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Table 5 Results of SWOT analysis for the implementation of chronic disease prevention and management programs

From: The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting

Strengths to leverage Weaknesses to address
Stakeholders, partnerships, and knowledge transfer Funding
Having a “complete picture” and understanding [needs] of key stakeholders, including decision- makers and their willingness to support change Length of project is too short to make a clinical or behavioural change in patients
Strong government leadership (local, regional, and national) Evaluation component is under financial and evaluation constraints bringing delays in patient interventions
Clinicians and clinical teams Lack of resource and funds (local, regional, and national)
Motivated clinicians
 Immediate embracing of the program by some clinicians—willingness to go above and beyond what the pilot project was meant to implement
Funding required sites to commit to the longevity of programs before programs were proven to be effective
Communication
Lack of communication/marketing plan aimed at reaching target populations
The presence of complete clinical teams composed of various professionals allows clinicians to learn from one another
Strong clinical leadership in the diverse professions Ineffective communication of teams in primary care and no systematic communication with referring doctors
Program structure Clinicians and clinical teams
A common model of care between projects
 Ability of a program to integrate into existing structures. Projects need to be able to weave a place into what already exists
Have a tendency to use “champion clinicians”. There is a danger in counting on “champions” who are not always available
Existing medical culture closed to the concept of interdisciplinary and preventative interventions
Nature of the programs is evidence-based Recruitment and turnover of personnel is especially difficult in a perspective of trying to transform clinical roles
 Address diseases as well as their risk factors Lack of participation from referring physicians
 Patient-centered approach compared to a typical silo approach Program structure
 Touch on psychosocial factors as much as biological factors Many tools available make the decision about choosing which one to use difficult
 Emphasis on interdisciplinary teams, and self-management Not having clinical information systems
  Low number of referrals to the programs. May be due to lack of awareness of referral forms or clear referral procedures
  Method of physician remuneration
  Lack of continuity of care
Opportunities to optimize Threats to mitigate
Funding
Seize public and private funding opportunities Funding
Capitalize on existing funding to add resources to Family Medicine Groups Ensure continuation of funding
Explore what currently exists in terms of remuneration models Lack of resources and difficulty of resources management
Stakeholders, partnerships, and knowledge transfer Ensuring constant and continuous data collection
Facilitate intra and inter-professional meetings for knowledge exchange and ensuring human contact between stakeholders Stakeholders, partnerships, and knowledge transfer
Integration of many organizations with different business models and cultures—brings challenges in terms of communication, authority, financing, etc
Working with people and community networks who have a shared vision and philosophy
 Influence changes in university curriculum to put greater emphasis on interdisciplinarity
Roles and responsibilities described in the law do not necessarily translate into real power or influence
Continuously talk about chronic disease in its entirety to incite others to associate themselves with the cause Lobby presence (ex. pharmaceutical, professional federations)
  Mobilization of primary care teams and all the financial factors involved—resource re-allocation
Clinicians and clinical teams
Make better use of clinical tools, stakeholders experience, and models which have already proven themselves—avoid reinventing the wheel
Will take effort to compile and disseminate the results of seven projects so that they can be used to guide decisions across the province
Capitalize on the synergy between research team and clinicians Clinicians and clinical teams
Strong evaluations and the guidance it can provide throughout the implementation process and for guiding future decisions Potential resistance that arises during the evaluation of clinical practice
Harmonizing the visions in the management of chronic disease (ex. expert clinician vs. the patient partner)
Support the transformation of professional roles by exploring different types of training
Program structure Learning to work in interdisciplinary teams
Support integration of self-management into patient care Lots of sudden changes can become tiresome
Adoption of health information technologies to facilitate referrals, care delivery, access to medical information, and communication Ensure that professionals are using their full potential, particularly in a context of the revision of roles
Would be good to have access to a single tool that could facilitate work of the doctor and properly identify the patient’s needs and show where they are in their care path Avoiding a doubling of services—make sure projects are not competing with existing services on a territory
Physicians often lack a complete health profile of their clientele
Restructure programs to better respond to personnel turnover
  A large proportion of the population does not have a family physician and therefore no access to these projects
  Conservative leadership of authorities—is the leadership sufficient to bring about the desired changes?