Tertiary prevention of occupational skin disorders/investigations on a prevention program including an in-patient phase [Tertiäre prävention von berufsdermatosen: Bericht über das forschungsprojekt "stationäre präventionsmaßnahme für hautkranke versicherte"]

Abstract

In an intervention study, funded by the Accident Insurance Fund for Health and Welfare Services (Hamburg, Germany) (Berufsgenossenschaft Gesundheitsdienst und Wohlfahrtspflege), employees with severe occupational skin disorders were treated as in-patients at the University of Osnabrueck, from 1994 to 1999. This study focussed on the tertiary prevention of skin disorders as well as on their optimized rehabilitation, aiming at maintaining the individual's occupation. For the study, cases with skin disorders resistant to conventional out-patient treatment were selected. Concerning occupational skin disorders, specifically trained dermatologists offered optimized diagnostic and therapeutic strategies as well as an individualized skin protection program. These medical interventions were complemented by educational interventions on three different levels: 1) Concerning occupational dermatoses general information was given. 2) One-to-one consultations and seminars in small groups concentrated on skin protection. 3) The working situation was practiced and trained using optimal skin protection. On an interdisciplinary level, dermatologists, ergotherapeutics, health educationalists and sports instructors were involved. In 1999 a psychologist was integrated into this group of professionals and in the year 2000 a specialist for occupational medicine. Data were obtained in the time period from October 1, 1994 up to September 30, 1999. In order to determine the quality of such intervention, the participants, the admitting dermatologists and the work insurance companies were interviewed one year after discharge from the hospital. Results of successful tertiary rehabilitation concerning skin disorders in Germany are presented here for the first time. 65.9 % (n = 232) of the participants (n = 353) maintained their occupation, 32.7 % (n = 115) had to quit, however 23 % (n = 81) because of their occupational skin disorder. 65.9% (n = 232) still had skin changes, which were severe in 27.2 % (n = 63), moderate in 40.1 % (n = 93) and slight in 32.3 % (n = 75); 35.5 % (n = 118) had healthy skin. Taking into account that all participants had severe skin changes and anticipated to be forced to give up their job, for most of them this tertiary prevention measure was estimated successful.