[Integrated care for patients with hand eczema: results of a randomized, controlled trial]

OBJECTIVE: To evaluate the effectiveness of integrated, transmural multidisciplinary care compared with usual care for patients with moderate to severe, chronic hand eczema after 26 weeks follow-up. DESIGN: Randomized, controlled study. METHOD: Patients who visited their dermatologist were randomized to integrated care or usual care. Integrated transmural care was carried out by a multidisciplinary team and consisted of a combination of clinical and occupational care to optimize treatment, the patient's quality of life and social functioning. Outcome variables were clinical assessment of hand eczema using the Hand Eczema Severity Index (HECSI) (primary outcome), quality of life, patient's global assessment of hand eczema and sick leave. RESULTS: Average improvement on the HECSI was 22.4 points in the integrated care group and 11.7 points in the control group. The mean difference in improvement on the HECSI between both groups after 26 weeks was 10.7 points in favour of the integrated care group (SE: 5.3; 95% CI: 0.3-21.1; p = 0.04). No differences between the groups were found for any of the other outcomes. CONCLUSION: The integrated care program significantly improved clinical outcome measures compared with usual care and was effective in treating patients with chronic hand eczema.