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GP MANAGEMENT PLAN - MBS ITEM No. 721 (Coronary Heart Disease CHD)
Applies to acute coronary syndromes, myocardial infarction, coronary angioplasty with/without stenting, and
bypass surgery. Similar guideline for other vascular disease (peripheral and cerebrovascular)
Patient problems / Goals - changes to be Required treatments and Arrangements for
needs / relevant achieved (if possible) services including patient treatments/services
conditions actions (when, who, and
contact details)
1. General
Patient's understanding Patient to have a clear Patient education GP/nurse
of coronary heart understanding of coronary heart
disease disease and the patient's role in
managing the condition
Chest pain action Develop action plan GP and patient agree on GP
plan written action plan on use of Patient
anti-anginals and when to
ring the ambulance
2. Lifestyle
Nutrition Healthy eating pattern, low fat diet Patient education GP/nurse to advise
Patient to implement
OR Dietitian
As per Lifescripts action plan
Weight Your target: Monitor Patient to monitor
BMI ≤ Review 6 monthly GP/nurse to review
Waist ≤ cm
Ideal: OR
BMI ≤ 25 As per Lifescripts action plan
Men waist ≤ 94 cm
Women waist ≤ 80 cm
Physical Activity Your target: Patient exercise routine Patient to implement
GP/nurse to review
Ideal: OR
At least 30 minutes walking or As per Lifescripts action plan
equivalent 5 or more days per
week
Smoking Complete cessation Smoking cessation strategy: Patient to manage
Consider: GP/nurse to monitor
- Quit
- Medication
OR
As per Lifescripts action plan
Alcohol Your target: Reduce alcohol intake Patient to manage
≤ standard drinks per day Patient education GP to monitor
Ideal:
≤ 2 standard drinks per day OR
(men) As per Lifescripts action plan
≤ 1 standard drinks per day
(women)
2. Biomedical
Cholesterol / Lipids Your target: Annual check GP
Cholesterol ≤ mmols/L
Triglycerides ≤ mmol/L
LDL-C ≤ mmol/L
HDL-C ≥ mmol/L
Ideal:
Cholesterol ≤ 4.0 mmols/L
Triglycerides ≤ 2.0 mmol/L
LDL-C ≤ 2.5 mmol/L
HDL-C ≥ 1.0 mmol/L
Blood pressure Your target: < Check every 6 months GP / nurse
Ideal:
< 140/90
I have explained the steps and any costs involved, and the patient has agreed to proceed with the plan.