title: Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.
abstract: BACKGROUND
  Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders' perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium.
  
  
  METHODS
  Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care.
  
  
  RESULTS
  Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today's health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines.
  
  
  CONCLUSIONS
  Our study's methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire other countries faced with the challenge of drafting reforms to tackle the issue of chronic care.
authors.affiliation: Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs, Brussels, Belgium. Therese.vandurme@uclouvain.be.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Van Durme
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
authors.forename: Sibyl
authors.initials: S
authors.lastname: Anthierens
authors.forename: Linda
authors.initials: L
authors.lastname: Symons
authors.forename: Olivier
authors.initials: O
authors.lastname: Schmitz
authors.forename: Dominique
authors.initials: D
authors.lastname: Paulus
authors.forename: Koen
authors.initials: K
authors.lastname: Van den Heede
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
mesh_terms: D001530:Belgium; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006801:Humans; D008134:Long-Term Care; D008297:Male; D018802:Patient-Centered Care; D011320:Primary Health Care; D036301:Qualitative Research; D011787:Quality of Health Care
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