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Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists
Author(s) -
Noels E.C.,
Lugtenberg M.,
Egmond S.,
Droger S.M.,
Buis P.A.J.,
Nijsten T.,
Wakkee M.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17818
Subject(s) - medicine , actinic keratosis , qualitative research , guideline , health care , primary care , grounded theory , family medicine , nursing , pathology , social science , basal cell , sociology , economics , economic growth
Summary Background 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. Objectives To gain insight into the management of AK by exploring the underlying motives of current practices among general practitioners ( GP s) and dermatologists in the Netherlands. Methods A qualitative study was conducted consisting of semistructured individual interviews with 22 GP s 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. Results 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. Conclusions 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 GP s. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.