Nationwide survey of the role of travel medicine in primary care in Germany
Nationwide survey of the role of travel medicine in primary care in Germany
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DOI：
10.2310/7060.2004.19104
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发表时间：
2004-09-01
影响因子：
25.7
通讯作者：
Stark, K
中科院分区：
文献类型：
--
作者：
Ropers, GD;Krause, G;Stark, K
背景：随着越来越多的人前往（亚）热带目的地旅行，旅行医学对许多国家的卫生保健系统构成了越来越大的挑战。本研究调查了全科医生提供的旅行医学在初级卫生保健中的作用和范围，评估了具体预防建议的决定因素，并确定了全科医生在旅行医学培训和合作方面的需求。方法：在德国随机抽取全科医生进行全国性调查。通过标准化的邮寄调查表获得了关于旅行医学活动的类型和程度、病人的人数和特点、具体信息系统的使用以及培训和合作的资料。代表性是通过计算机辅助电话调查评估的。进行单因素和多因素统计分析。结果：1320名全科医生中，95%提供旅行前或旅行后医疗咨询（13.2例/月）。旅行前咨询中最常见的主题是免疫接种（95%）、疟疾化学预防（94%）、暴露预防建议（41%）和性传播感染保护建议（43%）。全科医生经常建议某些患者群体（例如，心血管患者68%，孕妇20%）。旅行者腹泻是旅行后咨询中最常见的话题（89%），其次是发烧（38%）。在全科医生中，25%定期与在旅行医学或热带病方面具有专门知识的机构合作。64%的人接受过旅行医学方面的培训，86%的人表示需要额外的培训。在多变量分析中，暴露预防和性传播感染风险咨询的独立决定因素包括旅行医学方面的特殊培训、使用特定国家的信息来源以及在前西德和城市地区行医的地点。结论：旅行医学在德国初级卫生保健中占有重要地位。有必要改进接触和性传播感染预防方面的咨询。应加强全科医生在旅游医学方面的培训以及与热带医学研究所、诊所和实验室等机构的合作。
Background: With more persons traveling to (sub)tropical destinations, travel medicine is an increasing challenge for the health care system in many countries. This study investigated the role and scope of travel medicine provided by general practitioners (GPs) in primary health care, assessed the determinants of specific prophylactic recommendations, and identified the needs of GPs regarding training and cooperation in travel medicine.Methods: A national survey was conducted among randomly selected GPs in Germany. Information on the type and extent of activities in travel medicine, the number and characteristics of patients, the use of specific information systems, and training and cooperation, was obtained with a standardized postal questionnaire. Representativeness was assessed by a computer-assisted telephone survey among nonrespondents. Univariate and multivariate statistical analysis was performed.Results: Of all GPs (n= 1,320), 95% provided medical pretravel advice or post-travel counseling (13.2 patients/month). The most common topics in pretravel consultation were immunizations (95%), malaria chemoprophylaxis (94%), advice on exposure prophylaxis (41%), and advice on protection from sexually transmitted infections (STIs) (43%). GPs frequently advised certain patient groups (e.g., cardiovascular patients 68%, pregnant women 20%). Travelers' diarrhea was the most common topic in post-travel consultation (89%), followed by fever (38%). Of the GPs, 25% cooperated regularly with institutions with special expertise in travel medicine or tropical diseases. Sixty-four percent had received some training in travel medicine, and 86% stated a need for additional training. In the multivariate analysis, independent determinants for advice on exposure prophylaxis and STI risks included special training in travel medicine, use of country-specific information sources, and location of the practice in the former West Germany and urban areas.Conclusions: Travel medicine is of importance in primary health care in Germany. There is a need for improved counseling on exposure and STI prophylaxis. GPs' training in travel medicine and cooperation with institutions such as institutes, clinics and laboratories for tropical medicine should be improved.