Chronic Disease Management

At Cabrini, we understand how challenging it can be to live with a chronic disease. Our team of skilled health professionals are here to deliver specialist care, improve your quality of life and help you and your family understand and manage your condition.

General Inquiries

Phone: (03) 9508 1700

Operating Hours

Monday to Friday
9.00 am - 5.00 pm



For Patients | For GPs

Neuro-Oncology Nursing


Cabrini Malvern
181-183 Wattletree Road, Malvern VIC 3144
(03) 9508 1222
Cabrini Brighton
243 New Street, Brighton VIC 3186
(03) 9508 5888

About our chronic disease programs

At Cabrini, we are committed to helping our patients with chronic conditions live their lives to their fullest potential, by empowering them with information, connecting them to vital services and providing tailored care.

Our programs are designed to help people become more independent and improve their physical and emotional health. We provide a continuity of care following a hospital stay, to speed up recovery and prevent unnecessary re-admissions. This includes: 

  • Engaging and communicating with patients when they are in hospital
  • Connecting patients with our rehabilitation programs
  • Helping with transfers to accommodation such as rehabilitation, respite or aged care after a hospital stay
  • Implementing long-term programs that allow patients to self-manage their condition
  • Linking patients with community services to support them when they return home

Depending on your clinical needs, some services may be provided to you in hospital, out of hospital or in the comfort of your home. Your specialist and our team of health professionals will assess you and decide the best option for you. In the more advanced stage of illness, care can be provided at home through Cabrini’s Palliative and Supportive Care home service.

Our chronic disease programs include: 

  • Cardiac rehabilitation
  • Chronic heart failure services, including a heart failure rehabilitation group
  • Chronic respiratory services, including a pulmonary rehabilitation group
  • Community dementia nursing service
  • Continence clinic
  • Neuro-oncology program

Cardiac Rehabilitation Program

If you have heart disease or a pre-existing condition, cardiac rehabilitation, which includes an exercise program, can have important health benefits. Research has found rehabilitation can reduce the recurrence of cardiovascular disease-related issues by up to 35 per cent.

At Cabrini, we offer a group exercise, education and support program, which is individually tailored to each patient’s ability and recovery stage and helps them return to daily activities. The program caters for patients diagnosed with a heart and blood vessel-related disease, or who have had a recent episode due to a pre-existing condition such as heart attack, angioplasty or bypass surgery. 

You will be assessed by a cardiac nurse and physiotherapist before starting the program to ensure it meets your needs. When you finish, ongoing support can be arranged through our maintenance exercise support programs.

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Chronic Heart Failure Service

Cabrini provides high quality and holistic care for heart failure patients and their families, including: patient reviews in hospital, home visits, telephone support and a group exercise program.

Our Chronic Heart Failure Service caters for patients with a confirmed diagnosis of chronic heart failure caused by a heart attack, or long-term health problems, such as high blood pressure, diabetes or heart disease.

We run a program to help patients improve their quality of life, consisting of two parts:

  • One-on-one contact with a nurse specialising in chronic heart failure care. They may support you at one of our hospitals, or in your home, depending on your needs.
  • A 12 session group program which runs for six weeks.

Ultimately, the program aims to help boost your emotional health, increase independence, improve physical functions like walking and strength, and reduce fatigue and shortness of breath.

Chronic Respiratory Service

While there is no cure for chronic respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), sleep apnea and occupational lung diseases Cabrini specialists can help improve your quality of life. Our program aims to help increase independence, reduce shortness of breath, and improve emotional and physical health.

Patients with chronic respiratory conditions will need also support to regain their strength and capacity to walk. The program consists of two parts:

  • One-on-one contact with a nurse specialising in chronic respiratory conditions. This may occur at the hospital or in your home, depending on your needs.
  • A 12 session group program which runs for six weeks.

Community Dementia Nursing Service

We understand that a diagnosis of dementia is overwhelming and life-changing for both patients and their families. At Cabrini, our caring, specialised team of nurses are here to make the journey less confusing and daunting, and give you the support and practical help you need.

Our Community Dementia Nursing Service provides assessment and ongoing management for patients who have suffered dementia, as well as memory decline and changes to thought processes. Patients can receive care in hospital, during home community visits, at our clinics and in residential care facilities. 

This service supports patients with cognitive difficulties, their carers and families, by:

  • Helping with practical day-to-day problem solving
  • Liaising with a patient’s existing medical team and other care providers
  • Linking patients into support services based on their needs
  • Managing the behavioural and psychological symptoms of dementia
  • Providing ongoing monitoring and support in a patient’s home

Continence Clinic

The Cabrini Continence Service offers expert help for patients with bladder and bowel issues.

Our team of nurses provide continence and urological nursing advice, education, management and support for patients and their carers. Patients can access the service while in hospital, and by making an appointment at our outpatient clinic. We accept referrals from external healthcare providers, but prefer a referral from a Cabrini doctor or allied health worker.

This service provides support for issues including, but not limited to :

  • Patients discharged home with an indwelling catheter, suprapubic catheter or percutaneous nephrostomy
  • Patients requiring continence advice and product information
  • Post-surgical patients who require catheter removal
  • Self-catheterisation education
  • Patients requiring outpatient bladder scans or assessment of flow rates

If you need support for another problem, please get in touch as we may still be able to assist.

>> Download the Cabrini Continence Service brochure here

Diabetes Education Service

Educating patients about diabetes is an important aspect of the care we provide at Cabrini. We specialise in the provision of diabetes self-management education, to optimise the care and knowledge of patients and their families. The advice we offer is based on the most up-to-date scientific knowledge and innovations, delivered by a team of highly-skilled diabetes educators. 

Our team helps patients with diabetes modify their behaviour and lifestyle, and become equipped to successfully self-manage diabetes and its related complications. The Diabetes Education Service provides a range of inpatient and outpatient services for all forms of diabetes including type 1, type 2 and gestational. 

For people who are not being treated within the hospital, our diabetes educators are available for consultation. The outpatient service helps you make informed lifestyle choices to reduce the development of diabetes-related complications, while maintaining your quality of life and wellbeing.

Our diabetes educators can assist with your insulin pumps and Continuous Glucose Monitoring, and stay well-informed on all the latest diabetes-related technology.

This service is available to Cabrini patients and the wider community.

For further information please call us on (03) 9508 1700 or email us at


Neuro-Oncology Nursing Program

The Cabrini Neuro-oncology Nursing program is Australia’s only dedicated service that extends care from the hospital ward to the home for patients with a primary malignant brain tumour.

It’s just one of the ways we aim to optimise the quality of life of our patients, and provide crucial support to families and carers. Our nurses work with your doctors and allied health professionals to deliver compassionate care that addresses your every need, whether it’s physical, social, emotional, cultural or spiritual.

The services provided by our specialist neuro-oncology nurses include: 

  • Assessment
  • Education
  • Inpatient and outpatient rehabilitation
  • Management of symptoms
  • Palliative care
  • Patient and care support group
  • Psycho-social support for patients, their family and carer, in hospital and at home

Download our Neuro-oncology Nursing brochure to find out more.