Opening Hours: Monday – Friday 9:00 AM – 5:00 PM | Saturday 9:00 AM – 5:00 PM | Sunday 9:00 AM – 2:00 PM | Public Holidays: Closed

Living with a Chronic Condition? We're Here for the Long Haul.

Chronic Disease Management

Managing a chronic health condition isn’t just about treating symptoms. It’s about understanding your body, building a plan that works for your life, and having a trusted GP by your side every step of the way

At Mambourin Doctors, we provide structured, compassionate care for patients living with ongoing health conditions. Whether you’ve recently received a diagnosis or have been managing a condition for years, our GPs work with you to create a personalised approach that fits your everyday life here in Mambourin, Wyndham Vale, and the surrounding communities of Melbourne’s growing west.

What Is Chronic Disease Management?

A chronic condition is any health condition that lasts 6 months or longer and requires ongoing medical attention or limits daily activities. Common examples include:

  • Type 2 Diabetes
  • Heart disease and high blood pressure (hypertension)
  • Asthma and chronic obstructive pulmonary disease (COPD)
  • Arthritis (osteoarthritis and rheumatoid arthritis)
  • Chronic kidney disease
  • Thyroid disorders
  • Osteoporosis
  • Mental health conditions such as anxiety and depression
  • Chronic pain conditions

Living with a chronic condition can feel overwhelming. But with the right support, many people are able to manage their symptoms, reduce complications, and live full, active lives.

How We Support You at Mambourin Doctors

Our GPs take a whole-person approach to chronic disease management. We don’t just look at numbers and test results, we take the time to understand how your condition is affecting your daily life, your work, your family, and your wellbeing.

Medicare Chronic Disease Management (CDM) Plans

If you have a chronic condition, you may be eligible for a Medicare-subsidised Chronic Disease Management (CDM) Plan.

These plans are designed to:

  • Coordinate your care across multiple health professionals
  • Set clear health goals that are realistic and tailored to you
  • Provide access to Medicare rebates for allied health services (such as physiotherapy, podiatry, dietetics, and psychology) under a Chronic Disease Management Plan
  • Give you and your GP a shared roadmap for managing your condition


Your GP will review your plan regularly to make sure it continues to meet your needs as your health changes over time.

What to Expect at Your Appointment

When you come in for a chronic disease management consultation at Mambourin Doctors, your GP and nurse will:

  1. Review your current health status and any recent test results or specialist reports
  2. Discuss your symptoms, lifestyle, and any concerns you have
  3. Develop or review your Chronic Disease Management Plan, including goals and actions
  4. Coordinate referrals to specialists or allied health providers where appropriate
  5. Arrange any necessary investigations, such as blood tests, ECGs, or imaging
  6. Discuss medications and any adjustments that may be appropriate
  7. Book your next review to keep your care on track

We encourage you to bring a list of your current medications and any questions you’d like to discuss. You’re welcome to bring a support person to your appointment.

Allied Health Support Under Your Care Plan

For patients with an active Chronic Disease Care Plan, you may be eligible for Medicare rebates on 5 allied health visits per calendar year. Our clinic works closely with allied health professionals, including our in-house chiropractor Sam Irfan, to make sure your care is coordinated and connected.

Allied health services that may be part of your care plan include:

  • Physiotherapy
  • Podiatry
  • Dietetics and nutrition
  • Psychology and mental health support
  • Chiropractic care
  • Exercise physiology


Your GP will refer you to the services most appropriate for your individual condition and goals.

Bulk Billing for Chronic Disease Management

Mambourin Doctors is a bulk billing practice. All chronic disease management consultations are bulk billed for all patients with a valid Medicare card.

Why Ongoing Reviews Matter

Chronic conditions can change over time. A medication that worked well two years ago may need adjusting. A lifestyle change might open up new management options. Regular reviews with your GP help to:

  • Catch changes in your condition early
  • Keep your medications up to date and appropriate
  • Adjust your care plan as your health goals evolve
  • Reduce the risk of complications
  • Keep you informed and in control of your own health

We recommend scheduling a dedicated review appointment at least once or twice a year, depending on your condition. Our practice also uses a reminder system to help you stay on top of your preventative care.

Conditions We Commonly Manage

Our GPs have experience supporting patients across a wide range of chronic and complex conditions, including but not limited to:

ConditionExamples
CardiovascularHypertension, coronary artery disease, heart failure
MetabolicType 2 diabetes, obesity, high cholesterol
RespiratoryAsthma, COPD, sleep apnoea
MusculoskeletalArthritis, chronic back pain, osteoporosis
Mental HealthAnxiety, depression, chronic stress
Kidney & ThyroidChronic kidney disease, hypothyroidism, hyperthyroidism
NeurologicalMigraines, chronic headaches

A Community-Based Approach to Health

Mambourin and the surrounding suburbs of the Wyndham growth corridor are home to a vibrant, diverse, and rapidly growing community. We understand the unique challenges that come with living in a newer suburb, from building a new support network to finding healthcare services you can trust close to home.

At Mambourin Doctors, our goal is to be that trusted local health partner. We’re not just your GP practice, we’re part of the Mambourin community, and we’re committed to helping residents of Mambourin, Wyndham Vale, Hoppers Crossing, and the broader western Melbourne region live healthier, more supported lives.

Bulk Billing

MyMedicare Registration

To access Chronic Disease Management services at Mambourin Doctors, patients are required to be registered with MyMedicare.

MyMedicare is a free, voluntary Australian Government program that links you to your regular GP practice and supports better, more connected care. Registration is quick and easy and can be completed online before your appointment.

Get Started

Book Your Chronic Disease Management Appointment

Managing a long-term condition starts with a conversation. If you’d like to discuss a Chronic Disease Management Plan or simply review how you’re tracking with an existing condition, our team is here to help.

The information on this page is general in nature and is not a substitute for professional medical advice. Please speak with a qualified healthcare professional for advice tailored to your individual health needs.

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