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.
LINK
This contribution concerns the province of Drenthe in the Netherlands, focusing on four municipalities in the southeast of Drenthe where real estate vacancy is a top priority of ministers and interested parties. This study introduces questions, ideas and solutions. The municipalities are developing and are responsible for the developments in the field of economic developments, community real estate, vacancy and reallocation. But what is the uniting force? The skill in managing community real estate lies in asking questions and having patience with answers. Answers may develop by asking questions and entering into the dialogue with the community. Municipalities are continually attempting to establish a balance between the opportunities of interested parties and those of themselves. A balance between public values, legitimacy and organization (capacity). Einstein discovered surprising answers because of the many questions he asked. Always asking questions stimulates personal knowledge, expertise and skills. Just like sailors running a tight ship who are always on the lookout for wind and currents. The study in economic developments, community real estate, vacancy and reallocation was carried out by the readership for Community Real Estate with 77 professionals in four municipalities with a total population of 195,000 and a surface area of approximately 1,200 square kilometers, comparable to the province of Utrecht
