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​​​​​​Integrated Care in Cobar

​Integrated Care in Cobar was initially focused on improving the overall health and well-being of people dealing with chronic and complex health conditions. Often these patients are elderly or less mobile people who regularly present to their GP or the emergency department with the same health issues. A recent key milestone for the model in Cobar has been the commencement of enrolling patients under 70 years of age once the program was fully operational.

In addition to the programs expansion to include patients under 70, Cobar has also been a trial sites for the roll out of NSW Ambulance Paramedic Connect program.

Cobar has also begun initial stages of planning for the implementation of a First 2000 Days of Life model. Early planning stages are focussing on data collection, identification of potential service providers and likely resource requirements to deliver best practice models.

As part of the Western NSW Integrated Care Strategy, a local Integrated Care team has been established and is led by Dr Deon Heyns from the Cobar Primary Health Care Centre.

The team includes a range of different local health providers and its aim is to improve the connection between the health providers to gain a better understanding of a patient’s physical and mental health, as well as any other external factors (such as lack of transport or family support) that may be preventing ​patients from staying well. Together, they formulate a shared care plan that is managed by a care navigator.

Integrated Care GP Lead, Dr Deon Heyns (middle) with Cobar’s Care Navigators – Scott Tuckermann and Rosemary Zannes.

Care Navigators have been appointed to manage​ the shared care plans and provide sup​port and guidance to the patient and their carer to ensure their health stays on track.​