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Chronic diseases are long-term conditions that usually progress slowly over time. This includes conditions such as heart disease, diabetes, chronic kidney disease, asthma and chronic obstructive pulmonary disease (COPD), depression, and arthritis, among many others.

Chronic Disease Management (CDM) is ongoing care and support to assist individuals impacted by a chronic health condition with the medical care, knowledge, skills and resources they need to better manage on a day to day basis. This may include regular visits and support from your family physician, other primary care provider, community-based programs or referrals to specialist programs and services.

Good chronic disease management includes care and support that is:

  • Proactive
  • Team-based
  • Well integrated with primary care (e.g. your family physician) and the broader community
  • Coordinated across providers and points of care
  • Easily accessible
  • Has a focus on health promotion and well being


Dr G Tembo Medical Practice is a full-service primary care medical practice dedicated to providing our adult patients with individualized healthcare.

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