Care Pathway Flowchart

Coordinare, in partnership with the Illawarra Shoalhaven Local Health District, and the Southern NSW Local Health District are supporting a Multi-Disciplinary Team (MDT) approach to the management of COPD within the community.   

The LinkMyCare – COPD program will provide funding to a range of providers to deliver services to patients close to their home, at no cost to the patient, that should help avoid hospital visits.

The program is being funded through NSW Health. It is expected that the program will improve patients’ quality of life, reduce hospital admissions and length-of-stay (LOS) and assist providers to better work collectively to support patient health outcomes. Hear from local community members participating in the program and the benefits it has had for them here.

  

  

 

Key resources

  • Frequently Asked Questions

    COORDINARE has compiled a list of FAQs for the LinkMyCare - COPD Program.

    Read more

  • COPD Annual Cycle of Care

    The COPD annual cycle of care includes three practice appointments, one held every four months.

    Read more

  • Collaborative Commissioning Care Pathway

    The purpose of this report is to outline the proposed care pathway, which has been developed through a co-design process.

    Read more

LinkMyCare patient journeys

LinkMyCare - COPD helps to deliver services close to home, at no cost to the patient. Hear from local community members participating in the program and the benefits it has had for them.

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Brian Warner

Following Brian's last hospital stay, his GP and LinkMyCare – COPD nurse helped develop a COPD Action Plan, which he says has helped to reduce his anxiety. Read more here.

 

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Yvonne Kelly

Since receiving a COPD Action Plan, Yvonne has felt more confident in her ability to manage her symptoms and has been able to avoid going to hospital. Read more here.

 

 

When I first got this (COPD) I didn't know when to go to hospital. I used to be frightened when I couldn't breathe, especially when I was alone. Now I don't seem so scared when I get an attack, I think it is because I have a plan. I'm getting better faster because I can get straight into my plan, I have medications at home if I need them.

Yvonne Kelly

LinkMyCare – COPD patient

COPD is a serious chronic health issue for our region. Patients with COPD need significant support from their general practice teams, and need to access services with allied health providers and hospitals. The LinkMyCare program will encourage active involvement from patients and members of their practice team and will facilitate integration with allied health and hospital services to ensure the right care at the right time.

Dr Katherine Michelmore

Illawarra GP and Medical Director at COORDINARE

Our work with COORDINARE has seen active engagement in many of our transformational programs of work in areas such as Collaborative Commissioning, remote patient monitoring, and population health. Our Collaborative Commissioning work in partnership with PHN and ISLHD in particular is shaping to be highly impactful for us in supporting us to manage COPD patients across the care continuum, and we’re excited to see this work progress in the near future.

Chin Weerakkody

Manager Virtual Care, Programs & Innovation, Integrated Care & Allied Health, SNSW LHD