Written answers

Tuesday, 7 December 2021

Department of Health

Disease Management

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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475. To ask the Minister for Health the key performance indicators used to determine the success of the chronic disease management programme; if they are broken down by condition, age cohort, clinical outcomes, impact on mortality and other pertinent indicators; if there are specific key performance indicators for childhood asthma within the programme or other health strategies within his Department; and if he will make a statement on the matter. [59835/21]

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Chronic Disease Management (CDM) programme, introduced by the 2019 GP agreement, provides GP led care for adult GMS patients with one or more of the following chronic diseases; diabetes, asthma, chronic obstructive pulmonary disease or cardiovascular disease. Child patients under 6 years of age with asthma are treated under the Under 6’s GP Contract Asthma Cycle of Care programme.

The CDM Programme is being rolled out on a phased basis to all adult GMS and GP visit card patients over a 4-year period, having started in 2020 for those aged 75 years and over.

Patients in the CDM Programme will receive two scheduled clinical reviews in a 12-month period that will include patient education, preventative care, medication review, physical examination, investigations, and an individual care plan. Each review consists of a consultation with the practice nurse followed by a consultation with the GP. Detailed patient datasets are submitted to the HSE following consultations.

Registered child patients with asthma receive an initial consultation, a review consultation after three months of diagnosis and an annual review thereafter. Similarly, an annual data set pertaining each patient on the Asthma Cycle of Care Programme is submitted to the HSE.

Through dataset submission, the number of consultations/reviews provided to patients are recorded, ensuring that the programmes are performing with patient's receiving care as required.

Chronic diseases are health conditions that can be treated and managed but are usually not cured. Under the CDM programme, patients’ care plans are managed by their GP practice in recognition of the clinical aspects of each individual patient’s conditions. They also serve to educate patients on how they can improve self-management of their condition. The care plan is to be regularly reviewed and updated, reflecting the current health and wellbeing of the patient and their future expectations. Child patient care under the Asthma Cycle of Care is also managed by the patient's GP.

Approximately 430,000 patients with chronic disease, or at high risk of chronic disease, are estimated to be registered as participants on the CDM Programme when the programme reaches full implementation in 2023. As the Programme is rolled out and fully implemented over time, it is envisaged that it will result in a reduction in hospital attendance by patients with the four conditions.

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