Chronic Disease Management
A chronic disease is a long‑term health condition that requires ongoing care and monitoring. Our practice provides structured support to help patients manage these conditions effectively.
Structured Chronic Disease Management (CDM) Programme
The Structured Chronic Disease Management Programme is designed to help prevent, monitor, and manage certain long‑term conditions. It is available to patients aged 18 or over who have a medical card or GP visit card and have been diagnosed with one or more of the following:
- Type 2 diabetes
- Chronic obstructive pulmonary disease (COPD)
- Cardiovascular disease (including heart failure, angina, heart attack, stroke, atrial fibrillation)
- Asthma
The programme helps you work closely with your GP and practice nurse to monitor your condition, identify early treatment needs, and support your self‑management.
Benefits of the Programme
Taking part in the CDM Programme can help you stay well and reduce the risk of hospital admissions. Benefits include:
- Regular structured reviews with your GP and practice nurse
- A personalised care plan tailored to your needs and preferences
- Ongoing review of your care plan and medications
- Support to help you manage your condition day‑to‑day
- Access to education and self‑management resources
- Early detection of new conditions or complications
- Care delivered in your community, close to home
How the Programme Works
You will receive two free reviews every 12 months while enrolled in the programme. There is no charge for any tests carried out as part of these reviews.
Each review includes:
- A visit with the practice nurse
- A follow‑up visit with your GP
- Blood tests and other checks as needed
You may attend both appointments on the same day or at separate times. After each review, you will receive a written care plan.
You can continue to see your GP as normal outside of your scheduled CDM reviews.
Your Care Plan
Your care plan is created with your GP or practice nurse and outlines:
- Steps to help you manage your condition
- Supports available to you
- Your concerns and goals
- Advice to follow between reviews
This plan helps guide your care throughout the year.
Registering for the Programme
If you are eligible and wish to take part, your GP or practice nurse will register you for the programme.
Your Information
During each review, your GP or practice nurse will record information such as:
- Your name and age
- Your chronic disease diagnosis
- Relevant medical history
- Any symptoms or tests since your last visit
How the HSE Uses Your Information
After each structured review, your GP will send certain information to the HSE, including your name, address, medical card or GP visit card number, and chronic disease history.
This helps the HSE improve how chronic diseases are detected, treated, and managed across Ireland. Your information is stored securely in line with data protection regulations, and you can request access to it at any time.
You can read the full privacy statement for the Chronic Disease Management Programme on the HSE website.
Opting Out
Participation is entirely your choice. You can opt out at any time by informing your GP. If you opt out, you will no longer receive scheduled reviews or care planning under the programme, but you can rejoin later if you wish.
If you have any questions about the programme, please speak with your GP or practice nurse.
Disclaimer
This page provides general information and is not a substitute for medical advice. While we aim to keep content up to date, errors may occur. Please discuss any health concerns with your GP. If you have suggestions or updates that may help others, we welcome your feedback.