Would you care for some integrated care in your fragmented health system? A participatory action research to improve integration between levels of care in a Belgian urban setting.

Integration between levels of care is not facilitated by the Belgian health system. Indeed, patients have uninhibited access to every level of care, there is no gatekeeping system, and no structural coordination between levels of care. Meanwhile, on one hand, the occurrence of more complex care situations in the ambulatory setting is enhancing the need for coordination while on the other hand, hospitals face financial constraints to provide care in the community. The aim of the research was to organize coordination between levels of care at the local level, in an urban setting. We used the “Local Health System” model (LHS) that aims at integrating hospital and primary care activities for a defined population at the local level. We chose the participatory action research (PAR) methodology and its spiral plan-do-study-act cycles, to ensure the participation and implementation of results by the targeted actors (hospital and local general practitioners (GP) organizations)