A survey of general practice policies on travel medicine

Running a travel clinic

Annually, 1.5 billion passengers travel by air and 700 million travellers cross international borders, and around 50% of them can become unwell in some way. In today's world travel is important for business people as it is for humanitarian groups and immigrants, as it is also for holiday makers. All travellers need to be aware of potential health problems and consequences of their travel, and they need up to date authoritative advice. Travel health clinics provide this advice in a structured, practical and authoritative format. Such a format is discussed, and applied with the skills of medical, nursing and management practitioners. The four steps for giving travellers the foundation for healthy journeys are all explored: to assess pre-health, to analyse itineraries, to select appropriate vaccines, and to provide education about the prevention and self-treatment of travel-related diseases.

Health advice provided to hostelers from Australia: influence of a travelers' information evening

BACKGROUND

Little is known about the health advice provided to hostelers and the role and influence of hosteling organizations' travelers' information evenings in giving travel health advice. This study was designed to investigate these in relation to the Australian context.

METHODS

In 1997, hostelers attending travelers' information evenings in two regional centers and one metropolitan location in Queensland were asked to complete self-administered questionnaires.

RESULTS

Of 158 questionnaires, 110 (69.6%) were returned. Missing data have been excluded from the analysis. About two-thirds of the hostelers attending the travelers' information evening reported being age 35 years or younger (43/65, 66.2%). Almost two-thirds of attendees were female (42/65, 64.6%). The hostelers responding to this study were fairly evenly divided between regional centers (54/110, 49.1%) and the metropolitan center (56/110, 50.9%). Hostelers indicated that they were traveling to Europe and the United Kingdom (53/62, 85.5%), Canada (17/62, 27.4%), Asia (15/62, 24.2%), United States (10/52, 19.2%), and other destinations (7/51, 13.7%), mostly Africa. Hostelers were significantly more likely to have obtained travel health advice (x = 5.02, df = 1, p <.05) if they were traveling within 6 weeks. Hostelers indicated that they obtained advice from general practitioners (41/67, 61.2%), travel agents (29/67, 43.3%), books (22/67, 32.8%), travel clinics (10/67, 14.9%), and other sources (6/67, 9.0%). Most hostelers indicated that they learnt something new about healthy travel from the travelers' information evening (76/100, 76.0%). Of those hostelers who had not sought travel health advice or who had not planned to seek travel health advice prior to the travelers' information evening, almost all indicated that they now would seek travel health advice (32/33, 97.0%).

CONCLUSIONS

This cross-sectional study found that most hostelers attending an international hosteling organization's travelers' health information session in Australia were in the younger age groups and were predominantly female. Most of these hostelers had sought travel health advice from general practitioners, travel agents, and books. The information provided by the healthy travel session of the travelers' information evenings appeared to be of some benefit to hostelers, particularly as it appeared to have prompted most hostelers who had not yet sought travel health advice to do so.

Sources of health advice given to travelers

One of the biggest problems for health professionals and the travel industry has been getting travelers to present for pretravel health advice from a qualified source. Behrens1 stated that one of the most important factors in whether travelers seek health advice at all was the perceived risk and severity of tropical diseases. Travelers may obtain this health advice from the travel industry itself, or from health professionals in travel clinics, hospitals, public health units, general practices or other centers. They may also obtain advice by telephone directly from these areas. It is likely however that travel agents and the travel industry, especially various publications, are an important source of preliminary information on health and safety for travelers.

Training, experience and interest of general practitioners in travel medicine in New Zealand

BACKGROUND

In New Zealand, general practitioners (GPs) are a major group of travel health advisers. This study was designed to investigate the prevalence of training, experience, and interest in travel medicine or related areas, interest in undertaking training in travel medicine and how training might be best delivered.

METHOD

Four hundred GPs were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent.

RESULTS

Three hundred and thirty-two (83%) GPs responded and these GPs advised an average of two travelers per week. Most GPs (257/282, 91%) reported that they had no training in travel medicine/related area. Training in travel medicine/related areas was significantly associated with age group (x2=14.09, df=6, p<.05), with the proportion of GPs with training in travel medicine/related area tending to be higher in the 45-49 and 50-54 years age groups, and also with GP college membership/fellowship (x2=6.39, df=1, p<.05). Forty-one percent (121/298) of respondents stated that they had previous experience working in tropical medicine/developing country. There was a significant association between GPs having experience working in tropical medicine/developing countries and training in travel medicine (x2=14. 19, df=1, p<.001) and those who were non-New Zealand graduates (x2=7. 84, df=1, p<.01). Forty-four percent (131/300) of respondents stated that they had an interest in travel medicine. Nearly two thirds of respondents (200/309, 65%) indicated that they would be interested in undertaking various types of travel medicine training, with a short course most commonly identified (159/309). The interest for training in travel medicine was significantly associated with those GPs with an interest in travel medicine (x2=26.45, df=1, p<.001), in younger age groups (x2=41.30, df=6, p<.001), a lower mean number of years since graduation (t value=5.70, df=297, p<.001), a higher mean proportion of patients who were travelers (t value=23.15, df=303, p<. 01), and a higher mean number of travelers seen per week (t value=22. 94, df=303, p<.01). The most common postgraduate qualification amongst GPs was membership/fellowship of a GP college (85/282, 30%), which was significantly more prevalent amongst the older age groups (x2=18.18, df=8, p<.05). Membership of travel medicine was very low.

CONCLUSIONS

This cross-sectional study found that most GPs in New Zealand did not have any formal training in travel medicine, although more than two fifths of GPs indicated an interest in travel medicine and experience in tropical medicine/related area. GPs mainly wanted continuing medical education (CME) on travel medicine in the form of short and certificate level courses. As membership in GP colleges and other organizations was limited, other providers of CME should also be considered for providing more of these courses, such as universities and pharmaceutical companies. Providers of CME may target less experienced GPs and those GPs who may be seeing more travelers and use various approaches. Undergraduate and postgraduate medical curricula may also need to include more training in travel medicine.