Specialist assessment services - Health Independence Program

The Hospital Independence Program (HIP) incorporates a range of specialist clinics that provide specialist assessment, diagnosis, intervention, management, education and support to clients with specific medical conditions. These clinics treat:

• continence
• cognitive, dementia and memory services (CDAMS)
• falls and balance
• movement disorders
• chronic pain management
• chronic wound management
• young adults with complex medical needs
• polio.

HIP clients with complex care needs or who are in residential care have access to specialist assessment and intervention based on their care needs.

Continence clinics

HIP continence clinics provide:

• specialist assessment
• diagnosis
• time-limited goal-orientated management
• education and support for clients with bladder and/or bowel dysfunction.

They assess the need for continence products and then prescribe and assist people to access them through funding schemes.

The clinics also provide consultancy, education and advice to health professionals as well as support to carers and relatives.

Cognitive, dementia and memory services (CDAMS)

The HIP service provides early diagnosis, advice, support and referral for people with cognitive difficulties that cause confusion, memory loss or thinking problems.

Cognitive, dementia and memory services also aim to support family and carers of those with cognitive issues.

Cognitive Dementia and Memory Service Best Practice Guidelines

Falls and balance clinics

These clinics focus on the assessment and management of clients with falls and balance problems. Clinics aim to provide a diagnosis and referral to other services for ongoing client management. They may provide time-limited specialist intervention.

Clinics also provide education to clients, carers and health professionals.

Movement disorder clinics

These clinics are for people with movement disorders, particularly Parkinson’s Disease or other progressive neurological disorders. Movement disorder clinics provide assessment, education, medication review and development of management strategies.

Chronic pain management clinics

These clinics focus on reducing the risk of long-term disability through clinical assessment. They provide treatment on a time-limited basis for people presenting with moderate to severe levels of chronic non-malignant pain.

Integral to the service model is a focus on enabling clients to gain an improved ability to self-manage their condition, and on developing strong links with the patients’ primary carer. This is to support continuing management in a primary care setting, following discharge from a specialist service.

Chronic wound management clinics

Wound clinics provide specialist assessment, diagnosis, management and support to clients with chronic, complex, reoccurring or non-healing wounds.

Young adults with complex medical needs

There are clinics is for young adults with complex disabilities when they are transitioning from paediatric to adult health services.

The focus of these clinics is to provide case management for young adults, assisting them to access the most appropriate adult services for their needs.

These clinics are currently based at St Vincent’s Hospital, Melbourne Health, Monash Health, Barwon Health and Bendigo Health.

Different health services have different diagnostic focuses. Diagnoses seen so far include: spina bifida, cerebral palsy and other congenital neurological conditions resulting in ongoing physical disability.

Polio Services Victoria

Polio Services Victoria provides assessment, care planning and long-term review of clients with post-polio syndrome. This statewide service is based at St Vincent’s Hospital. Regular rural and regional clinics are held throughout the state.

Polio Services Victoria provides consultation, education, training and support to health professionals and services working with clients who have post-polio syndrome.

Residential aged care clients

Specialist assessment services for people living in residential aged care services provide short-term care coordination, outreach and specialist assessment of aged care residents.

More specifically, these services provide assessment and management (in appropriate circumstances) of acute medical conditions that would otherwise result in a resident unnecessarily going to hospital.

Some services may also be able to provide specialist geriatric medical assessment regarding a resident’s other conditions.

These services have been commonly referred to as residential in-reach, for more information on locations of these services, see Residential in-reach serviceson our Better Health Channel website.

Residential In-Reach Pilot Program Evaluation 2009 Report

Chronic and complex needs

People with complex needs and/or chronic conditions, including HIV, have access to specialist assessment and chronic disease management interventions based on their care needs and condition.

People with progressive neurological diseases (PNDS) can access a statewide model provided by Calvary Health Care Bethlehem (CHCB).

The role of CHCB is to build the capacity of providers across the state to deliver appropriate, integrated services to this group of people (those who are experiencing high levels of complex needs), through:

• regional PND services, supported by CHCB
• outreach tools to support patients, families, new PND services and the general workforce; for example, shared care plans, secondary consultation and education.