Department of Dermatology, Erasmus University Medical Centre, 3000 CA, Rotterdam, the Netherlands.
Department of Public Health, Erasmus University Medical Centre, 3000 CA, Rotterdam, the Netherlands.
Br J Dermatol. 2019 Jul;181(1):96-104. doi: 10.1111/bjd.17818. Epub 2019 Mar 15.
The increasing incidence of actinic keratosis (AK) is causing a large burden on healthcare systems. The current management of patients with AK seems to vary within and between primary and secondary care; however, an in-depth understanding of healthcare providers' management of AK is currently lacking.
To gain insight into the management of AK by exploring the underlying motives of current practices among general practitioners (GPs) and dermatologists in the Netherlands.
A qualitative study was conducted consisting of semistructured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim and inductively analysed by two researchers drawing on elements of grounded theory.
GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK. They mainly applied cryotherapy or referred to secondary care due to lack of experience, varying in their applications and providing mostly patient-driven follow-up care. They also reported a great need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated pursuing proactive clinical assessments of cutaneous photodamage and the goal of providing guideline-driven AK care. However, patient preferences still largely influence both treatment choices and follow-up regimens. Furthermore, dermatologists reported the need to improve AK and skin cancer management in primary care.
For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision-making tools along with adequate (framing of) patient information may be useful.
光化性角化病（AK）的发病率不断上升，给医疗系统带来了巨大负担。目前，初级保健和二级保健机构对 AK 患者的管理似乎存在差异；然而，目前对医疗保健提供者管理 AK 的深入了解还很缺乏。
通过探索荷兰全科医生（GP）和皮肤科医生当前实践的潜在动机，深入了解 AK 的管理。
进行了一项定性研究，包括对 22 名全科医生和 18 名皮肤科医生进行半结构化的个人访谈，重点是 AK 管理的潜在动机。使用了一份预先确定的主题清单。所有访谈均进行了录音，逐字转录，并由两名研究人员进行了归纳分析，借鉴了扎根理论的元素。
GP 报告由于缺乏价值感知，对皮肤光损伤进行了有限的主动临床评估，在诊断 AK 的方法上存在差异。他们主要应用冷冻疗法或因缺乏经验而转诊至二级保健机构，在应用上存在差异，并主要提供以患者为导向的随访护理。他们还报告由于缺乏 AK 管理知识，非常需要指南。皮肤科医生表示，他们积极主动地评估皮肤光损伤，并致力于提供基于指南的 AK 护理。然而，患者的偏好仍然在很大程度上影响着治疗选择和随访方案。此外，皮肤科医生报告需要改善初级保健中的 AK 和皮肤癌管理。
为了使荷兰初级保健中 AK 护理更加标准化和统一，需要实施指南和（持续）教育，以解决 GP 普遍报告的缺乏价值、经验和知识等障碍。为了皮肤科医生更有效地利用护理资源，共享决策工具以及充分（框架）的患者信息可能会有所帮助。
