Practice Consultations Research Articles

Antibiotic prescribing in remote versus face-to-face consultations for acute respiratory infections in primary care in England: an observational study using target maximum likelihood estimation

The COVID-19 pandemic has led to an ongoing increase in the use of remote consultations in general practice in England. Although the evidence is limited, there are concerns that the increase in remote consultations could lead to more antibiotic prescribing. In this cohort study, we used patient-level primary care data from the Clinical Practice Research Datalink to estimate the association between consultation mode (remote versus face-to-face) and antibiotic prescribing in England for acute respiratory infections (ARI) between April 2021 and March 2022. Eligibility criteria were applied at both practice-level and patient-level. 400 practices in England were sampled at random and then 600,000 patients were randomly sampled from the eligible patients (whose sex was recorded). Consultations for acute respiratory infections were identified. All antibiotic prescriptions were included, with the exception of antituberculosis drugs and antileprotic drugs, as identified through chapter 5.1 of the British National Formulary. The CPRD Aurum data was linked to the COVID-19 ONS infection survey by region. All analyses were done at the individual level. Repeated consultations from the same patient within 7 days were grouped together. We used targeted maximum likelihood estimation, a causal machine learning method with adjustment for infection type and patient-level, clinician-level and practice-level factors. There were 45,997 ARI consultations (34,555 unique patients) within the study period, of which 28,127 were remote and 17,870 were face-to-face. For children, 48% of consultations were remote and, for adults, 66% were remote. For children, 42% of remote and 43% of face-to-face consultations led to an antibiotic prescription; the equivalent values for adults were 52% and 42%, respectively. After adjustment with TMLE, adults with a remote consultation had 23% (odds ratio [OR] 1.23, 95% CI: 1.18-1.29) higher chance of being prescribed antibiotics than if they had been seen face-to-face. We found no significant association between consultation mode and antibiotic prescribing in children (OR 1.04 95% CI: 0.98-1.11). The higher rates of antibiotic prescribing in remote consultations for adults are cause for concern. We see no significant difference in antibiotic prescribing between consultation mode for children. These findings should inform antimicrobial stewardship activities for health-care professionals and policy makers. Future research should examine differences in guideline-compliance between remote and face-to-face consultations to understand the factors driving antibiotic prescribing in different consultation modes. None.

Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness

BackgroundVideo consultation was implemented as a new service in a hospital hand therapy setting. PurposeTo describe the first year’s practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. Study DesignIterative design including economic evaluation. MethodsUsing the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients’ municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. ResultsOf 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. ConclusionsThe results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

Analysis of the Survey Results of Interns of the First Year of Study Regarding Training in the Specialty «Otolaryngology» at the Undergraduate Level

Otolaryngology is a narrow medical specialty that focusses in the diagnosis, treatment and prevention of diseases of the ENT organs, as well as surrounding tissues. Today, there is a need in the experienced doctors who have knowledge, skills and conduct ethical rules. Otolaryngology is an important specialty relevant to family medicine, pediatrics, and general practice, as 20% to 40% of adult general practice consultations are related to otolaryngological complaints. Taking into account the problem of insufficient training in otolaryngology in medical universities in some leading countries, we have proposed a questionnaire for persons who have graduated from medical universities in Ukraine and have not yet completed an internship on the subject of training in the specialty “Otolaryngology” at the university. The objective: to analyze the degree of satisfaction with study of otorhinolaryngology in leading higher educational institutions of Ukraine at the undergraduate level of future general practitioners-family medicine doctors. Materials and methods. A survey of first-year interns who graduated from various medical higher educational institutions of Ukraine was conducted. The questionnaire contained 11 questions. The questionnaire was distributed using Google Forms and processed using Excel. Results. The analysis of the results of the survey showed that the training of doctors in the specialty “Otolaryngology” remains at an insufficient level due to the reduction of teaching hours. 1.9% of respondents were very dissatisfied and 17.3% of the respondents were dissatisfied with the quality of the obtained theoretical knowledge in otorhinolaryngology at the undergraduate level, in fact 1/5 of the respondents. 5.9% and 31.4% of respondents, i.e. 1/3 of surveyed persons, were very dissatisfied and dissatisfied, respectively, with the quality of the acquired practical skills in otorhinolaryngology at the undergraduate level. The majority of respondents (76.9%) plan further training in otorhinolaryngology. Respondents want to improve their knowledge in all areas of ENT pathology (64.7%). Conclusions. The improvement if the training process for future doctors, intensifying the training process and introducing modern methods to it, presenting the latest technology for disease diagnosis and treatment to interns remains a priority. In order to obtain high-quality theoretical and practical skills, it is necessary to increase the time for studying otolaryngology in medical higher education institutions.

Interpreting technology: Use and non-use of doctor-patient video consultations in Danish general practice

This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice.

Prevalence and factors associated with a prescription of a Lyme borreliosis serology for erythema migrans diagnosis in general practice: a study from the French sentinel network, 2009–2020

BackgroundSerological testing of patients consulting for typical erythema migrans (EM) is not recommended in European recommendations for diagnosis of Lyme borreliosis (LB). Little is known on the level of adherence of French general practitioners to these recommendations. The objectives were to estimate the proportion of Lyme borreliosis serological test prescription in patients with erythema migrans seen in general practice consultations in France, and to study the factors associated with this prescription.MethodsLB cases with an EM reported by the French general practitioners (GPs) of the Sentinelles network between January 2009 and December 2020 were included. To assess the associations with a prescription of a serological test, multilevel logistic regression models were used.ResultsAmong the 1,831 EM cases included, a prescription for a LB serological test was requested in 24.0% of cases. This proportion decreased significantly over the study period, from 46.8% in 2009 to 15.8% in 2020. A LB serological prescription was associated with patients with no reported tick bite (Odds Ratio (OR): 1.95; 95% confidence interval [1.23–3.09]), multiple EM (OR: 3.82 [1.63–8.92]), EM of five centimeters or more (OR: 4.34 [2.33–8.08]), and GPs having diagnosed less than one EM case per year during the study period (OR: 5.28 [1.73–16.11]).ConclusionsSerological testing of patients consulting for EM is not recommended in European recommendations for diagnosis of Lyme borreliosis. Therefore, the significant decrease in the rate of LB serological test for EM over the study period is encouraging. The factors identified in this study can be used to improve messaging to GPs and patients. Further efforts are needed to continue to disseminate diagnostic recommendations for LB to GPs, especially those who rarely see patients with EM.

Group consultations for menopause: A way forward if we can encourage women to join?

The number of patients presenting to primary care requiring support with menopause symptoms is increasing and the number of available appointments in general practice is reducing. In attempt to improve access new ways of engaging with these patients may be beneficial. Group consultations could be a solution. Here I describe my experience of setting up group consultations in a GP practice.

The effect of a goal-setting strategy with integrated feedback on goal attainment in inflammatory arthritis patients: a mixed method study.

Patients with Inflammatory Arthritis (IA) often experience difficulties in daily life as a result of their disease. Unfortunately, outpatient consultations in daily practice tend to focus on medical topics, thereby ignoring the impact of the disease on patients' daily lives. Patient-Reported Outcomes (PROs) can be used to understand this impact, but they are not enough for offering person-centered care. Because the patient's true values and goals can only be ascertained during a proper conversation, which should include both medical as well as patient goals. Therefore, the aim of the study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in IA patients. IA patients with an active disease were given the opportunity to set and follow-up goals. In addition to goal setting, patients were asked to complete online questionnaires on various PROs, including HRQoL. Ninety-two IA patients participated in the study. The mean age was 51years and most of them had rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. In the entire population, HRQoL did not change over time, but patients who did not meet their goals tended to report a lower HRQoL. Incorporating a feedback mechanism in a goal-setting strategy has a positive effect on goal attainment. Yet no effect was seen on HRQoL, but this may due to the fact that general HRQoL measurement are not sensitive or specific enough to detect changes that are accompanied with goal setting and attainment.

Routine developmental screening in Australian general practice: a pilot study

BackgroundParents’ Evaluation of Developmental Status, (PEDS), is a validated screening tool designed for primary health care clinicians to assess child development. Despite widespread use by local government child-nurse services, PEDS has not been tested in Australian general practice. We examined the effect of an intervention that aimed to use PEDS to improve documented assessment of child developmental status during routine general practice consultations.MethodsThe study took place in a single general practice in Melbourne, Australia. The intervention included training of all general practice staff regarding PEDS processes and provision of PEDS questionnaires, scoring and interpretation forms. Mixed methods incorporated audits of clinical records of young children (1 to ≤ 5 years) before and after the intervention, and written questionnaires and a focus group (informed by the Theoretical Domains Framework and COM-B model) with receptionists, practice nurses and general practitioners.ResultsDocumented developmental status more than doubled after the intervention with almost one in three (30.4%) records documenting the PEDS tool. Overall, staff responses to questionnaires indicated that PEDS processes had been successfully implemented, half of the staff felt PEDS had developed their professional skills and clinicians expressed confidence using the tool (71%). Thematic analysis of the focus group transcript revealed divided reactions to PEDS screening with most barriers arising from general practitioners’ motivation to use PEDS tools and perceptions of environmental constraints.ConclusionsA team-practice intervention that applied PEDS training and implementation, more than doubled documented rates of child developmental status during routine visits. Solutions to underlying barriers could be incorporated into a revised training module. Future studies need to test the tool in more methodologically robust studies that include analysis of the outcomes of developmental surveillance and long-term sustainability of PEDS use in practices.

Prescription-free consultation: A cross-sectional study in general practice

In 2005, 10% of consultations in France ended without a prescription. In 2019, a review of the literature found 30 to 70% of prescription-free consultations in Northern Europe and 10 to 22% in Southern Europe and underlined the scarcity of quantitative data. Different factors contribute to this heterogeneity, such as product availability and status, modes of management, distribution channels, clinical practice recommendations, public policies targeting certain classes, etc. The main objective of our study was to quantify the rate of prescription-free consultations in general practice in France in 2021. The secondary objective was to characterize prescription-free consultations and analyze their determinants. This was a quantitative observational study conducted using self-questionnaires among patients in medical practices in Auvergne. Out of 540 questionnaires, the rate of prescription-free consultations was 24% (95% CI [20.11-27.41]). Prescription-free consultations were for prevention, administrative problems, and gestures. The limiting factors are "feeling a need for a medication" (OR=0,006), "not knowing if a medication is needed" (OR=0.11) and "consultations for acute reasons" (OR=0.33). Acute consultations limit prescription-free consultations. General practitioners (GPs) probably overestimate patients' expectation of drug prescription. The French GP must be supported in their decision to not prescribe drugs. This is a long-term investment of time, to educate patients and avoid new consultations for acute reasons. A tool to help doctors manage non-prescription during acute consultations will be created in a future study in France.

Опыт преподавания телемедицины в системе высшего профессионального образования.

In healthcare, a new digital branch of medicine has emerged – telemedicine, which is especially relevant for primary healthcare. To ensure the quality functioning of telemedicine centers, it is important to provide timely and high-quality training of medical personnel in the relevant field of knowledge. The solution of this problem is entrusted to the leading medical universities of the country. The article is devoted to the generalization of the experience of teaching telemedicine technologies at the Department of Family Medicine with the course of telemedicine technologies of the Samara State Medical University at the levels of specialist, residency, advanced training of doctors and primary retraining of doctors in the specialty "General Medical Practice (Family Medicine)" and «Therapy». A successful combination of presenting theoretical material and developing practical skills for conducting telemedicine consultations in practical classes in the form of training simulation telemedicine consultations in real conditions of outpatient practices, including using the capabilities of the Center for Remote Medicine Clinics of the Samara State Medical University, made it possible to train more than 300 specialists who have the skills to conduct telemedicine consultations, who use telemedicine consultations in real medical practice in medical institutions of the Samara region.

The modern view on the epiglottitis treatment

Primary health care is defined as “primary contact, continuous, comprehensive, and coordinated care provided to the population without differentiation by gender, disease, or organ system”. Versatility, as part of medical school curricula, is intrinsically important for those pursuing careers with a significant primary care component, such as family medicine, emergency medicine, therapy, and pediatrics. Otolaryngology is an important specialty related to family medicine, pediatrics, and general practice. Otolaryngological problems make up a significant part of appeals for primary health care. Approximately 20 to 40 % of adult general practice consultations are related to otolaryngological complaints. The Ukrainian health care reform makes significant adjustments in approaches to the diagnosis and treatment of most diseases. Pathology can be so varied and the scope of practical skills can be limited by doctor’s competence. For diagnosis, a family doctor can use the ISPS-2 international classification, which greatly facilitates and unifies the work of a general practitioner. An epiglottic abscess is usually the final stage of inflammation of the epiglottis (epiglottitis) and surrounding tissues. The etiology of the disease can be of infectious or non-infectious nature. Clinical signs of epiglottitis vary depending on age, severity, and etiology. Without treatment, epiglottitis can progress to life-threatening airway obstruction, so prompt diag­nosis and management of epiglottitis in children is extremely important. The disease must be diagnosed at the early stages of the pathological process, following the patient’s route. It requires deep knowledge of the disease etiopathogenesis, mastering research methods, and using all the possible arsenal of treatment to prevent complications. Coordinated cooperation of medical staff at all stages of providing medical care should be ensured.

Newly diagnosed hypertension: case study.

The role of an advanced nurse practitioner encompasses the assessment, diagnosis and treatment of a range of conditions. This case study presents a patient with newly diagnosed hypertension. It demonstrates effective history taking, physical examination, differential diagnoses and the shared decision making which occurred between the patient and the professional. It is widely acknowledged that adherence to medications is poor in long-term conditions, such as hypertension, but using a concordant approach in practice can optimise patient outcomes. This case study outlines a concordant approach to consultations in clinical practice which can enhance adherence in long-term conditions.

Effect of the implementation of clinical guidelines on management of candidemia in elderly patients.

Mortality from candidemia is higher in elderly population than in younger patients, which may be related to suboptimal management. The aim of the present study is to evaluate adherence to the recommendations for the clinical management of candidemia in a population over 75 years before and after implementing specific training. We recorded retrospectively data from candidemia episodes in elderly patients during two periods of time: 2010-2015 years (before training) and 2017-2022 years (after training), as well as adherence to the recommendations of the clinical practice guidelines, mortality and consultation to infectious disease specialists. Forty-five episodes of candidemia were recorded in the first period and 29 episodes in the second period. A better compliance to the recommendations of the clinical practice guidelines was observed in the second period: echocardiogram performance (75.9% vs. 48.9% p = .021), fundoscopy (65.5% vs. 44.4% p = .076), follow-up blood cultures (72.4% vs. 42.2% p = .011), removal of central venous catheter (80% vs. 52.9% p = .080) and adequate antifungal treatment (82.6% vs. 52.6% p = .018). A trend towards lower mortality was observed during the second period (27.6% vs. 44.4% p = .144). The improvement of knowledge of clinical guidelines on candidemia and the participation of infectious disease specialists may increase the quality of care in elderly patients with candidemia. It would be necessary to enlarge the sample size to evaluate the real impact of this intervention on mortality.

Advancing menopause care in Australia: barriers and opportunities.

Advancing menopause care in Australia: barriers and opportunities.

Headache in the general practice

Headaches are one of the most frequent causes of consultations in general practice. Of more than 350 known headache tendencies, tension-type headache and migraine are particularly common in general practice. Medication overuse headache (MOH) is also common but rarely diagnosed. The medical consultation with a targeted anamnesis is the cornerstone of the diagnosis and correct classification. A detailed neurological examination completes the basic diagnosis. Additional laboratory and instrumental diagnostics follow in cases of atypical headache or clinical suspicion of secondary headache. This article focuses on the diagnosis and treatment of Tension-type Headache, migraine and Medication Overuse Headache.

Clinicians’ experiences in signposting an online mental health resource to expectant mothers: a qualitative study

BackgroundPoor maternal mental well-being and a lack of secure parent-infant attachment, have been identified as important factors associated with adverse mental health outcomes later in a child’s life. Interventions designed to care for maternal mental well-being during pregnancy and early parenthood, are therefore likely to support healthy child development. Mentalization is a skill parents can practice, improving the emotional bond to the child, offering insights into their own and the child’s mental states and potentially improving parental mental well-being. Most pregnant women in Denmark schedule antenatal consultations in general practice, potentially offering a solid platform to promote web-based interventions aiming to enhance mentalization skills. Signposting towards online resources has several advantages including high accessibility, ease of distribution and cost-effectiveness. We aimed to explore the attitudes and experiences of clinicians in general practice in signposting women towards a web-intervention to increase parental mentalization skills.MethodsThe intervention was offered to pregnant women at their primary preventive antenatal consultation in Danish general practice around week eight of pregnancy, and was designed to be incorporated into the following antenatal- and pediatric consultations until the child’s second birthday. Semi-structured interviews about clinicians’ experiences with signposting the intervention were conducted with 11 general practitioners (GP), three practice midwives (MW) and one practice nurse (NR).ResultsClinicians wanted to enhance the focus on mental well-being in pregnancy and early childhood during preventive consultations. The main barriers to signposting the web-program were decreasing motivation over time, lack of financial viability and time limitations. Utilizing a psychoeducational web-intervention was generally accepted by clinicians, but ideally not carried out solely in general practice.ConclusionSignposting web-programs to improve parental mentalization skills can be welcomed by clinicians in general practice but need to be more tailored to suit the everyday workflow of the clinics. Addressing parental mentalization remains largely unchartered territory for pregnant women and clinicians alike, therefore training clinicians on the subject and its presentation should be offered.Trial registrationThe study is part of a larger project that has been approved by the Research Ethics Committee at the University of Copenhagen, Nov. 2019 (reference number 504–0111/19–5000).

Assessing cultural safety in general practice consultations for Indigenous patients: protocol for a mixed methods sequential embedded design study

BackgroundAssessment of cultural safety in general practice consultations for Indigenous patients is a complex notion. Design and development of any assessment tool needs to be cognizant that cultural safety is determined by Indigenous peoples and incorporates defined components of cultural safety and current educational theory. Consideration of how social, historical, and political determinants of health and well-being impact upon the cultural safety of a consultation is also important. Given this complexity, we assume that no single method of assessment will be adequate to determine if general practice (GP) registrars are demonstrating or delivering culturally safe care. As such, we propose that development and assessment of cultural safety can be conceptualised using a model that considers these variables. From this, we aim to develop a tool to assess whether GP registrars are conducting a culturally safe consultation, where cultural safety is determined by Aboriginal and Torres Strait Islander peoples.MethodsThis protocol will be situated in a pragmatic philosophical position to explore cultural safety primarily from the Australian Aboriginal and Torres Strait Islander patients’ perspective with triangulation and validation of findings with the GP and GP registrar perspective, the Aboriginal and Torres Strait Islander community, and the medical education community. The study will integrate both quantitative and qualitative data through three sequential phases. Data collection will be through survey, semi-structured interviews, an adapted nominal group technique, and a Delphi questionnaire. We aim to recruit approximately 40 patient and 20 GP participants for interviews, conduct one to five nominal groups (seven to 35 participants) and recruit fifteen participants for the Delphi process. Data will be analysed through a content analysis approach to identify components of an assessment of cultural safety for GP registrars.DiscussionThis study will be one of the first to explore how cultural safety, as determined by Indigenous peoples, can be assessed in general practice consultations. This protocol is shared to stimulate awareness and discussion around this significant issue and prompt other studies in this area.

General practice experiences for parents of children with intellectual disability. Systematic review.

Parents of children diagnosed with intellectual disability are at increased risk of mentaland physical health difficulties compared to other parents. They are likely to regularly seek medical treatment for their health concerns from general practice as well as on behalf of their child with intellectual disability, yet there is limited evaluation of the role general practice plays for this patient group. To explore parents' experiences of general practice support when caring for a child with intellectual disability. Systematic review of studies reporting experiences of general practice as described by parents who care for children with intellectual disability METHODS: Databases were searched using a pre-defined search strategy. Studies were included based on detailed inclusion criteria, title, abstract and full-text screening. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted. A total of nine studies were identified. There was a clear absence of data on parents own health experience and consultation in general practice. Findings relate to navigating general practice on behalf of their child's health including accessibility of general practice and positive and negative experiences of general practitioners (GP). Findings from this review highlight priority areas for research and the importance of continuity of care for this patient group. This review also considers implications for clinical services.

Demographic and clinical characteristics of patients with low back pain in primary and secondary care settings in Southern Denmark

Objective To describe and compare the demographic and clinical characteristics of patients with acute or chronic low back pain across all health care settings treating this condition. Design and setting: Concurrent prospective survey registration of all consecutive consultations regarding low back pain at general practitioners, chiropractors, physiotherapists, and the secondary care spine centre in Southern Denmark. Subjects Patients ≥16 years of age with low back pain. Main outcome measure Demographic characteristics, symptoms, and clinical findings were registered and descriptively analysed. Pearson’s chi-square tested differences between the populations in the four settings. Multiple logistic regression assessed the odds of consulting specific settings, and t-test assessed differences between patients attending for a first and later consultation. Results Thirty-six general practitioners, 44 chiropractors, 74 physiotherapists, and 35 secondary care Spine Centre personnel provided information on 5645 consultations, including 1462 first-visit consultations. The patients differed significantly across the settings. Patients at the Spine Centre had the most severe symptoms and signs and were most often on sick leave. Compared to the other populations, the chiropractor population was younger, whereas the physiotherapist population was older, more often females, and had prolonged symptoms. In general practice, first-time consultations were with milder cases while patients who attended for a second or later consultation had the worst symptoms, findings, and risk of sick leave compared to the other primary care settings. Conclusion The demographic and clinical characteristics of patients with low back pain differ considerably across the health care settings treating them. KEY POINTS The study describes the symptoms and clinical findings of patients with low back pain consulting the Danish health care system in all its settings. Patients with chiropractors were youngest, while those with physiotherapists were the oldest and most frequently female. First consultations in general practice were generally with the least symptomatic patients while those returning for a subsequent consultation had more severe disease including more sick leave compared to patients in the other primary care settings. Our findings call for caution when generalizing between health care settings for patients with low back pain.

Malaria: an update for nurses in general practice

Malaria is a mosquito-borne, potentially fatal disease that is distributed throughout the tropics. Malaria is caused by the parasite Plasmodium, transmitted to humans by the bite of a female Anopheles mosquito, most active between dusk and dawn. Insect bite avoidance is crucial to prevent bites from infected mosquitoes causing infection. All travellers visiting malaria endemic areas are at risk of exposure. Conducting a pre-travel risk assessment and providing appropriate advice to the individual is essential. The malaria prevention guidance emphasises that effective bite prevention should be the first line of defence against malaria infection, even when chemoprophylaxis is used. Recommendations for antimalarials should be appropriate for the destination, tailored to the individual, and account for the risks and benefits to the traveller. Malaria is a preventable, but potentially fatal illness. Sandra Grieve provides an update for those providing travel consultations in general practice