Health advice given by general practitioners for travellers from Australia

Abstract

Objectives: To investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia.

Design and setting: A postal questionnaire was sent to general practitioners (GPs).

Participants: 433 GPs were randomly selected from the register of the Medical Directory of Australia from the areas of western Sydney and Townville.

Results: Two hundred and thirteen questionnaires (49.2%) were returned. Approximately two-thirds of the sample was male (133/207,64.3%) and one-third female (74/207,35.7%). The mean age of the GPs was 46.7 (SD±12.1) years. The GPs reportedly saw an average of 3.9 (SD±11.8) travellers per week. Most GPs (160/202,79.2%) reported that they spent between 5–25 min for pre-travel consultations. GPs generally reported giving advice to travellers on travel vaccines, malaria prophylaxis, personal protective measures against insect bites, geographic diseases, clothing, and sexually transmitted infections. The majority of GPs did not routinely give information on travel insurance, unsafe sex, barotrauma, in-flight exercise, jet lag or first aid knowledge. Most GPs reported not routinely giving written documentation in the form of written travel health advice, a doctor's letter or a travellers' vaccination record.

Conclusions: GPs report seeking core information needed for formulating travel health advice. GPs also provided travellers with health advice on most of the areas, which need to be covered in the pre-travel consultation. More GPs may wish to consider advising travellers about the importance of travel insurance and managing common maladies of travellers, such as motion sickness, barotrauma, and jet lag. With limited time in general practice to advise travellers, more GPs should consider providing written advice and documentation for travel, including a travellers' vaccination record.

Introduction

Conservatively, it is estimated that between 30–50% of travellers become ill or injured whilst travelling.¹ Relative estimated monthly incidence rates of various health problems have been compiled elsewhere.² The risk of severe injury is thought to be greater for people when travelling abroad.³ The main health complaints of returned Australian travellers reported in a recent survey of travel insurance claims included respiratory (20%), musculoskeletal (17%), gastrointestinal (14%), ear, nose and throat (12%), and dental conditions (7.2%).⁴ Fortunately, few Australian travellers die abroad and those that do tend to die of pre-existing conditions, such as myocardial infarction, as well as accidents.⁵

One of the biggest problems for health professionals and the travel industry has been getting travellers to present for pre-travel health advice from a qualified source. One of the most important factors in whether travellers seek health advice at all was the perceived risk and severity of tropical diseases.¹ Travellers 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 centres. They may also obtain advice by telephone directly from these areas. It has been found that only 44% of travellers were seeking pre-travel health advice, mostly from travel agents, although other studies have shown preferences for seeing general practitioners (GPs) as high as 65%.⁶

The health advice given to travellers must be destination specific, take account of any medical problems or allergies which the traveller may have, and will depend also on the nature and duration of travel.7., 8. It also needs to be given adequate time.⁸ “Those advising travellers need to know about the changing epidemiology of travel-associated diseases, and the availability of specific new preventive and treatment measures”.⁹ Table 1 has listed the areas that may need to be considered when advising travellers.⁶

There have been few studies examining what advice is provided by GPs and travel clinics and whether written advice is given. In a New Zealand survey, most GPs would give advice concerning malaria, immunisation, travellers' diarrhoea, insect avoidance, sexually transmitted infections, human immunodeficiency virus, and water purification.¹¹ In contrast, only about half of GPs in New Zealand would provide safety advice, together with advice concerning health and travel insurance and finding medical assistance abroad.¹² Written advice was usually given by GPs in New Zealand.¹¹ Where advice was usually given more than 90% of the time in travel clinics, i.e. malaria, insect avoidance, and traveller's diarrhoea, written information tended to be made available to travellers.¹³ Several observers have alluded to the limited time which GPs had available to deliver travel health advice,1., 13. but only 4% of GPs in one study would have given British travellers to Turkey any advisory leaflets.¹⁴

Little is known about the health advice given by GPs for travellers from Australia. This present study was designed to investigate the prevalence of travel health advice and written documentation reported to be given by general practitioners to travellers from Australia and to investigate the baseline information obtained from travellers during the travel health consultation.