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Better Access to Multidisciplinary Care

What is Nhulundu Health Service Integrated Team Care?

Nhulundu Health Service Integrated Team Care provides vital support to the General Practice to improve timely access to doctors who are specialists in certain areas of health for Aboriginal patients with chronic disease.

The Care is funded under the Commonwealth’s Integrated Team Care (ITC) program to improve outcomes for Aboriginal and Torres Strait Islander people through better access to multidisciplinary care and improved access to culturally appropriate services in mainstream primary care services.

Eligibility Criteria

To access this level of care, you need to fulfil the following requirements:

Aboriginal & Torres Strait Islander patients who –

  • Live in the Central Queensland PHN region;
  • Have a diagnosed chronic disease;
  • GRAICCHS Integrated Team Care focuses on the key lifestyle diseases causing excess mortality & morbidity;
  • Cardiovascular disease;
  • Diabetes;
  • Chronic respiratory disease;
  • Chronic kidney disease;
  • Cancer;
  • Mental Health.

Exceptional circumstances will be considered on a case by case basis. Patients are referred by their usual treating doctor and need to have a current GP Management Plan (GPMP).

Additional Services that may be available under the scheme are there to support the Integrated Care Team so that you are provided with 360-degree level support.

  • Gap fees associated with health appointments e.g allied health, specialist appointments;
  • Travel and accommodation to attend health appointments;
  • Webster packs for patients with polypharmacy;
  • Assisted breathing equipment – Asthma;
  • Spacers, Nebulisers, CPAP & CPAP Accessories;
  • Blood Sugar/Glucose Monitoring Equipment;
  • Medical footwear prescribed and fitted by a Podiatrist;
  • Mobility Aids;

Nhulundu Health Service Integrated Team Care will provide these services if documented as a need in patients’ GPMP and where they are not available under other programs.

How to Access the Program

You are not just another Medicare number – we aim to ensure you get the full end to end health care and that every patient or client is treated as fairly and comprehensively as the next. To access the program, the Care Team will help you get the following necessary documentation and plans in place. You are not alone – we are here to help and make things simpler for you.

GP Completes ATSI Health Check MBS 715

GP Completes GP management plan MBS 721 / 723
GP assesses the patient’s needs for extra services and refers an eligible patient to GRAICCHS Integrated Team Care to arrange/purchase extra services. GRAICCHS Integrated Team Care review the referral. If accepted, a Local Care Link Worker is assigned to follow-up with the patient and referring doctor

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