High- and Low-risk Actinic Keratosis Referrals to Secondary Care

Study Overview
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Brief Summary
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This study evaluates the implementation of the General Practitioners guidelines 'Suspicious Skin Lesions' and investigated whether their publication and implementation has led to a reduction in the proportion of referrals of low-risk patients with actinic keratosis to secondary care, after publication of the General Practitioners guidelines and implementation activities.

Detailed Description
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In the Dutch healthcare system, patients are first examined by the general practitioner who decides whether a referral to a dermatologist is indicated. Both general practitioners and dermatologists can diagnose and treat patients with actinic keratosis. Therefore, it is necessary to distinguish which patients the general practitioner should refer to a dermatologist and which patients are suitable to be treated by the general practitioner. This retrospective data study evaluates the proportion of low risk actinic keratosis patients in 2019 en 2018.

Official Title
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High- and Low-risk Actinic Keratosis Referrals to Secondary Care. Implementation of the General Practitioners Guidelines for Actinic Keratosis Patients.

Conditions
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Actinic Keratoses

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients of 18 years and older referred to dermatologist for suspicion of actinic keratosis and diagnosed as actinic keratosis by the dermatologist treated at MaastrichtUMC+ or TergooiHospital Exclusion Criteria: different diagnosis than actinic keratosis referred by a different specialist than the general practitioner referred with multiple problems referred for a second opinion if the patients was treated as different diagnosis than actinic keratosis by general practitioner

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Low risk patients<br>Low risk actinic keratosis patients referred by the general practitioner and diagnosed as actinic keratosis by the dermatologist in 2018 and 2019. | |
| High risk patients<br>High risk actinic keratosis patients referred by the general practitioner and diagnosed as actinic keratosis by the dermatologist in 2018 and 2019. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in proportion of low-risk actinic keratosis patients among all actinic keratosis patients. | The change in proportion of low-risk actinic keratosis patients among all actinic keratosis patients referred by the general practitioner to the dermatologist. The definition of low-risk actinic keratosis patients was based on the General Practitioners guidelines 'Suspicious skin lesions' (published in 2017). Patients were defined as low-risk when they were not immunocompromised, did not have a cutaneous malignancy in their medical history, did not have previous treatment or if they did not have extensive lesions. | 2018 compared to 2019 (2 years) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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General Practitioners guidelines, actinic keratosis, general physician, dermatology, low-risk patients, referrals