全科医生为来自新西兰的旅行者提供的健康建议。

Leggat P A, Heydon J L, Menon A

School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia.

N Z Med J. 1999 May 14;112(1087):158-61.

AIMS

To investigate where general practitioners (GP's) in New Zealand view travel health advice best given and where they refer for this advice, the prevalence of travel health advice reported to be given, and the prevalence of written advice, including a doctor's letter.

METHOD

This was a descriptive cross-sectional study, using self-report questionnaires, sent to 400 GPs randomly selected from the register of the New Zealand Medical Council.

RESULTS

Three hundred and thirty-two GPs (83%) responded. Most GPs reported that they saw travel medicine as best practised in general practice (241/308, 78%) or in a combination of locations, usually including general practice (28/308, 9%). Most GPs (223/308, 72%) did not refer travellers for travel health advice. Health advice concerning malaria (310/310, 100%), immunisation (309/310, 100%), travellers' diarrhoea (296/305, 97%), insect avoidance (287/ 299, 96%), sexually transmitted diseases/human immunodeficiency virus (233/283, 82%), water purification (235/293, 80%) and other areas (35/75, 47%) was given. Written advice was usually given by 23% of GPs (69/302). Written advice was significantly more likely to be provided by those GPs with an interest in travel medicine (chi2=5.67, df=1, p<0.005), experience in tropical medicine/developing countries (chi2=6.69, df=1, p<0.001), a policy on travel medicine (chi2=21.4, df=1, p<0.001), a written policy on travel medicine (chi2=302.0, df=1, p<0.001), who saw a higher number of travellers per week (t=-2.51, df=296, p<0.05) and who saw a significantly higher proportion of patients who were travellers (t=-3.27, df=-295, p=0.001). Almost all GPs (303/310, 98%) reported giving their travelling patients a doctor's letter at least sometimes but only 7% (23/310) always gave travellers a doctor's letter. GPs with training in travel medicine/related area were significantly more likely to provide travellers with a doctor's letter (chi=11.61, df=3, p<0.01).

CONCLUSIONS

This study confirmed that GPs in New Zealand see travel health advice as best given in general practice. Travel health advice, as recommended by New Zealand guidelines, should continue to be given. With limited time in general practice to advise travellers, GPs should also consider giving written advice, including a doctor's letter, more often. Epidemiological and specialist support by public health units and commercial groups, continuing medical education and training in travel medicine for GPs are among the major considerations. Further studies are needed concerning the adequacy and currency of destination-specific advice for travellers.

目的

调查新西兰的全科医生（GP）认为旅行健康建议在何处提供最为合适以及他们会将患者转至何处获取此类建议，报告的旅行健康建议的提供率，以及书面建议（包括医生信函）的提供率。

方法

这是一项描述性横断面研究，采用自填式问卷，发送给从新西兰医学委员会注册名单中随机选取的400名全科医生。

结果

332名全科医生（83%）做出回应。大多数全科医生报告称，他们认为旅行医学在普通诊所（241/308，78%）或多个地点联合提供服务（通常包括普通诊所，28/308，9%）时能得到最佳实践。大多数全科医生（223/308，72%）不会将旅行者转至其他地方获取旅行健康建议。提供了关于疟疾（310/310，100%）、免疫接种（309/310，100%）、旅行者腹泻（296/305，97%）、防蚊（287/299，96%）、性传播疾病/人类免疫缺陷病毒（233/283，82%）、水净化（235/293，80%）及其他领域（35/75，47%）的健康建议。23%的全科医生（69/302）通常会提供书面建议。对旅行医学有兴趣的全科医生（χ²=5.67，自由度=1，p<0.005）、有热带医学/发展中国家经验的全科医生（χ²=6.69，自由度=1，p<0.001）、有旅行医学政策的全科医生（χ²=21.4，自由度=1，p<0.001）、有书面旅行医学政策的全科医生（χ²=302.0，自由度=1，p<0.001）、每周接待旅行者数量较多的全科医生（t=-2.51，自由度=296，p<0.05）以及接待旅行者占患者比例显著更高的全科医生（t=-3.27，自由度=-295，p=0.001）更有可能提供书面建议。几乎所有全科医生（303/310，98%）报告称至少有时会给旅行患者开具医生信函，但只有7%（23/310）的全科医生总是给旅行者开具医生信函。接受过旅行医学/相关领域培训的全科医生更有可能为旅行者提供医生信函（χ=11.61，自由度=3，p<0.01）。

结论

本研究证实，新西兰的全科医生认为在普通诊所提供旅行健康建议最为合适。应继续按照新西兰指南的建议提供旅行健康建议。鉴于普通诊所为旅行者提供建议的时间有限，全科医生还应考虑更频繁地提供书面建议，包括医生信函。公共卫生单位和商业团体提供的流行病学及专业支持、全科医生的继续医学教育和旅行医学培训是主要考虑因素。还需要进一步研究针对旅行者的特定目的地建议是否充分及是否及时更新。