Early interventions for healthy ageing

The Australian Government Department of Health and Aged Care funds North Western Melbourne Primary Health Network to support older people to live at home for as long as possible. This is achieved through commissioning early intervention activities and models of care for chronic disease management to support healthy ageing and reduce pressure on hospitals, aged care and other health services.

Through its Early interventions for healthy ageing program, NWMPHN commissioned 10 general practices to develop and implement models of care that aim to:

• identify and engage people aged at least 50 (or Aboriginal and Torres Strait Islander adults aged at least 35) who are at risk of or have one or more chronic conditions.
• provide a proactive and prevention-focused model of multidisciplinary care for these patients, to promote healthy ageing at no cost to patients
• examine how flexible block funding can complement Medicare Benefits Schedule (MBS) fee-for-service funding, to enable this model.

The project aims to support older people to live at home longer by helping them stay well and connected in the community. Intended outcomes include:

• timely detection and intervention to improve the physical and mental health needs of people at risk of or living with chronic conditions
• better self-management by patients with chronic conditions
• improved integration of care to reduce unplanned hospital presentations and admissions of people with chronic conditions.

Reporting from the 2023–24 financial year shows that:

• 7,691 participants enrolled in the program, including 45 per cent from priority populations
• 74 per cent of participants reported satisfaction with their experience and felt that the care they received was of high quality
• 88 per cent of surveyed participants reported a stable or improved quality of life by the end of the program
• Commissioned providers continue to connect with community organisations such as Launch Housing, The Living Room, Orange Door and the Salvation Army to increase referrals into the program, and refer patients out to address their social needs.

Evaluation of this program is underway, which will help inform future programs as part of ongoing primary care reform.

Page updated: 30 September 2024.