RE: Review on article Skin Diseases in Family Medicine: Prevalence and Health Care Use

1. Sampling Bias:The study relies on a morbidity registry within a network of family practices in the Netherlands, which may introduce sampling bias. The findings may not be representative of the broader population, limiting the generalizability of the results.

2. Response Rate: The article mentions a response rate of 68.0% for the patient questionnaires. While this is relatively good, the non-response of 32.0% could introduce selection bias and affect the accuracy of prevalence estimates, especially if those who did not respond differ systematically from those who did.

3. Self-Reporting:The study utilizes self-reported data for disease-related quality of life, extent, and duration of skin disease. Self-reporting can be subjective and may introduce inaccuracies due to individual interpretation and perception, potentially affecting the reliability of the conclusions.

4. Limited Geographic Scope: The study focuses on family practices in the Netherlands, and cultural, demographic, or healthcare system differences may influence the prevalence and healthcare utilization patterns for skin diseases. This limits the external validity of the findings to other regions or populations.

5. Incomplete Analysis of Alternative Health Care: While the study mentions the utilization of alternative health care practitioners, the analysis of this aspect appears brief. More in-depth exploration and discussion of alternative healthcare practices and their impact on the overall management of skin diseases could enhance the comprehensiveness of the study.

6. Lack of Longitudinal Data:The study provides a snapshot of prevalence and healthcare use within a specific timeframe but lacks longitudinal data. Long-term trends and changes in patient behavior over time could provide a more nuanced understanding of the dynamics of skin disease management.

7. Generalization of Family Physician Involvement:While the conclusion suggests that most patients have their skin diseases treated mainly by their family physician, the study does not delve into the specific nature of treatments provided or consider the qualifications and expertise of family physicians in dermatological care.

8. Limited Exploration of Socioeconomic Factors: The article lacks a thorough exploration of socioeconomic factors that might influence healthcare utilization for skin diseases. Understanding how socioeconomic status may impact access to and preferences for different forms of healthcare could add depth to the analysis.