title: The ideal of biopsychosocial chronic care: how to make it real? A qualitative study among Dutch stakeholders.
abstract: BACKGROUND
  Chronically ill patients often experience psychosocial problems in everyday life. A biopsychosocial approach is considered to be essential in chronic care. In Dutch primary health care the current biomedically oriented clinical practice may conflict with the biopsychosocial approach. This study is aimed to explore the views of Dutch stakeholders on achieving a biopsychosocial approach to the care of patients with chronic diseases.
  
  
  METHODS
  In a qualitative explorative study design, we held semi-structured interviews with stakeholders, face-to-face or by telephone. Data were analysed using content analysis. Thirty representatives of Dutch patients with chronic illnesses, primary care professionals, policy makers, health inspectorate, health insurers, educational institutes and researchers were interviewed.
  
  
  RESULTS
  Stakeholders were aware that a systematic biopsychosocial care approach is lacking in current practice. Opportunities for effective change are multidimensional. Achieving a biopsychosocial approach to care relates to active patient participation, the training of professionals, high-quality guidelines, protocols and tools, integrated primary care, research and financial issues.
  
  
  CONCLUSIONS
  Although the principles and importance of the biopsychosocial model have been recognized, the provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system. All parties involved need to make a commitment to realize the ideal of biopsychosocial chronic care. Together they need to equip health professionals with skills to understand patients' multifaceted needs and to reward integrated biopsychosocial care. Patients need to be empowered to be active partners in their own care.
authors.affiliation: Department of General Practice, Maastricht University, School for Public Health and Primary Care (CAPHRI), PO Box 616, 6200 MD Maastricht, the Netherlands. anneke.vandijk@maastrichtuniversity.nl
authors.forename: Anneke
authors.initials: A
authors.lastname: van Dijk-de Vries
authors.forename: Albine
authors.initials: A
authors.lastname: Moser
authors.forename: Vera-Christina
authors.initials: VC
authors.lastname: Mertens
authors.forename: Jikke
authors.initials: J
authors.lastname: van der Linden
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Jacques Th M
authors.initials: JT
authors.lastname: van Eijk
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000288:Administrative Personnel / Q000523:psychology; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D002983:Clinical Competence; D019033:Delivery of Health Care, Integrated / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006075:Governing Board / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D008297:Male; D009426:Netherlands; D009722:Nurse Practitioners / Q000523:psychology; D010353:Patient Education as Topic; D010358:Patient Participation / Q000523:psychology; D010361:Patients / Q000523:psychology; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D011369:Professional-Patient Relations; D036301:Qualitative Research; D020127:Recovery of Function / Q000502:physiology; D012108:Research Personnel / Q000523:psychology; D011795:Surveys and Questionnaires; D000078329:Workforce