Samenvatting

Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician
care providers by care reallocation. Reallocating care from physicians to non-physicians can play an
important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting
lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care
provision, are well suited for exploring the opportunities for care reallocation as many different types of care
professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general
practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among
which dermal therapists and beauticians are the most common professions. However, the role and added value of
non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians
and identify drivers for and barriers to reallocation.
Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of
the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians.
Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad
spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a
low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all
interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they
considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to
successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver
for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper
protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for
reallocation.
Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between
physicians and non-physicians within acne healthcare, when barriers are adequately addressed.