How important a priority is travel medicine for a typical British family practice?

General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives

BACKGROUND

General practitioners (GPs) are an important source of pre-travel health advice for travelers; however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers.

METHODS

A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers.

RESULTS

Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis.

CONCLUSIONS

Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.

High-risk travel abroad overtook low-risk travel from 1999 to 2004: characterization and trends in 2,622 Spanish travelers

BACKGROUND

Travel medicine in Spain is provided by a few specialized centers that do not come under the auspices of the main health system. Some kind of reform is required to avoid common summer collapses and postponements of the service. In contrast to other European countries, neither the exact role nor the responsibilities of general practitioners and primary health care in travel medicine are clearly defined.

METHODS

An observational study was performed with retrospective data concerning 2,622 travelers from 1999 to 2004. Although the study was performed at a third-level travel medicine center, continuous contact with and support to general practitioners was maintained throughout the period.

RESULTS

International travel was a steadily increasing reality between 1999 and 2004 despite well-known tragic events involving world safety. The number of high-risk travels (53.4%) also increased and even overtook low-risk ones (46.6%). This trend was explained as the result of an increasing number of journeys to sub-Saharan Africa (14.9%) and those made by traveling immigrants (64.1% of those journeys), which represented a significantly higher proportion of high-risk travels compared with those made by autochthonous subjects (52.1%; p < .001). Moreover, traveling immigrants tend to consult more frequently in periods < 15 days prior to travel than do autochthonous travelers (p < .0001). A substantial number of highly vulnerable travelers, such as pregnant women, infants, elderly people, and immunosuppressed subjects, was found (1.8%). Low-risk travelers who could have been advised and vaccinated by general practitioners were 1,139 (43.4%).

CONCLUSIONS

Given the increasing number of travelers undertaking high-risk travels abroad, any kind of reinforcement of travel medicine provision in Spain should be considered essential. General practitioners could attend to a significant proportion of low-risk travelers.

Review of 1 year's activity in the Grampian travel clinic: the importance of the oil industry

BACKGROUND

A review of the activities of the Grampian travel clinic was carried out over 1 year to obtain an overall perspective of the clinic workload and to determine how much of the workload was dependent on the oil industry.

METHODS

A specially designed data collection sheet was completed for each of the 669 consultations conducted at the Grampian travel clinic, Aberdeen, between February 1, 2002, and January 31, 2003.

RESULTS

Patients attending the clinic came in equal numbers from the city of Aberdeen and the Grampian region. Twenty-five percent were traveling for work purposes: 87.4% of this travel was oil related, and most patients were headed to Africa. The commonest vaccines given were for yellow fever, Japanese B encephalitis, and rabies, reflecting the specialist nature of the clinic. Most travelers did leave adequate time for immunization before travel. The public is still apprehensive about using mefloquine as malarial prophylaxis.

CONCLUSIONS

Most attendees were traveling on holiday, but a quarter of the consultations were for travel related to the oil industry. Almost 70% of attendees had already visited their general practitioner and were therefore attending the clinic for specialist advice and vaccines. There is a need for increased clinic capacity.

A description of travel medicine in general practice: a postal questionnaire survey

BACKGROUND

Travel-related diseases are important aspects of public health. The number of UK residents traveling abroad is increasing at a rate of 16% a year, thereby increasing exposure to travel-related morbidity. Provision of comprehensive pretravel health advice is essential to reduce this trend. In the UK, pretravel health advice is predominantly provided through general practices.

METHODS

A postal questionnaire was sent to all 91 general practices in South Cheshire Health Authority. The questionnaires were to be completed by the lead advisor in travel medicine for each practice. Questions were asked on service provision, training and reference resources used, subjects advised on, and health promotion material used. Nonresponders were contacted and sent a further questionnaire.

RESULTS

A response rate of 86% (78/91) was achieved. Of the lead advisors, 97% were nurses and 3% general practitioners. Thirty-eight sources of advice were quoted, the commonest of which comprised wall immunization charts (72%). Duration of consultation ranged from less than 5 min to over 30 min, with a median and mode of 11 to 15 min. Most respondents reported advising on most travel-associated risks, 40% of practices lacked a protocol, and 83% of providers had attended a training course on travel medicine for 2 days or less.

CONCLUSIONS

This survey identified inadequacies of training and use of multiple sources of reference which may lead to inconsistencies in advice. Most practitioners could not define their workload in travel medicine. For effective protection of travelers, a careful risk assessment, clear risk communication and health education with detailed health promotion are necessary, but these are not likely to be provided within an average consultation time of 11 to 15 min. There is no evidence of consistent governance, planned training and monitoring of service quality of travel medicine practice. This may be due to lack of a national policy on best practice and guidance in this subject. National protocols with validated information resources, set standards of training, along with adequate consultation time for educating, advising, and prescribing, will lead to improved health of the traveling public.

[Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)]

OBJECTIVES

To improve and evaluate the travel advice by community pharmacists.

DESIGN

Cross-sectional and prospective study.

SETTING

Community pharmacies from Asturias, Barcelona, Madrid and Valencia.

PARTICIPANTS

483 travellers to high health risk countries who visit the community pharmacies and were agreed with the aims of the study.

METHOD

Community pharmacists gave information regarding immunization and prophylaxis about travel-related disease according to the destination, type and duration of travel and other features of the tourist (age, taking medicines, diseases, etc.).

MAIN MEASUREMENTS

Destination, adherence to the prophylaxis and vaccinations recommended, adverse effects and diseases the tourists have in the travel and one month after they are back.

RESULTS

Only 6.3% of the travellers were effective vaccinated and took prophylaxis (all vaccines and prophylaxis according to the destination). 36.2% of the travellers experienced an illness while abroad. The commonest disease were travellers' diarrhoea (15.7%). The pharmacists were the only source of information about sunscreens, repellents, and other sanitary goods.

CONCLUSIONS

The community pharmacists can give accurate information regarding immunization and prophylaxis about international travels. It is necessary to improve the communication between family physician, the tropical travel clinic and community pharmacists in order to improving compliance. It is necessary keep the bureaucratic barriers away to get this kind of drugs. The international tourists still travel without the necessary vaccines and prophylaxis to the high health risk areas.

Tropical infections can mimic common western European diseases

With increasing international travel and migration, clinicians must have an increased awareness of tropical illnesses. Four case reports in this issue emphasize that these conditions can be difficult to diagnose and can mimic common Western European diseases, including disseminated carcinoma.