Skudlik Christoph, Weisshaar Elke, Scheidt Reginald, Wulfhorst Britta, Diepgen Thomas Ludwig, Elsner Peter, Schönfeld Michael, John Swen Malte
Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Sedanstrasse 115, Osnabrück, Germany.
J Dtsch Dermatol Ges. 2009 Feb;7(2):122-6. doi: 10.1111/j.1610-0387.2008.06864.x. Epub 2008 Aug 26.
Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi-step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi-step intervention procedure for occupational skin diseases--"Stufenverfahren Haut") insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so-called dermatologist's procedure ("Hautarztverfahren") was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health-educational intervention seminars ("secondary individual prevention"[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention"[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management"-"Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens"[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3-year dermatological follow-up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).
近年来,职业皮肤病学中基于科学的预防和患者管理理念有了显著改善。目前,公共法定雇主责任保险机构资助了一种多步骤干预方法,旨在为职业性皮肤病的所有严重程度级别提供快速预防帮助。一项行政指南(职业性皮肤病分层多步骤干预程序——“皮肤分层程序”)确保了法定保险人代表提供专业支持和最佳患者指导。对于二级预防,最近更新了所谓的皮肤科医生程序(“皮肤科医生程序”),以便提供更快速的皮肤科会诊,公共法定雇主责任保险机构对此予以承保。此外,在全国范围内为受影响的员工提供联合门诊皮肤科和健康教育干预研讨会(“二级个体预防”[SIP])。对于那些门诊预防措施不成功的职业性皮肤病病例,已经制定了跨学科住院康复措施(“三级个体预防”[TIP])。TIP需要3周的住院治疗,包括强化医疗保健指导和心理咨询,随后由当地皮肤科医生进行门诊治疗。2005年,一项德国前瞻性队列多中心研究(“职业性皮肤病医疗康复程序——住院管理的优化和质量保证”——“职业性皮肤病医疗康复程序——治疗方法的优化和质量保证”[ROQ])启动,该研究将进一步规范TIP并深入评估科学可持续性(对1000名患者进行3年的皮肤科随访)。该研究由德国法定事故保险(德国法定事故保险[DGUV])资助。