Department of Infectious Diseases, Hospital Saint-Louis, Paris, France.
J Travel Med. 2012 Mar-Apr;19(2):76-83. doi: 10.1111/j.1708-8305.2011.00591.x. Epub 2012 Feb 24.
The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France.
We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines.
A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized.
Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care.
法国公民的国际旅行数量不断增加，我们希望评估法国一家疫苗和旅行医学中心向旅行者提供建议的适宜性。
我们在巴黎的一个中心进行了为期 3 个月的前瞻性研究，在那里，经过旅行医学培训的医生会根据计算机化决策支持系统（Edisan）向旅行者提供处方和建议。我们使用问卷记录旅行特征、患者人口统计学特征和处方。主要观察指标是预防疟疾、黄热病和甲型肝炎疫苗的处方是否符合法国指南。
这项研究共纳入 730 名受试者，中位年龄为 28 岁。旅行目的地为撒哈拉以南非洲（58%）、亚洲（21%）和南美洲（18%）。在 608 名前往疟疾流行地区的患者中（83%），有 578/608 名患者（95.1%，95%CI：93-96.5）的疟疾预防符合指南，首选方案为多西环素（48%）。有 8 名患者的疟疾预防方案不当，其中 1 名患者出现恶性疟原虫疟疾。所有 413 名（100%，95%CI：99-100）需要接种黄热病疫苗前往黄热病流行地区的患者均正确接种了疫苗。然而，有 3 名患者未接种黄热病疫苗却被接种了。此外，442/454 名（97.4%，95%CI：95.4-98.5）有资格接种甲型肝炎疫苗的患者进行了免疫接种。
在使用计算机化决策支持系统培训医生的旅行医学和疫苗中心，提供了预防疟疾、黄热病和甲型肝炎疫苗接种的适当建议。然而，即使在这种情况下，也可能会出现错误，应定期评估专业实践，以改善医疗保健。
