Caring for people with chronic conditions – a health systems perspective

Perhaps the greatest challenge to face health systems in the twenty-first century will be to develop effective responses to the growing burden of chronic diseases.

The multi-system nature of many chronic diseases, as well as the diverse needs that they create, requires a multifaceted response. Yet while it is clear that the traditional relationship between an individual patient and a single doctor is inappropriate, it is much more difficult to define what is the best model. At the same time it is recognised that many chronic conditions require active participation by informed patients.

Countries are now experimenting with new models of care delivery to address the complex challenges posed by the rising burden of chronic illness, redesigning delivery systems to achieve better coordination of services along the continuum of care. However, although integration and coordination of care delivery have a logical appeal, the available evidence of the effectiveness of different approaches is limited. Furthermore, context is important; the diversity of health systems means that there are no universal solutions. Each system must find its own solution, although it can also draw on the lessons learned by others.

This paper provides an overview of models and strategies to chronic disease management that have been developed and/or implemented in Europe and will assess some of the contextual factors that enable or hinder implementation of strategies to address chronic illness. It finds that an effective response to the rising burden of chronic disease requires a health system environment that allows for the development and implementation of structured approaches to chronic disease management. Experience suggests that systems that are characterised by fragmentation of health services are facing considerable challenges in the successful implementation of system-wide strategies to provide care for patients with chronic illness.