Which patients

Who a case conference can be held for

All Medicare eligible patients are eligible for this service.

Explanatory note AN.0.49

Who it is for

Overwhelmingly, doctors use case conferencing to improve the care of their chronic disease patients

Chronic painDiabetesFrailty & fallsCOPDObesity & metabolicSleep disordersCancerArthritisCardiovascular diseasePeripheral vascular diseaseUrinary incontinenceChronic kidney diseaseNeuropathyDementiaNeurological conditionsMedication complexityStroke recoveryMental health needs

A care plan is not a prerequisite.

Common cases

The patients who benefit most

These cohorts benefit most — but any patient with a chronic condition or in residential aged care is eligible for a GP-coordinated case conference.

Geriatric

Falls risk, polypharmacy, cognitive decline, frailty, dementia, Parkinson's.

Chronic pain

Osteoarthritis, chronic low back pain, fibromyalgia, CRPS, neuropathic pain.

Diabetes

Blood glucose instability, poor adherence, limb ischaemia, neuropathy.

Cardiovascular

Heart failure, post-stroke care, atrial fibrillation, hypertension.

Mental health

Treatment-resistant depression, PTSD, bipolar disorder, eating disorders.

Patient benefiting from coordinated care

Any chronic condition

Eligible for a case conference

Where they are

Patients qualify in three settings

  1. In the community

    At home, or in supported accommodation.

  2. In residential aged care

    A resident of an aged care facility.

  3. Leaving hospital

    Before the patient goes home.

Other families

Some conditions have items of their own

21 itemsMental health
From 1 July 2023 there is a full set of items for organising or taking part in a conference about a patient’s mental health care, with a series each for GPs, prescribed medical practitioners, psychiatrists and paediatricians, and allied health.
3 itemsComplex neurodevelopmental & disability
Allied health professionals have their own participation items for a patient under 25 diagnosed with, or suspected of having, a complex neurodevelopmental condition such as autism, or an eligible disability.
4 itemsCancer
Specific items exist for conferences that develop a multidisciplinary treatment plan for patients with cancer.
4 itemsHeart valve suitability
Specific conference items exist for discussions that decide whether a patient is suitable for transcatheter aortic valve implantation or mitral valve repair.