Responding to the challenge of chronic diseases: ideas from Europe.

Health systems everywhere face increasing challenges in responding to chronic disease. This paper explores the nature of these challenges, including the increasing burden of chronic disease and the weak evidence that informs clinical and policy responses. It then describes a series of innovations in different parts of Europe that seek to address these challenges: nurse-led clinics; mechanisms to bridge health and social care; and two more comprehensive programmes, Disease Management Programmes in Germany and national service frameworks in England. Finally it discusses how to overcome the barriers to change and the scope for learning from international experience.