Optimised dermatologist's procedure : Results of a pilot-study in Northwest Germany

Abstract

The so-called dermatologist's procedure was introduced in 1972; it is the most important tool for secondary prevention in the German statutory employers' liability insurance. The statutory insurances are informed about a suspected occupational dermatosis by a special form (dermatologist's report) and then, - if necessary, - initiate preventive medical treatment and consultation ("dermatologist's procedure"). The dermatologist's report forms have remained essentially unchanged since 1972. To increase efficacy of the dermatologist's procedure was the aim of the first modernization of the report forms ("optimised reports") in 2000. In this pilot-study, for the first time, the new forms were investigated. Methods: In Northwest Germany, a non-randomized, controlled intervention study with 225 patients with suspected occupational skin disease was conducted from October 2002 to June 2004. The patients were followed-up for 6 months. Study-partners were the Employers' Liability Insurance Association of the Construction Industry, the Accident Insurance Fund for Health and Welfare Services and the Employers' Liability Insurance Association of the Metalworking Industry. Results: 57 dermatologist's procedures initiated by an "optimised report" (intervention) and 168 initiated by a "classical" dermatologist's report (controls) were subjected to standardized analysis. The quality of information was significantly higher in the "optimised" dermatologist's reports (vs. "classical"). At the same time, structure and handling of the "optimised" dermatologist's reports proved to be superior. The increased effort for filing an "optimised" report was covered by a higher fee to be charged by the reporting dermatologist. However, the overall-costs of the "optimised" (vs. "classical") procedures after 6 months showed no differences. The acceptance of the dermatologist's procedure amongst the patients was generally high (> 70%), regardless whether it was "optimised" or "classical". Conclusion: The "optimised" dermatologist's reports markedly and cost-effectively increased the quality of information and case-documentation. Its nationwide introduction can be recommended.