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Notable increase in contacts with chronic disease programme

By David Lynch - 24th Feb 2025

chronic disease programme

The first half of 2024 witnessed a marked increase in patient engagement with GPs and community specialist teams in the HSE’s chronic disease management (CDM) programme.

The Sláintecare programme board discussed the HSE data at a meeting in September 2024, according to minutes.

Members were told that GPs completed 371,598 reviews of patients enrolled in the CDM programme in the first seven months of 2024. Some 92 per cent of patients who were registered in the CDM programme were fully managed routinely in primary care and were not attending hospital for ongoing management of their chronic condition.

The meeting also heard that community specialist teams for chronic disease management (CD-CSTs) delivered 196,542 patient contacts from January to July 2024. This represented an increase of approximately 180 per cent from the same period in 2023.

The CD-CSTs provide self-management support services to which GPs can refer patients. Members of the CD-CST include advanced nurse practitioners, clinical nurse specialists, physiotherapists, diabetes dietetic services, diabetes podiatry services, senior cardiac and respiratory physiologists, and ‘stop smoking’ advice services. 

The Medical Independent recently reported that chronic kidney disease (stages four and five) and peripheral arterial disease are due to be added to the GP CDM treatment programme this year.

The CDM treatment programme is for patients who have a medical or GP visit card and a diagnosis of one or more specified chronic diseases.

This year, the prevention component of the programme is also due to be extended to “eligible people at risk of developing or who have” chronic kidney disease (stages one to three), valvular heart disease, and familial hypercholesterolaemia.

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