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.
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A tool to calculate the environmental and economic impact of different ways to collect and process organic waste. The tool contains calculations for waste generation, transport, waste processing and application/ substitution.
Personalization, production on-demand, and flexible manufacture facilities are growing within the European apparel sector, supported by national and regional public policy. These developments seem to embody a much waited “paradigm shift” in the fashion industry; a shift from global to local scale, from quantity to quality and from standard products to personalized services. Such values, however, are far from new, and scholars have already pointed out the similarities between emerging and pre-industrial systems of production and consumption. This article argues that in order to understand current developments in historical context, we should return to the process of industrialization of the apparel industry during the turn from the 19th to the 20th C, taking into account aspects of production as much as mediation and consumption. With this aim in mind, the article traces the rise of ready-made garments in the Netherlands and northwest Europe, and the associated decline in custom- and home-made garments in the region. Although available statistical data is insufficient to accurately map these phenomena, secondary sources suggest that both processes were not simultaneous and therefore there was not a straightforward substitution of custom- and home-made clothing by ready-mades. While availability and trade of mass-produced ready-mades was escalating since the early 19th C, it was not until mid 20th C that custom- and home-made clothing declined among the middle class. In this study, such a gap is explained by a steady increase in the amount of clothes acquired per person: an expanding culture of consumption during the period under consideration may have enabled these different systems to flourish all together. A parallelism of the findings above with current developments suggests that we should not regard emergent industrial formats as substitutionary of established ones, but as complementary. We may then reevaluate to what extent does the rise of the flexible factory enable a “revolution”, a shift from a problematic present to a contrasting and desirable future. This historical overview indicates that, on the contrary, emerging product-service-systems manufacturing personalized garments on-demand must be considered in relation to – and in coexistence with- traditional industrial models.
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