Chronic Disease Management

Chronic Disease Management including telephone based support, disease specific education and self- management strategies for people with chronic diseases including heart and lung diseases, diabetes and HIV

About Us

What We do

The HARP Chronic Disease Management team provides care coordination and disease-specific intervention programs to improve the self-management skills of clients with complex needs due to chronic diseases.  Clients work with their care coordinator to improve their health outcomes with the aim of reducing the need for hospitalisation. The team offers specialist disease nurses, medical assessment and support, community nurses and allied health professionals who assist clients to:

  • Improve their understanding of their disease, 
  • Identify signs and symptoms, 
  • Improve compliance with medication regimes
  • Reduce the impact of the disease on independence, health and wellbeing.  

Health Management Coaching (previously the COACH program) is a telephone-based coaching program that reduces avoidable hospital admissions for people with either cardiovascular disease or Type 2 Diabetes by promoting self-management and risk factor modification. Clients are coached over the phone for a period of 6 – 12 months to target their particular modifiable risk factors, following best practice evidence set by the Heart Foundation.  

Who We See

The team works with clients who have chronic diseases and/or complex needs. This includes, but is not limited to, chronic cardiac conditions and heart failure, asthma and other chronic respiratory diseases, diabetes and HIV.


  • Referrals to or fax 9231 2202

Contact Us

  • Contact HIP Central intake on 1300 131 470