Effective healthcare for individuals with chronic conditions can be improved through evidence‑based clinical care, particularly as these patients have frequent interactions with their healthcare providers. However, as most of these people need to undertake ongoing self-management, supporting them in managing their health and well-being is also essential. This support includes guidance on healthy lifestyle choices and effective medication management. Integrated care of chronic conditions in primary care helps to prevent complications and avoidable hospital admissions.
One common chronic condition is diabetes – a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation. In individuals living with diabetes and hypertension, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are recommended in most national guidelines as first-line anti-hypertensive medications to reduce blood pressure.
Figure 6.12 reveals broad consistency in the proportion of patients with diabetes on recommended antihypertensive medications in 2023, although Iceland, the Netherlands and Türkiye had rates at around 80% or lower. The average rate of antihypertensive prescribing increased by 4 p.p. from 2013 to 2023 across OECD countries with available data, reflecting improved adherence to clinical guidelines, with the improvement particularly notable in Finland.
Since the risk of amputations among diabetes patients can be reduced through effective diabetes management, the rate of hospital admissions for lower extremity amputation can indicate the long-term quality of diabetes care. Despite high adherence to clinical recommendations on prescribing in OECD countries, Figure 6.13 shows large international variation in rates of both major and minor lower extremity amputations among adults with diabetes. Iceland, Portugal, Italy, Korea and Sweden reported rates lower than 12 per 100 000 population, while Chile, Czechia, Slovenia and Germany reported rates higher than 40 per 100 000. Minor lower extremity amputations can be considered as treatment to prevent major lower extremity amputations, severe complications due to uncontrolled diabetes, but the rate of minor lower extremity amputations varies across countries, suggesting differences in timeliness and quality of primary care intervention for diabetes at an early stage. However, it should be noted that minor lower extremity amputations can be conducted in outpatient settings in OECD countries, which is common practice in Sweden, hence the rate of minor lower extremity amputations in hospital settings is relatively low, so caution is needed when interpreting cross-country variations in this indicator.
Self-management support, understood as empowering patients with the knowledge and skills to manage their conditions, is more effective when patients are actively involved in decisions about their own care. Results from OECD’s PaRIS shows that at the primary care level, people are more confident in managing their health when doctors involve them in decision making and support them in taking a more active role in managing their health conditions (OECD, 2025[1]). Figure 6.14 shows that on average across OECD countries, while 70% of people without chronic conditions reported being confident to manage their own health, only 59% of people living with chronic conditions were confident in self-management. Confidence in self-management among people aged 45 and over with chronic conditions varied almost four‑fold across surveyed countries, ranging from 92% in France to under 40% in Italy, Iceland and Greece.
