Department of Health and Human Services

Early intervention in chronic disease

Page contents: Overview | Services provided | Evaluation | Resources | Further information


The EIiCD initiative funds the delivery of services that aim to assist people with chronic disease improve their capacity to manage the condition/s, prevent complications, and improve their health and wellbeing.

The initiative also assists agencies drive service system improvements. It builds on the work already being done by community health services to support people in the community living with chronic disease and implement new approaches that are consistent with evidence-based chronic care. In addition, the initiative supports work across the service system to improve the coordination of care for people who access multiple services over long periods of time. This work is termed Integrated Chronic Disease Management (ICDM).

The EIiCD initiative is funded into 36 LGAs across the state, resulting in 40 community health services delivering EIiCD funded services.

Services provided

The EIiCD initiative provides services to people with chronic disease. Services include allied health, nursing and psychosocial support. They are provided using multidisciplinary approaches and include education, care coordination and self-management support.

Funding supports the delivery of flexible services and models of care that meet the needs of local population groups. These include site based services, outreach services, telephone services and/or group programs.

The initiative targets people with a diagnosed chronic disease having difficulty managing their condition. It aims to provide early intervention services that support people to be good self-managers of their health, so as to maintain good health and wellbeing, and to prevent future complications.

Guidelines to support the implementation of the EIiCD initiative in the context of an integrated chronic disease management approach are available for agencies with and without EIiCD funding.


Revised Chronic Disease Management Program Guidelines for Primary Care Partnerships and Primary Health Care Services October 2008 (606kb, pdf)

Diabetes self-management - Guidelines for providing services to people newly diagnosed with Type 2 diabetes


Between 2007-08 the department commissioned the Australian Institute for Primary Care (AIPC) to undertake a state-wide evaluation of the EIiCD initiative, including the role of primary care partnerships (PCP). The evaluation set out to demonstrate improvements at the systems level and the resultant benefits to clients. The evaluation was finalised in 2008 and the executive summary of the final report and the technical report in full provides details about the evaluation methodology and outcomes.

EIiCD Evaluation - Final Report - Executive summary (296kb, pdf)

EIiCD Evaluation - Technical Report (816kb, pdf)

Further information

Contact information for further queries.