A Quality Improvement Initiative Using a Novel Travel Survey to Promote Patient-Centered Counseling
Article first published online: 21 MAY 2013
© 2013 Lehigh Valley Health Network
Journal of Travel Medicine
Volume 20, Issue 4, pages 237–242, July/August 2013
How to Cite
Mackaness, C. A., Osborne, A., Verma, D., Templer, S., Weiss, M. J. and Knouse, M. C. (2013), A Quality Improvement Initiative Using a Novel Travel Survey to Promote Patient-Centered Counseling. Journal of Travel Medicine, 20: 237–242. doi: 10.1111/jtm.12034
- Issue published online: 1 JUL 2013
- Article first published online: 21 MAY 2013
- Manuscript Accepted: 4 FEB 2013
- Manuscript Revised: 29 JAN 2013
- Manuscript Received: 3 AUG 2012
We sought to evaluate and provide better itinerary-specific care to precounseled travelers and to assess diseases occurring while traveling abroad by surveying a community population. An additional quality improvement initiative was to expand our post-travel survey to be a more valuable tool in gathering high-quality quantitative data.
From de-identified data collected via post-travel surveys, we identified a cohort of 525 patients for a retrospective observational analysis. We analyzed illness encountered while abroad, medication use, and whether a physician was consulted. We also examined itinerary variables, including continents and countries visited.
The 525 post-travel surveys collected showed that the majority of respondents traveled to Asia (31%) or Africa (30%). The mean number of travel days was 21.3 (median, 14). Univariate analysis demonstrated a statistically significant increase of risk for general illness when comparing travel duration of less than 14 days to greater than 14 days (11.3% vs 27.7%, p < 0.001). Duration of travel was also significant with regard to development of traveler's diarrhea (TD) (p = 0.0015). Destination of travel and development of traveler's diarrhea trended toward significance. Serious illness requiring a physician visit was infrequent, as were vaccine-related complications.
Despite pre-travel counseling, traveler's diarrhea was the most common illness in our cohort; expanded prevention strategies will be necessary to lower the impact that diarrheal illness has on generally healthy travelers. Overall rates of illness did not vary by destination; however, there was a strong association between duration of travel and likelihood of illness. To further identify specific variables contributing to travel-related disease, including patient co-morbidities, reason for travel, and accommodations, the post-travel survey has been modified and expanded. A limitation of this study was the low survey response rate (18%); to improve the return rate, we plan to implement supplemental modalities including email and a web-based database.