Chronic Disease Management

Affiliated Patient Services

OHIP Covered

Comprehensive Care Approach

Did you know that three in five Canadians over the age of 20 live with a chronic illness? Even more concerning, four in five are at risk, according to the Public Health Agency of Canada.

Among the most common chronic conditions affecting Canadians today are high blood pressure, diabetes, heart disease, cancer, and chronic obstructive pulmonary disease (COPD). 

Our chronic disease management program takes a team-based approach to help patients not just manage these conditions but to get ahead of them.  

Diabetes Management

Diabetes is a condition that affects how your body processes insulin, either by not producing it at all or by being unable to use it effectively. Living with diabetes requires constant care and attention, which is why our healthcare team works together on all aspects of your health.

• Support for diabetes, prediabetes, and gestational diabetes 
• Strategies covering diet, exercise, medication, foot care, and mental health support
• Guidance and education on how to live well with diabetes

Memory Clinic

Our Memory Clinic is a specialized service dedicated to supporting patients experiencing memory difficulties, dementia, and Alzheimer's disease. Patients and their family members meet with our team of healthcare professionals who provide comprehensive cognitive assessments and recommendations. The insights gained through our assessments help both patients and their family doctors better understand cognitive health status and develop effective care strategies.

As an accredited MINT Memory clinic, we follow evidence-based approaches to memory care that focus on both clinical needs and quality of life. Our goal is to provide patients and families with the knowledge and tools needed to navigate cognitive health challenges and safety with confidence and dignity.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease is a progressive lung condition that makes breathing difficult due to airflow blockage and lung damage.  Our program offers diagnostic testing and comprehensive support for people living with COPD and other chronic respiratory conditions. Our team works with you and your family doctor to take a holistic approach focused on nutrition, exercise, medication management, and mental health support. While COPD is progressive, quality care can significantly improve the quality of life. 

Congestive Heart Failure (CHF)

Heart failure occurs when the heart cannot pump blood effectively to meet the body's needs, causing symptoms like fatigue and shortness of breath. Our program provides diagnostic testing and comprehensive support for people living with heart failure and other chronic cardiac conditions. Our team collaborates with you and your family doctor to implement a holistic approach that includes diet, mental health support, and medication management. Although heart failure is progressive, quality care can substantially improve the quality of life. 

Supportive Care

Supportive care focuses on improving the quality of life for people with progressive illnesses like COPD, heart failure, or dementia—and helps families and caregivers too. This care begins at diagnosis, not just at the end of life, and complements your regular appointments and treatment.

Your care team—including your family doctor, nurse practitioner, and other healthcare professionals— can provide personalized support such as consults at our office and phone appointments to discuss pain management, all designed to make your day-to-day easier. 

We also work closely with patients and caregivers on having advance care planning conversations about future healthcare wishes. These discussions prepare your "substitute decision maker" for possible situations where you might be unable to communicate your preferences. As your support team, we are here for you and can connect you to grief support, counseling, and local community programs that can help you through these challenging times.