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.
LINK
In bilingual streams in the Netherlands, school subjects are taught in an additional language so that pupils learn both subject content and the target language by using language meaningfully. Teachers of English in bilingual streams (TEBs) are often expected to collaborate with subject teacher colleagues (STs). In addition, they teach separate language lessons. This provides TEBs with specific challenges. This article reports on a focus group (FG) study exploring the extent to which the ideals of stakeholders in bilingual schools in the Netherlands reflect the literature on this topic, using a frame of reference developed for this purpose (Dale, Oostdam & Verspoor, 2017). Five FGs were held with TEBs and STs from Dutch schools in the network for bilingual education and with members of the network’s quality assurance panels. Each FG consisted of between three and six participants with a similar role in bilingual education; audit panel chairpersons, audit panel secretaries and STs and TEBs from different schools. Participants were asked to discuss what an ideal English teacher would do in English lessons and in cooperation with subject colleagues. Data consists of five transcripts of the FG discussions. On the basis of inductive and deductive analyses (using MaxQDA), the ideals of stakeholders are positioned in the framework to explore to what extent different types of stakeholders have complementary or conflicting views. The findings suggest that stakeholders need to develop more shared understandings and a shared language to allow TEBs to realise their ambitions. References Dale, L., Oostdam, R., & Verspoor, M. (2017). Searching for identity and focus: Towards an analytical framework for language teachers in bilingual education. International Journal of Bilingual Education and Bilingualism, doi:10.1080/13670050.2017.1383351
MULTIFILE
