The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders

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.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.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.Like that in other Western countries, Dutch primary health care is being challenged by the rapidly rising prevalence of chronic diseases [1,2]. Given the long-term nature of chronic conditions, there is a growing recognition that patients need to be supported in managing their own health [3]. Good self-management skills are associated with improved patient-reported outcomes and reduced health care costs [4]. Lorig distinguishes three self-management tasks: medical, emotional and role tasks [4]. Ideally, health professionals should systematically and simultaneously address the way patients cope with these tasks. This would require them to apply the biopsychosocia