Italy

In Italy, major initiatives to address chronic diseases are relatively recent but relevant strategies are receiving increasingly greater attention by policy-makers and health care providers. However, as a consequence of the increasing autonomy of regions, there is considerable diversity with regard to the extent and quality of such strategies across the country, or even across local health authorities within regions, with many initiatives tending to be located in the north of the country. In addition, as in other countries, there is considerable fragmentation between social (municipalities) and health care services (local health agencies). Recent initiatives have aimed to overcome these challenges through implementing centrally planned and target-driven coordination. Examples include diabetes, for which there is a framework for initiatives of regional and local authorities, which are responsible for adapting the guidelines to their own specific organizational and epidemiological features and to achieving the targets agreed upon. This framework for diabetes was confirmed by the 2010 national plan for prevention, covering the period 2010–2012 and identifying diabetes management as a priority for regional and local authorities and which has been adopted by all regions. Furthermore, a small number of regions and local health agencies have cautiously introduced a number of experimental initiatives on chronic diseases that are not (yet) considered by national projects, mainly involving specific formation of GPs – often promoted by scientific organizations or pharmaceutical companies. Accordingly, attempts to implement disease management can be expected to spread slowly.