Characteristics and potential quality indicators for evaluating pre-travel consultations in Japan hospitals: the Japan Pretravel consultation registry (J-PRECOR)

Abstract

Background Awareness of pre-travel consultations (PTCs) and prevention methods for overseas travel-related diseases, and the understanding of PTCs among Japanese travelers and medical professionals remains low in Japan. A multicenter registry was established to examine PTCs in Japan. This study assessed the PTC implementation rate and examined the indicators of PTCs that can be used as criteria for evaluating quality. Methods Clients who presented for their PTCs at 17 facilities and were registered between February 1, 2018, and May 31, 2020, were included. Medical information was extracted retrospectively via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by the facility were evaluated using Spearman’s ordered phase relations (α = 0.05). Results Of the 9700 eligible clients (median age, 32 years; 880 [9.1%] aged < 16 years and 549 [5.7%] aged ≥65 years), the most common travel duration was ≥181 days (35.8%); higher among younger clients. The most common reason for travel was business (40.5%); the US (1118 [11.5%]) and Asia (4008 [41.3%]) were the most common destinations and continents, respectively. The vaccine number (median three per person) increased after the PTCs except for the tetanus toxoid. Only 60.8% of the clients recommended for malaria prophylaxis received anti-malarial agents. The gross national income; the incidence of human rabies, typhoid fever, falciparum malaria; and dengue risk category were associated with the percentage of hepatitis-A vaccines; explaining rabies post-exposure prophylaxis, typhoid-fever vaccinations, malaria-prophylaxis prescriptions; and mosquito repellants, respectively. Conclusions Although the characteristics of the travelers differed, the quality of the PTCs should be improved to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan.

Integrating sexual and reproductive health into pre-travel consultations

“…Overall, the studies identified showed considerable heterogeneity in the inclusion of SRH content in travel medicine consultations. Rates varied between 8.3 and 84.1%, 34 , 38 , 39 although rates of inclusion were scarcely reported as a percentage. When using a Likert scale, the inclusion of SRH topics in consultations, as reported by HCPs, ranged from 19.7% of respondents ‘always’ providing relevant information 37 to 76% ‘usually’ providing advice.…”

“… 28 , 30–33 , 35 , 39 Four studies were conducted in North America, 27 , 28 , 35 , 38 four in Europe, 30 , 31 , 36 , 39 three in Australia, 29 , 32 , 33 one in the Middle East 37 and one in Asia. 34 One study had a global sample by studying members of the International Society of Travel Medicine. 35 …”

“…where ‘Type of travel advice’ was reported as ‘STI’ 37 ). 28 , 31 , 32 , 34–39 STIs were ‘always’ discussed in 19.7–30.3% of cases, and unsafe sex in 11.8–22.9% of cases. 32 , 37 One study reported that 43% of respondents provided counselling regarding STI prevention.…”

“…For example, the majority of papers solely described the information covered as STI advice or ‘STI prevention’. 30–32 , 34 , 35 , 37–39 A widely variable frequency and poorly described SRH content are concerning given the high incidence of unprotected casual sex amongst travellers, 14 , 22 its associated risk of STI/HIV transmission and acquisition 11–13 and mounting concerns over global antibiotic resistance. 21 , 22 More thoroughly described studies are necessary to improve our understanding of the content and quality of SRH information disseminated during pre-travel consultations.…”

“…Increased dissemination of SRH advice alone may not substantially change behaviours or reduce the risk of negative SRH outcomes, 23 especially if advice is not comprehensive and aligned with the nuanced and culturally responsive needs and behaviours of the traveller. 41 For example, two of the included papers 27 , 34 , 38 were conducted after the availability of HIV PrEP, and though one mentions HIV 27 , there was a noted lack of information provided about this effective biomedical HIV prevention strategy (e.g. whether it was discussed with travellers or recommended).…”