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

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

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.

Study Overview

• Status: Active, not recruiting
• Conditions: Actinic Keratoses

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 3379

Contacts and Locations

Study Locations

• Netherlands
  • Maastricht, Netherlands
    • Ellen Oyen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Data from patients are collected retrospectively using the Electronic health records. Patients were selected based on the diagnosis-treatment-combination (DTC) 17 (premalignant lesion) and DTC 14 (cutaneous malignancy) that was registered from January 2018 to December 2019 by the dermatologist.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Low risk patients; 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; 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?

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)

Collaborators and Investigators

• Sponsor: Maastricht University Medical Center
• Collaborators: Tergooi Hospital
• Investigators: Principal Investigator: Klara Mosterd, prof.dr., Maastricht UMC+; Principal Investigator: Maud Jansen, dr., Maastricht UMC+

Publications and helpful links

Helpful Links

• the Dutch College of General Practitioners guidelines 'Suspicious Skin lesions'. [updated 2020].

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): September 1, 2023
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: July 20, 2023
• First Submitted That Met QC Criteria: August 3, 2023
• First Posted (Actual): August 4, 2023

Study Record Updates

• Last Update Posted (Actual): April 19, 2024
• Last Update Submitted That Met QC Criteria: April 18, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: dermatology; actinic keratosis; general physician; referrals; General Practitioners guidelines; low-risk patients
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Precancerous Conditions; Keratosis, Actinic; Keratosis
• Other Study ID Numbers: 2020-2432

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No