Strategic Forum: Integrated Care

Chair: Angus Forbes, Professor of Diabetes Nursing, King’s College London, UK

Member: Markku Saraheimo, Joao Filipe Raposo, Drazenka Pongrac Barlovic, Ronan Roussel, Maja Bujas-Bobanovic, Jyothis George, Gabriela Teodorescu, Prabhav Trivedi, Pinar Topsever, Niti Pall, Nebojsa Lalic, Caroline Martineau, Declan Cody, Dagmar Kownatka


Ninety percent of diabetes care in Europe occurs in primary care. Pandemic diabetes creates a quantitative stress on the time and resources of primary care teams. The complexity of treatment options combined with patient complexity (ageing population, multi-morbidity) further stress the systems. The trend is unsustainable in the medium to long term.

Healthcare systems are not set up to manage chronic, complex and growing diseases such as diabetes. The settings and systems for primary care vary greatly throughout Europe as well as within countries and regions. The care of people with diabetes is hindered by fragmented management. A lack of long-term focus and a silo system of care contribute to an overall poor patient experience, poor adherence, poor compliance and sub-optimal outcomes. 

Objectives & Directions for Solutions

Enlighten the way for integrated care and sustainable financing of diabetes in the future

  • Share and implement best practices regarding integrated care solutions
  • Align incentives in the HC system to be matched to longer-term outcomes for PwD
  • Support frontline diabetes care with up to date and clinically translatable postgraduate education and continued professional development
  • Support decision-making in primary care, including ‘live’ support regarding guidelines
  • Facilitate communication between primary care, secondary care and the different specialty groups within secondary care
  • Prepare policy recommendations on integration of care at a European level and provide guidance for regional/national translations 

Five Priorities for Advancing Integrated Care

Integrated care is an emergent set of practices that seeks to move away from care that is fragmented, episodic, and service-based, with care that is continuous, coordinated, and outcomes-focused. As the WHO describes it, integrated care is “seamless, smooth, and easy to navigate.” 

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Viewpoint Story by Angus Forbes

Angus Forbes sets out the opportunities that care integration can bring for improving diabetes care. He emphasises the opportunities that integrating care provides, in improving patient activation and engagement and ultimately care outcomes. A key message from the group is that integration can yield resource efficiencies that are important in dealing with growing demand. 

Interesting Literature

Rethinking health systems: Integrated care and empowerment of primary care for people with diabetes
EFPIA Round Table in Belgium - September 2019

Implementing integrated diabetes systems in Europe - The enabling role of integrated finance and IT
November 2020

Integrated diabetes systems in Europe - Scorecard
November 2020

EGIDE - Integrated care for chronic diseases in Europe
November 2020