Reallocations in acne healthcare: exploring the possible roles and added value of nonphysicians by a mixed-methods study design

Authors Femke de Vries , Marlies Welbie , Esther Tjin , Rieke Driessen , Peter van de Kerkhof
Published in BMC Health Services Research
Publication date 2021
Research groups Innovation in Healthcare Processes in Pharmacology
Type Article


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.


  • Femke de Vries| Researcher | Research group Innovation in Healthcare Processes in Pharmacology
    Femke de Vries
    • Researcher
    • Research groups: Innovation in Healthcare Processes in Pharmacology
  • Marlies Welbie | Researcher | Methodology of Practice-Based Research
    Marlies Welbie
    • Researcher
    • Research groups: Research Competence
  • Esther Tjin | Researcher | Research group Innovation in Healthcare Processes in Pharmacology
    Esther Tjin
    • Researcher
    • Research groups: Innovation in Healthcare Processes in Pharmacology

Language English
Published in BMC Health Services Research
Key words acne vulgaris, healthcare services, mixed methods, non-physicians, reallocation, task substitution, qualitative research