Closing the Gap

Are you Aboriginal and/or Torres Strait Islander and struggling to manage your chronic disease?

What is a chronic disease?

A chronic disease is a disease that you have for a long time which may affect your ability to do your daily tasks. This can include cancer, diabetes, stroke, kidney disease, heart disease and lung disease. 

Chronic disease is the leading cause of illness, disability and death in Australia. These conditions may never be cured completely, so there is generally a need for long-term management.

How does the program work?

Program Flowchart

What is the Closing the Gap Integrated Team Care program?

Our Closing the Gap program provides short-term support to Aboriginal and Torres Strait Islander people living with complex chronic disease who are unable to effectively manage their condition. 

Chronic disease could include; diabetes, cancer, cardiovascular disease, chronic respiratory or kidney disease and eye health conditions associated with diabetes.

Our program adopts a team approach. Both Outreach Workers and Care Coordinators will work with you to support you to access medical care and other culturally appropriate health and community services. 

Working together, our team can help you to develop self-management skills to better manage your chronic condition and live a longer, healthier life.

How can the program help me?

We can provide you with support that you may need to:

  • Better understand your chronic condition and what it means for you.
  • Access medication and follow GP treatment plans.
  • Go to your medical appointments; including short-term assistance with transport and support during your appointment. 
  • Access recommended allied health equipment.
  • Connect to ongoing community supports who can provide assistance to improve your physical health and wellbeing.


To be eligible for the program, clients must:

  • Identify as Aboriginal and/or Torres Strait Islander;
  • Be enrolled for chronic disease management in a GP practice/AMS and;
  • Be unable to effectively manage your condition requiring one-on-one assistance through care coordination.

Service locations

Metropolitan Adelaide, Gawler-Barossa, Yorke Peninsula & Mid North South Australia


Complete the External Referral Form and email to


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