Abstract
.The Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS) examines the integrated relationship between provider and patient inputs and health outcomes associated with travel and deployments. This study describes malaria chemoprophylaxis prescribing patterns by medical providers within the U.S. Department of Defense’s Military Health System and its network of civilian healthcare providers during a 5-year period. Chemoprophylaxis varied by practice setting, beneficiary status, and providers’ travel medicine expertise. Whereas both civilian and military facilities prescribe an increasing proportion of atovaquone–proguanil, doxycycline remains the most prevalent antimalarial at military facility based practices. Civilian providers dispense higher rates of mefloquine than their military counterparts. Within military treatment facilities, travel medicine specialists vary their prescribing pattern based on service member versus beneficiary status of the patient, both in regards to primary prophylaxis, and use of presumptive anti-relapse therapy (PQ-PART). By contrast, nonspecialists appear to carry over practice patterns developed under force health protection (FHP) policy for service members, into the care of beneficiaries, particularly in high rates of prescribing doxycycline and PQ-PART compared with both military travel medicine specialists and civilian comparators. Force health protection policy plays an important role in standardizing and improving the quality of care for deployed service members, but this may not be the perfect solution outside of the deployment context. Solutions that broaden both utilization of decision support tools and travel medicine specialty care are necessary.
Highlights
The U.S military identifies malaria as among the most important infectious disease threat to the health and operational readiness of deployed forces.[1]
Annual case burden within the U.S military varies based on the geographic and operational posture of the force, ranging from 35 to 126 in between the time period of 2009−2018.2 The U.S military uses a detailed set of force health protection (FHP) policies and procedures encompassing a broad array of medical threats, to include malaria.[3,4,5,6]
A previous study, conducted after a major FHP policy shift in 2009, away from the use of mefloquine as a first-line antimalarial agent, demonstrated that patterns prescribed by the Military Health System for antimalarial medications varied both as a function of the medical specialty of the ordering provider and time.[14]
Summary
The U.S military identifies malaria as among the most important infectious disease threat to the health and operational readiness of deployed forces.[1]. A body of literature, including several reports by the National Academy of Sciences, point to the
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