Umweltmedizinischer Beratungsbedarf am Gesundheitsamt: Erfahrungen am Gesundheitsamt Kreis Aachen

Abstract

Since November, 1999 environmental medical advice is offered to interested citizens in the Aachen district at the District Aachen Public Health Office in cooperation with the outpatient unit of environmental medicine (UEM) of the Institute of Hygiene and Environmental Medicine of the University Hospital at Aachen, Germany. Advisory cases are documented in a data bank of Microsoft(R) Access 97. Until now, all advisory cases between November, 1999 and March, 2001 have been descriptively analysed. In this period, 34 personal and two telephonic advices were performed. The frequency of advisory activities is in the lower rang of published experiences in environmental medicine. Age distribution, more frequent advice utilization by women than by men and predominance of unspecific health disorders are comparable with published environmental medical experiences. However, in respect of suspected exposures, unspecific indoor-related environmental factors are predominant. In the past this was true for wood preservatives. Judgement about possible relationships between suspected environmental factors and health disorders or diseases was positive among 11.8 % of the persons seeking advice. This percentage is higher than published experiences which mostly show values below 10 %. It must be considered that this judgement depends primarily on the physician. Other reasons may be the too small number of advice seeking persons and selective influences. Furthermore, a definite judgement can be made only after environmental medical diagnostics (biological monitoring, local inspection, ambient monitoring) and differential diagnostics. Conspicuously, 76.5 % of the advisory cases had no contact to environmental medicine prior to the environmental medical advice at the Aachen District Public Health Office. This points to an information deficit about possibilities to clarify questions concerning environmental medicine in the population. In this context a regional guide on environmental medicine may be helpful. The environmental medical advice for citizens is an excellent example of a successful cooperation between a public health office and an university, which have different special experience in environmental hygiene and environmental medicine. This cooperation brings selectively citizens seeking for advice in environment-related health risks and disorders to practitioners specialised in environmental medicine.

Umweltmedizinische Versorgungssituation von Patientinnen und Patienten in Deutschland

“…Eine flächendeckende umweltmedizinische Versorgung konnte bis zum heutigen Zeitpunkt nach wie vor nicht realisiert werden [26]. Das betrifft sowohl den niedergelassenen Bereich, den öffentlichen Gesundheitsdienst als auch die Universitätskliniken [3,29]…”

Umweltbezogene Gesundheitsst�rungen

“…▂ UMA Aachen [14], ▂ UMEB Düsseldorf [57,58], ▂ UMEB Eschweiler [85], ▂ UMEB Hamburg [28], ▂ UMA Heidelberg [23], ▂ UMEB Wiesbaden [75], ▂ Niedergelassene Hamburg [20], ▂ Niedergelassene UMK Baden-Würt-temberg [69], ▂ Niedergelassene UMK Schleswig-Holstein [10]. …”

“…Dies führte bei Patienten und Ärzten zu einer vermehrten Nachfrage nach adäquater umweltmedizinischer Versorgung und resultierte in der Etablierung der Klinischen Umweltmedizin [38,71] und der Einrichtung umweltmedizinischer Ambulanzen und Beratungsstellen im universitären Bereich [3,6,11], im Bereich des öffentlichen Gesundheitsdienstes (ÖGD) [6,11,45,67,72,75,85] sowie bei Landesbehörden [6,28]. Die Aktivitä-ten der umweltmedizinischen Ambulanzen und Beratungsstellen im universitär-en Bereich werden seit 1999 in einem bundesweiten Arbeitskreis abgestimmt und koordiniert [3,5].…”

“…B. Nordrhein [30,92] und Westfalen-Lippe [46,47], Modellprojekte zur Finanzierung umweltmedizinischer Leistungen. Ungeachtet oder gerade wegen dieser Entwicklung im Bereich der Klinischen Umweltmedizin ist der Bedarf an umweltmedizinischer Beratung und Patientenbetreuung in Deutschland nicht gedeckt, wie Erfahrungen mit einer umweltmedizinischen Bürgerbera-tung am Gesundheitsamt Kreis Aachen zeigen [85].…”