General Practice

Chronic Disease Management

Living with a chronic condition requires consistent, expert medical support. Our chronic disease management programme combines regular monitoring, evidence-based treatment protocols, lifestyle counselling, and coordinated specialist referrals to help you manage your condition effectively. We partner with you to set achievable health goals, optimise your medication, and reduce the risk of complications.

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General Practice

What to Expect

  • An initial comprehensive assessment including blood tests and baseline measurements
  • A personalised chronic care plan with clear, measurable targets
  • Regular follow-up consultations at intervals appropriate to your condition
  • Medication reviews and adjustments to achieve optimal control
  • Lifestyle and dietary guidance tailored to your diagnosis
  • Coordination with specialists, dietitians, and allied health professionals as required
Chronic Disease Management
Areas Covered

Conditions We Treat

Type 1 and Type 2 diabetes mellitus
Hypertension (high blood pressure)
Asthma and chronic obstructive pulmonary disease (COPD)
HIV and AIDS management and antiretroviral therapy
Hyperlipidaemia (high cholesterol)
Thyroid disorders
Rheumatoid arthritis and other autoimmune conditions
Epilepsy
Our Process

How It Works

1

Initial Assessment

We perform a thorough clinical assessment, review your medical history, and order baseline blood work and investigations.

2

Care Plan Development

Together we develop a personalised chronic care plan, including medication, lifestyle modifications, and monitoring schedules.

3

Ongoing Monitoring

Regular follow-up consultations track your progress, with blood tests and clinical measurements at recommended intervals.

4

Plan Optimisation

We continuously review and adjust your treatment plan based on results, ensuring the best possible disease control.

Benefits

Why Choose This Service

Structured care aligned with South African clinical guidelines and Chronic Disease List (CDL) benefits
Reduced risk of disease-related complications through proactive monitoring
Medical aid prescribed minimum benefits (PMB) support and chronic medication authorisation assistance
Empowered self-management through patient education
Improved quality of life and long-term health outcomes
FAQ

Common Questions About Chronic Disease Management

Most medical aids cover conditions listed on the Chronic Disease List (CDL) as prescribed minimum benefits. We assist with chronic medication applications and authorisations to ensure you receive the cover you are entitled to.
This depends on your condition and how well it is controlled. Typically, patients with well-managed chronic conditions visit every 3–6 months, while those requiring closer monitoring may visit monthly.
Yes. Dr Nel is experienced in managing patients with multiple comorbidities. We take a holistic approach to ensure all your conditions are addressed in a coordinated manner.
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