Sources and appropriateness of medical advice for trekkers

A descriptive study of advising practices during travel health consultations in France

BACKGROUND

Recommendations for improving traveler adherence address both the content of the advice given and the structure of the consultation. The objective of this article is to describe how travel health consultations are structured in France.

METHODS

A questionnaire based on both theoretical foundations and recommendations in the literature was sent to health professionals who practice in travel clinics, all of them members of France's Société de Médecine des Voyages.

RESULTS

The response rate was 78.5% (176/224). One hundred thirty nine respondents (78.9%) reported that treatment (vaccinations, in particular) and advising were done at separate times in the consultation. The majority of respondents questioned the traveler on his wishes, difficulties, expectations, experiences, and previous knowledge. A third explored the traveler's perceptions regarding the seriousness of diseases, the effectiveness of prevention measures and the latter's adverse effects with a difference when health professionals were practicing >5 years and/or had received specific training ( P  < 0.05). At the end of the consultation, 92% of the respondents asked the traveler whether he understood the advice given. One hundred thirty seven respondents (77.8%) gave travelers a booklet with additional advice, and 66.5% gave them a website where they could find health advice on their destination. Travelers were almost never offered group consultations or the opportunity to work on real-life situations. When there were language barriers, the respondents were more likely to seek help from a French-speaking member of the traveler's entourage (48.9%) than from an interpreter (22.7%).

CONCLUSIONS

While the majority of practitioners follow most of the recommendations regarding the structure of travel health consultations, some of the factors that enhance traveler learning are underutilized, reducing the likelihood that travelers will apply the advice given. The study illustrates the need to develop more educational intervention methods and to evaluate their impact on travelers.

Health hazards and medical treatment of volunteers aged 18-30 years working in international social projects of non-governmental organizations (NGO)

The specific health risk profile and diversity of treatments sought by young volunteers participating in international social projects should differ from those of their older colleagues. In the absence of any data to identify whether this was correct, a retrospective analysis was performed using a standardized questionnaire. Questions included what diseases occurred, and details of the frequency and types of treatment sought during their stay - (e.g. self-treatment, medical/dental intervention, or local healer). The 153 participants were aged 18-30 years and worked in a non-governmental organization for >6 months. The participants were: 53% female, mean age 20 years, and mean duration of stay was 11.2 months. Their NGO placement abroad was in Latin America 65.4%, 14.4% in Africa, and 9.8% in Asia. 83% of the young volunteers had received some advice regarding travel medicine before their departure. However, they suffered from more injuries compared to private travellers, and febrile infections were more common when compared to older studies. 21.2% suffered from dental problems and 50% of them sought medical treatment. This study highlights a previously unreported higher risk profile of specific health problems occurring in young NGO volunteers, including some potentially life-threatening diagnoses that differed from their older colleagues and normal travellers. It is recommended that young volunteers should receive age specific, comprehensive pre-departure training in health and safety, first aid, and management of common health problems. A medical check-up upon returning home should be mandatory. The provision of a basic first aid kit to each volunteer before departure is also recommended.

Acute mountain sickness in travelers who consulted a pre-travel clinic

BACKGROUND

The main objective of this study was to investigate the incidence and predictors of acute mountain sickness (AMS) in travelers who consulted a pre-travel clinic and the compliance with advices concerning this condition.

METHODS

A post-travel questionnaire was sent to clients of five travel clinics who planned to climb above 2,000 m.

RESULTS

The response was 77% and the data of all 744 respondents who stayed above 2,500 m were used for the analysis. Eighty-seven percent (646) read and understood the written advices on AMS. The incidence of AMS was 25% (184), and the predictors were previous AMS [odds ratio (OR) 2.2], female sex (OR 1.6), age (OR 0.98 per year), maximum sleeping altitude (OR 1.2 per 500 m), and the number of nights between 1,500 and 2,500 m (OR 0.9 per night). Eighty-seven percent of respondents understood the written advices about AMS but 21% did not read or understand the use of acetazolamide. Forty percent spent less than two nights between 1,500 and 2,500 m and 43% climbed more than 500 m/d once above 2,500 m. Acetazolamide was brought along by 541 respondents (72%) and 116 (16%) took it preventively. Of those with AMS 62 (34%) took acetazolamide treatment and 87 (47%) climbed higher despite AMS symptoms. The average preventive dose of acetazolamide was 250 mg/d, while the average curative dose was 375 mg/d. We found no relation between acetazolamide prevention and AMS (p = 0.540).

CONCLUSIONS

The incidence of AMS in travelers who stayed above 2,500 m was 25%. Predictors were previous AMS, female sex, age, maximum overnight altitude, and the number of nights between 1,500 and 2,500 m. Only half of these travelers followed the preventive and curative advices and 21% did not read or understand the use of acetazolamide. We found no preventive effect of a low dose of acetazolamide in this retrospective observational study.

Awareness of rabies risks and knowledge about preventive measures among experienced German travel health advisors

BACKGROUND

Every year, millions of people travel to countries where rabies is enzootic. However, the quality of rabies-specific information provided by travel health advisors and the extent of their knowledge about pre- and postexposure prophylaxis have not been examined on a large-scale basis up to now.

METHODS

5,780 German physicians and pharmacists, who identified themselves as active travel health advisors, were chosen from a database. The selected providers were asked to complete an Internet-based questionnaire. The form requested both demographic information and the assessment of different concrete scenarios, each of which featured individuals seeking pre-travel advice on rabies or appropriate postexposure treatment after returning from abroad.

RESULTS

Overall, 496 physicians and pharmacists completed the questionnaire. Almost all respondents indicated that they would mention the risk of rabies and appropriate preventive measures to long-term travelers and tourists planning to visit rural areas. However, only 35% to 60% of the advisors would provide this information to individuals on business trips, package tours, or travelers in urban centers as well. The assessment of the scenarios yielded 51% to 98% of adequate advice. Potentially harmful decisions included, for instance, the failure to recommend further prophylactic measures after exposure of already vaccinated people or the fact that the necessary postexposure prophylaxis was inappropriately withheld in cases where treatment had been initially delayed.

CONCLUSIONS

Although the participants of this study were well aware of the travel-associated rabies risks and provided adequate information about this health hazard to most of their clients, evident flaws exist regarding the correct assessment of specific situations in pre- and postexposure rabies prophylaxis. Our findings therefore provide important cues on topics that should be more intensely covered during future postgraduate training in travel medicine and also underline the need for more practically orientated, readily available information on specific prophylactic treatment against rabies.

Travel health advice as recalled by 552 tourists to Peru

BACKGROUND

The process of health advice/education affects two groups of people, the health professionals who give the advice and the recipients who are offered this advice. The content of travel health advice has been investigated many times and has often been found to be of varying quality. However, little is known about how much advice clients recall. This study examined the travel health advice-seeking behavior of travelers to Peru, the degree of recall, and the amount of advice remembered.

METHOD

This descriptive study was based on questionnaires completed by 552 travelers to Peru while in Cusco. Information was collected on travel health-seeking behavior, sources of advice, tourists' degree of recall of information, and advice remembered.

RESULTS

Sixty-two percent (n=492) claimed to always seek health advice before traveling whereas 96% sought advice only for this specific trip. Most advice was obtained from travel clinics (37.7%), general practitioners (20.2%), or a guidebook (19.6%). Most tourists (60.4%) claimed to recall most of the advice; 23.4%, everything; 15.5%, some; and 0.6%, none (n=470). The number of items remembered ranges from 0 to 11.

CONCLUSION

Findings from the study indicated that the usefulness of travel health advice depends on the quality of information given and the recall of this advice. Both aspects need to be considered in order to be certain that the objective of travel health advice is met, which is the informed and safe travel health behavior. Further research is recommended.

Potential cost-savings and quality improvement in travel advice for children and families from a centralized travel medicine clinic in a large group-model health maintenance organization

BACKGROUND

Cost, as well as accuracy and quality of medical care, is an important factor from the perspective of the health care payer. We evaluated the potential pharmacy cost savings, appropriateness of recommendations, and patient satisfaction associated with a proposed centralized travel medicine service in a large group-model health maintenance organization (HMO).

METHODS

From computerized pharmacy records, we identified 101 children 18 years of age or younger from six different facilities of Kaiser Permanente in northern California who obtained malaria prophylaxis, typhoid vaccine, or yellow fever vaccine for international travel from their primary care practitioner. We obtained records of all vaccinations and prescriptions provided to each patient and interviewed their parents concerning medical services they received in preparation for travel. We compared what vaccinations and prescriptions were actually given to expert recommendations, and compared total pharmacy costs for actual versus recommended care.

RESULTS

Travel advice obtained from primary care practitioners in this system was often inefficient and varied from expert recommendations. Primary care practitioners frequently overestimated risk, leading to unnecessary prescribing, especially of mefloquine and typhoid vaccine. This created potential cost-savings of US $12 per patient (17% of total pharmacy costs per patient). We were unable to quantify additional savings that could result from improved efficiency of providing care.

CONCLUSIONS

A travel medicine clinic staffed by practitioners who provide expert and current advice may provide savings in pharmaceutical costs as well as improvements in quality of care compared to primary care practitioners without expertise in travel medicine.