Summary Background The high prevalence of actinic keratosis (AK) requires the optimal use of healthcare resources. Objectives To gain insight in to the healthcare utilization of people with AK in a population‐based cohort, and the management of AK in a primary and secondary care setting. Methods A retrospective cohort study using three complementary data sources was conducted to describe the use of care, diagnosis, treatment and follow‐up of patients with AK in the Netherlands. Data sources consisted of a population‐based cohort study (Rotterdam Study), routine general practitioner (GP) records (Integrated Primary Care Information) and nationwide claims data (DRG Information System). Results In the population‐based cohort (Rotterdam Study), 69% (918 of 1322) of participants diagnosed with AK during a skin‐screening visit had no previous AK‐related visit in their GP record. This proportion was 50% for participants with extensive AK (i.e. ≥ 10 AKs; n = 270). Cryotherapy was the most used AK treatment by both GPs (78%) and dermatologists (41–56%). Topical agents were the second most used treatment by dermatologists (13–21%) but were rarely applied in primary care (2%). During the first AK‐related GP visit, 31% (171 of 554) were referred to a dermatologist, and the likelihood of being referred was comparable between low‐ and high‐risk patients, which is inconsistent with the Dutch general practitioner guidelines for ‘suspicious skin lesions’ from 2017. Annually, 40 000 new claims representing 13% of all dermatology claims were labelled as cutaneous premalignancy. Extensive follow‐up rates (56%) in secondary care were registered, while only 18% received a claim for a subsequent cutaneous malignancy in 5 years. Conclusions AK management seems to diverge from guidelines in both primary and secondary care. Underutilization of field treatments, inappropriate treatments and high referral rates without proper risk stratification in primary care, combined with extensive follow‐up in secondary care result in the inefficient use of healthcare resources and overburdening in secondary care. Efforts directed to better risk differentiation and guideline adherence may prove useful in increasing the efficiency in AK management. What's already known about this topic? The prevalence of actinic keratosis (AK) is high and, in particular, multiple AKs are a strong skin cancer predictor. The high prevalence of AK requires optimal use of healthcare resources. Nevertheless, (population based) AK healthcare utilization and management data are very rare. What does this study add? Although AK‐related care already consumes substantial resources, about 70% of the AK population has never received care. Primary care AK management demonstrated underutilization of topical therapies and high referral rates without proper risk stratification, while in secondary care the extensive follow‐up schedules were applied. This inefficient use of healthcare resources highlights the need for better harmonization and risk stratification to increase the ...

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Validation is an important topic in the system dynamics field. A large body of knowledge addresses validation tests and procedures. However, the use of validation in practice and its results are scarcely reported. This is surprising as some authors assume that in order to build confidence in a model, it is crucial to at least communicate the validation process and its results. In this paper, we described a validation process in direct interaction with clients. We describe the tests and procedures we employed to iteratively build and validate a simulation model with the National Health Care Institute (The Netherlands) in a group model-building setting. The involvement challenged the clients' opinions and in some cases led to changes in their mental models.

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Summary Actinic keratoses (AK) are rough skin lesions (patches) caused by long‐term sun exposure in people with light skin. The prevalence of AK is high, affecting 24‐60% of people above the age of 50. Having many AKs is a sign that a person may be more likely to develop skin cancer. This study, from the Netherlands, aimed to provide insight in the management (treatment) of AKs, by describing how healthcare services are used by people with AK, and its management by GPs and dermatologists. The authors found that a large proportion of people with AK are not aware of having AK, and thus not aware of an increased skin cancer risk. Its treatment at the GP largely seems inconsistent with guidelines, and 31% are directly referred to the dermatologist at the first GP appointment. These referrals are usually not related to the extensiveness of the AK, meaning how many AKs the person has. This causes a high burden in secondary care (e.g. hospitals, where people are referred to dermatologists) with patients who could be easily treated by the GP. At the dermatologists there is a high rate of follow‐up of patients with AK, meaning they come back for further appointments. The authors conclude that their findings indicate inefficient use of healthcare resources. They suggest that to overcome this, motives of GPs and dermatologists for diverging from current guidelines in the management of AK need to be explored.