based care settings close to a person’s home
  • delivery of a sustainable whole-of-system response to prevention and management of chronic conditions.

You can read COORDINARE’s strategy statement for chronic conditions in full here.

The St Vincent’s Hospital Multidisciplinary Pain team are providing chronic pain management up-skilling workshops for clinicians in Southern NSW through a joint collaboration with the Agency for Clinical Innovation (ACI), COORDINARE and Southern NSW Local Health District. The dates and locations for 2018 workshops will be available on the COORDINARE events pages.

COORDINARE in collaboration with the ACI is also providing local Chronic Pain Management Programs for people experiencing low to moderate chronic pain for more than six months. For details please contact Sue Rogers at

COORDINARE, as the South Eastern NSW PHN is working with local primary care providers and consumers to identify and implement locally appropriate initiatives to increase consumers’ capacity to manage their own chronic conditions focusing on the concept of patient activation.

The organisation announced funding for five new programs to focus on reducing overweight and obesity levels our local population. These evidence-based physical activity, nutrition and weight loss programs include:

  • Chronic Pain Management Program Referrals - open now - COORDINARE and the NSW Agency for Clinical Innovation (ACI) are offering small group education programs in May 2018 targeting those patients suffering low to moderate chronic pain for more than 3 months. The program is now open for referrals and is being delivered in Moruya, Batemans Bay, Bermagui, Goulburn and Jindabyne. Click here for more information.

  • Programmed shared medical appointments: Australasian Society for Lifestyle Medicine (ASLM) – eight medical practices have been selected to offer shared medical appointments in weight control. A series of medical consultations in a supportive group setting where individuals can listen, interact, and learn. Milton Medical Centre will be the initial hub, with centres located in Wollongong, Merimbula, Cooma and North Nowra, with the addition of an Aboriginal Medical Service.

  • Rural and regional service gaps: Grand Pacific Health – offering a series of evidence-based physical activity and nutrition programs to fill an identified service gap to tackle the issue of overweight and obesity in the South Eastern NSW region.
  • Active8, Peer Coaching and Eat, Plant, Learn: Neami National – programs to address the poor physical health, particularly the high incidence of overweight and obesity, commonly experienced by people who have a mental illness.
  • Obesity service: Shoalhaven Family Medical Centres – offering a centralised obesity service for clients in the Shoalhaven region to access weight management, assessment and screening. It will also provide training opportunities by specialists in the field of weight loss and obesity to health providers to build knowledge and skills in obesity engagement in the local area.

All programs will be funded until 30 June 2018. Read more here.

Telehealth outreach service 

COORDINARE's chronic pain telehealth outreach service has been offered to consumers in Southern NSW as part of a partnership between COORDINARE, Southern NSW Local Health District and St Vincent's Hospital Pain clinic. Watch the video to hear one person's experience accessing the service from the Far South Coast of NSW.