Abstract
ABSTRACT.The Deployment and Travel Medicine Knowledge, Attitude, Practice and Outcomes Study investigates the various clinician and traveler contributions to medical outcomes within the U.S. Military Health System. Travelers’ diarrhea is among the most common travel-related illnesses, making travelers’ diarrhea self-treatment (TDST) important for traveler health. A cohort of 80,214 adult travelers receiving malaria chemoprophylaxis for less than 6 weeks of travel were identified within the U.S. Department of Defense Military Health System Data Repository. Associated prescriptions for TDST medications within 2 weeks of chemoprophylaxis prescriptions were identified. Prescription patterns were compared by service member versus beneficiary status and site of care, military facility versus civilian facility. At military facilities, medical provider demographics were analyzed by clinical specialty and categorized as travel medicine specialists versus nonspecialists. Overall, there was low prescribing of TDST, particularly among civilian providers and military nonspecialists, despite guidelines recommending self-treatment of moderate to severe travelers’ diarrhea. This practice gap was largest among service member travelers, but also existed for beneficiaries. Compared with nonspecialists, military travel medicine specialists were more likely to prescribe a combination of an antibiotic and antimotility agent to beneficiaries, more likely to provide any form of TDST to service members, and more likely to prescribe azithromycin than quinolones when using antibiotics. Our study suggests that enhancing provider knowledge and use of travelers’ diarrhea treatment recommendations combined with improved access to formal travel medicine services may be important to increase the quality of care.
Highlights
The Deployment and Travel Medicine Knowledge, Attitude, Practice and Outcomes Study (KAPOS) investigates medical provider and traveler contributions to medical outcomes within the U.S Military Health System.[1]
Military travel medicine specialists were more likely to prescribe a combination of an antibiotic and antimotility agent to beneficiaries, more likely to provide any form of travelers’ diarrhea self-treatment (TDST) to service members, and more likely to prescribe azithromycin than quinolones when using antibiotics
A practice gap existed for both Department of Defense service members and beneficiaries cared for at military facilities
Summary
The Deployment and Travel Medicine Knowledge, Attitude, Practice and Outcomes Study (KAPOS) investigates medical provider and traveler contributions to medical outcomes within the U.S Military Health System.[1] Travelers’ diarrhea is among the most common of travel-related illnesses, and travelers’ diarrhea self-treatment (TDST) is a recommended topic in pretravel healthcare visits.[2,3,4] The U.S military considers travelers’ diarrhea to be one of the most important infectious disease threats to force health protection, and as such, it is a major focus of research and development activities.[5] Guidelines for the use of TDST exist, with many of the underlying studies conducted in a military setting.[6,7,8,9] Studies predating these guidelines show inconsistent awareness among military clinicians of travelers’ diarrhea management principles.[10,11] The aim of this study was to describe prescription patterns for travelers’ diarrhea in the Military Health System and identify variation in practice by practice setting (military versus civilian facilities), military duty status (service members versus other beneficiaries), and provider specialty (travel medicine specialists versus nonspecialists)
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