Secondary prevention of occupational dermatoses: first systematic evaluation of optimized dermatologist's procedure and hierarchical multi-step intervention

Abstract

Background: In 2011, 25,056 notifications of suspected occupational dermatitis (OD) were submitted to the statutory accident insurance (UVT), predominant by dermatologist's reports. Parallel to the introduction of the improved dermatologist's procedure, the hierarchical multi-step intervention approach to OD was launched within the UVT. It is aimed at ensuring that patients with OD can be allocated to preventive dermatological interventions quickly and appropriately according to the severity of their OD. From 2007-2010, the quality of dermatological interventions as well as the corresponding administrative procedures were evaluated in a unique research project supported by the German Social Accident Insurance. Patients and methods: About 10 % (n = 1 600) of notified cases with suspected OD in 2007 in Germany were analyzed in a random quota sample by occupational dermatologists and administrations. Follow-up was 12 months. If a dermatologist's procedure was initiated after the initial notification, patients' and dermatologists' opinions were obtained by questionnaires. Results: More than 85 % of the OD notifications were submitted by dermatologists and only 1.6 % by occupational physicians. In 88 %, the dermatologist's report was used. Yet, there is room for optimizing procedures: e. g., the clinical and/or occupational relevance of type IV allergies was assessed only in 36.5 % of patients. Job loss due to OD occurred less often if suitable preventive and/or therapeutic strategies (e. g., skin protection seminars) were implemented by the UVT (p = 0.001). Preventive and therapeutic strategies were initiated more often when the dermatologist's report was conclusive, a central element is the outpatient care by a dermatologist. Conclusions: The research project shows that the quality of dermatological intervention, as well as administrative procedures, can be optimized. Early intervention with suitable preventive and therapeutic strategies in patients with OD should be aimed at, as this is crucial for the outcome of OD.