Table 4 Illustrative quotes for Key-themes

Key-theme 1: Definition of the role of non-physicians and possibilities for care reallocation

Applied treatment modalities

“…We are able to offer acne patients manual lesion removal, always combined with a chemical peel, which we select based on the clinical signs. We have glycolic acid, salicylic acid, Jessner’s solution, trichloroacetic acid and phenols. We also treat people with microdermabrasion and different types of laser…With this extensive variation of treatment options we are able to deliver care that is tailored to the patients’ needs.”(DT2)

“…We measure patients’ skin, using a skin analysing-device. We measure moisture, sebum, PH-value, redness and pigmentation in every new patient and after every 3 months”(B4)

“…First we counsel patients on skin physiology, using a skin poster. I notice that hardly any of the patients are sufficiently informed on this matter….We also pay attention to skin picking, psychological factors and the different types of drugs that are available. I witness my patients getting more and more empowered to understand the meaning of acne, its treatment and proper drug use…”(DT1)

Key theme 2; Drivers and barriers

Drivers

Interviewer:”…and what is your vision on their role into acne care?” Respondent:”…Well I have 10 min consultation time to spend on a patient…However, proper drug use, instructions, life style coaching… I don’t think I have enough time for that, let alone the knowledge…”(GP5)

“…I suppose acne is per definition suitable for outsourcing, especially the first treatment steps, such as topical medication and consultation…Until systemic medication is required because then the GP should take over again…”(GP2)

Barriers

“…This morning, I consulted the GP from downstairs regarding a patient with a persistent type of acne and asked her for medical support… The GP was open for suggestions due to the fact that she didn’t exactly know what to prescribe herself… Last week, I had a similar situation in which the GP called me and asked me if I recommended a local or systemic antibiotic…”(DT5)

Respondent: “In the past, dermal therapists used to refer patients directly to me. Nowadays, patients first have to visit a GP. No matter how much you desire your patients to be referred to a dermatologist, if the GP decides otherwise, the patient is not being referred to a dermatologist. I regret this, in a sense this refrains patients for optimal therapy.”(D5)

“…The present system, which consists of registering and documenting monthly check-ups, forces us dermatologists to spend a large amount of time behind the computer, at the expense of patient time…” D2)

Interviewer:“…Are there any tasks that you might want to delegate in order to relieve some work pressure? Respondent:”…Yes, however it requires education and training to recognize the different types of acne. I rather leave this up to a care provider possessing a medical Higher Vocational Education background…”(GP4)