Managing ongoing health conditions

If you are living with an ongoing (chronic) health condition, Gold Coast Health offers services for Aboriginal and Torres Strait Islander peoples to help you stay strong, well and connected to care.

Our services support your whole health; body, mind, spirit and culture. Our teams work alongside you, your family and your GP to improve access, coordination and long-term health and wellbeing.

Our Ongoing (chronic) health condition services

We provide three connected services:

• Mungulli Service
• Better Cardiac Care
• Care Coordination.

Together, these services support prevention, education, treatment and care coordination.

Resources

• Mungulli Clinic fact sheet
• Mungulli GP Fact Sheet
• Better Cardiac Care fact sheet 

The Mungulli Service supports Aboriginal and Torres Strait Islander adults living with ongoing (chronic) health conditions. Our team works together to offer holistic care. We will create a safe space to yarn, learn and take steps to stay strong and well.

A group program which helps to:

• Understand your health condition
• Create a personalised health care plan
• Recognise signs and changes in your health
• Build confidence to talk with your health team
• Share experiences and support each other.

The Mungulli Team will provide education about conditions such as diabetes, heart health, lung health, and kidney health and social and emotional wellbeing.

A half-day education session for people living with ongoing (chronic) health conditions and their carers. Deadly Tracks helps you:

• Learn more about your health condition
• Understand your treatment and care options
• Build a personal care plan
• Connect with the right services.

A 5-week community program to help you feel stronger, healthier and more confident. Weekly sessions include:

• Healthy eating and bush tucker
• Heart health and risk factors
• Medicines and how they work
• Social and emotional wellbeing
• Physical activity and cultural activities.

We check your health at the start and finish (blood pressure, heart rate and oxygen levels) so you can see your progress.

Weekly supervised gym sessions for all abilities, developed by our Physiotherapist and Nurse

• Build strength and balance
• Improve confidence
• Stay active with mob in a safe and supportive space.

A weekly supervised group walking program with healthy lifestyle yarns. Small groups offer individual support and connection. Each session includes:

• A gentle, self-paced outdoor walk
• Yarns about healthy lifestyles
• Support from our Senior Health Worker, Physiotherapist and Nurse
• Yarn and Walk is supported by the Gold Coast Primary Health Network.

Better Cardiac Care supports Aboriginal and Torres Strait Islander peoples who are at risk of, or living with, heart disease. Heart disease can include:

• Coronary heart disease
• Heart failure
• Conditions that increase your risk of heart attack or stroke.

Better Cardiac Care helps by:

• Supporting you after a cardiac event or hospital stay
• Improving access to specialist heart services
• Helping you understand your medicines
• Supporting cardiac rehabilitation
• Coordinating care between hospital, community and your GP.

The program aims to improve heart health outcomes and reduce preventable hospital admissions.

Our complex and ongoing health conditions care coordination is provided by highly trained Nurse Navigators. The Nurse Navigators will help you move through the health system with confidence. They can support you if you have one or more ongoing (chronic) health conditions or complex care needs.

Nurse Navigators work with you, your GP, specialists and other health teams to make sure your care fits together and works well for you. They help you understand your health, plan your care and find the right services at the right time. You can meet your Nurse Navigator at the hospital, in the community or by phone, wherever you feel most comfortable.

The team can help you:

• work out what health care you need
• build a care plan that fits your health goals
• link you with the services and supports that you need
• find ways to get care that fits your situation
• support you to understand your health and make informed choices
• reduce any gaps in care
• prevent unnecessary hospital admissions.

Nurse Navigators will help you reach your best possible health outcomes. They work closely with the Mungulli Service and Better Cardiac Care to get you the right care, at the right time.

You can join our services and programs if you:

• Identify as Aboriginal and/or Torres Strait Islander
• Are 18 years or older
• Are living with one more ongoing (chronic) health conditions
• Have a referral from your GP or health professional.

Our services accept hospital-based referrals (qhRefer) and GP referrals (Smart Referrals).

If you are unsure, contact us and we can guide you.

Speak with your GP (doctor) about a referral to:

• Mungulli Service
• Better Cardiac Care
• Care coordination - complex and ongoing health conditions.

For useful management information and referral criteria:

• Mungulli Service (Referral guidelines)
• Mungulli GP Fact Sheet
• Better Cardiac Care (Referral guidelines)
• Aboriginal and Torres Strait Islander Chronic Disease Nurse Navigation (Referral guidelines)