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Br J Dermatol. 2018 Dec 30. doi: 10.1111/bjd.17594. [Epub ahead of print]

Factors influencing current low-value follow-up care after basal cell carcinoma and suggested strategies for de-adoption: a qualitative study.

Author information

1
Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
2
Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
3
Department of Dermatology, Mohs Klinieken, Dordrecht, The Netherlands.
4
Department of Dermatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.

Abstract

BACKGROUND:

Providing follow-up to low-risk basal cell carcinoma (BCC) patients can be considered as low-value care. However, dermatologists still provide substantial follow-up care to this patient group, for reasons not well understood.

OBJECTIVES:

The aim of this study was to identify factors influencing current BCC follow-up practices among dermatologists and suggested strategies to de-adopt this low-value care. In addition, views of patients regarding follow-up care were explored.

METHODS:

A qualitative study was conducted consisting of 18 semi-structured interviews with dermatologists and three focus groups with a total of 17 low-risk BCC-patients who had received dermatological care. The interviews focused on current follow-up practices, influencing factors, and suggested strategies to de-adopt the follow-up care. The focus groups comprised preferred follow-up schedules and providers as well as content of follow-up. All (group)interviews were transcribed verbatim, and analysed by two researchers using Atlas.ti software.

RESULTS:

Factors influencing current follow-up care practices among dermatologists included complying with patients' preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow-up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de-adopt the low-value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realising appropriate financial reimbursement and informing dermatologists about the low-value of care.

CONCLUSIONS:

A mixture of factors appear to contribute to current follow-up practices after low-risk BCC. In order to de-adopt this low-value care, strategies should be aimed at dermatologists, GPs as well as patients. This article is protected by copyright. All rights reserved.

PMID:
30597525
DOI:
10.1111/bjd.17594

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