Asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes are four of the most common chronic health conditions. Common to these four conditions is the existence of a solid evidence base for effective patient management in primary care. A well-performing primary care system can reduce acute deterioration of people living with asthma, COPD, CHF or diabetes, thereby preventing unwanted and costly avoidable hospital admissions (OECD, 2020[8]).
Figure 6.8 shows hospital admission rates for the two chronic respiratory diseases, asthma and COPD. In 2021, the EU average was 117 hospital admissions per 100 000 population, of which 84% were due to COPD. High impact interventions for these conditions, such as pulmonary rehabilitation for COPD, medication optimisation and personalised action plans for people with asthma can improve outcomes and reduce health spending. Admission rates for both conditions varied more than 12‑fold across EU countries, with Italy, Croatia and Portugal reporting the lowest rates, and Ireland, Denmark, Norway and the United Kingdom reporting the highest rates. These latter four countries also have among the highest rates of COPD prevalence in Europe (Safiri et al., 2022[9]). Across EU countries, hospital admission rates for asthma and COPD have almost halved between 2019 and 2021 after falling by only 12% between 2011 and 2019. This was due at least partly to disruptions in hospital services during the pandemic that resulted in a reduction in most causes of hospitalisations.
Hospital admission rates for CHF varied over seven‑fold across EU countries in 2021, averaging 225 per 100 000 population (Figure 6.9). Romania, Croatia, the United Kingdom, Belgium and the Netherlands had the lowest rates for this condition – less than 150 hospital admissions per 100 000 population. Poland, the Slovak Republic, Germany and Czechia had rates surpassing 350 per 100 000 population. Rates across the EU have declined during the pandemic, falling by 20% between 2019 and 2021, after falling by 17% between 2011 and 2019.
Data on avoidable hospital admissions for diabetes also show significant variations in admission rates across countries in 2021, ranging from less than 50 per 100 000 population in Italy, Iceland and the Netherlands up to over 150 per 100 000 population in the Slovak Republic and Germany (Figure 6.10). Avoidable hospital admissions for diabetes have also fallen markedly between 2019 and 2021, with 19% fewer admissions per 100 000 population across the EU on average, following a reduction of 24% between 2011 and 2019.
The steep reductions in hospital admissions for these four chronic conditions between 2019 and 2021, as well as many other causes of hospitalisations, was largely due to disruptions in hospital services and hesitancy among patients to seek hospital care during the COVID‑19 pandemic.
Countries are experimenting with integrated models of care in response to the growing number of people living with complex health needs who are at risk of receiving fragmented care. Telemonitoring, teleconsultation, and hospital at home programmes have been shown to reduce CHF-related mortality, reduce the risk of hospitalisation, and improve quality of life for patients with CHF. Virtual care for patients living with COPD has been found to reduce hospitalisations and emergency room visits among severe patients, and reduce exacerbation of the condition (OECD, 2023[10]).
