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Travel Medicine I n Alberta: Can Public Health D o more?

Travel Medicine I n Alberta: Can Public Health D o more?. Silvina Mema 1 , Judy MacDonald 2 , Rudy Zimmer 3 , David Strong 2 , Lynn McIntyre 4 1 Public Health and Preventive Medicine, University of Calgary 2 Medical Officer of Health, Alberta Health services, Calgary Zone

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Travel Medicine I n Alberta: Can Public Health D o more?

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  1. Travel Medicine In Alberta: Can Public Health Do more? Silvina Mema1, Judy MacDonald2, Rudy Zimmer3, David Strong2, Lynn McIntyre4 1 Public Health and Preventive Medicine, University of Calgary 2 Medical Officer of Health, Alberta Health services, Calgary Zone 3 Travel Health Services Consultant, Alberta Health Services 4 Professor, Community Health Sciences, University of Calgary

  2. Travel Health & International Travel • Travel Health is concerned with*: • Prevention of infectious diseases and environmental risks • Personal safety and responsible travel • Early identification and careof post-travel illness • Travel Risks: • Preventable, avoidable, manageable, unexpected • International Travellers: • Tourists, volunteers, immigrants visiting friends and relatives (VFRs) *Definition from Travel Health Capacity Building Working Group 2013, PHAC

  3. The Sick Returned Traveller Costs money Affects others back home Sexually Transmitted Diseases, measles, & other diseases Outbreaks • Exotic diseases, misdiagnosed • Multiple visits to doctors/ER • Hospitalization/labs/ treatment • Indirect costs: missed work, suffering, pain...

  4. Travel Health in Alberta: Not Publicly Funded Alberta Health Services Private Providers • Urban and rural • Operate at full capacity • Publicly funded vaccines • Nurses (overseen by physician) • Provincial algorithm • Access to medical records • See 35-45% of all clients • Urban • Compete price/customization • Physicians, nurses, pharmacists • Varying standards • Charge fees • No standards

  5. Review of Travel Health Program Purpose: • Define the role of public health • Identify challenges and opportunities • Develop a vision for a new and improved travel health program Outcome

  6. International Travel, Alberta 2003-2013 Source: Statistics Canada

  7. Hepatitis A, Malaria & Typhoid 2003-2012 Source, Alberta Health Services

  8. Traveller’s Profiles: Edmonton Travel Clinic Survey, 2013 • VFRs=Visiting Friends and Relatives: • Immigrants who return to their country of birth to visit • Less likely to seek a pre-travel consultation • Barriers include: Cost, risk perception, lack of awarenes, cultural factors

  9. Travel Program Challenges & Opportunities • Capacity • AHS clinics at full capacity • Opportunity to see more clients, generate revenue • Equitable access to travel health • High risk groups not actively targeted • Opportunity to improve equity • Standards • Varying across Alberta • Opportunity to create uniform service across province/providers

  10. Strategy Formulation • Target group: • Population • High risk Strategy Formulation • Service Provided: • Advice based ($) • Client centered ($$)

  11. Strategy Formulation

  12. Strategy Formulation Business opportunity Opportunity to remove barriers

  13. Travel Medicine In Alberta:Can Public Health Do More? • Recognize the growing demand for travel health • Acknowledge burden on high risk groups (VFRs) • Consider a client centered strategy: • Generate revenue • Save healthcare costs by preventing disease • Engage private providers: • Build capacity in addressing the demand • Ensure uniform service delivery through provincial standards

  14. Thank you! Acknowledgements: • Katie Meleta, Public Health Officer at Public Health Agency of Canada • Dr. Raymond Tellier, ProvLab, Alberta • Dr. Kevin Fonseca, ProvLab, Alberta • Dr. Olga Petricevic, Haskayne School of Business, University of Calgary

  15. Resources • Alberta Health Services. Travel Health Services. • Alberta Health-Notifiable disease guidelines and related documents. Hepatits A. 2013 • Bui, Yen‐Giang, et al. "Cases of malaria, hepatitis A, and typhoid fever among VFRs, Quebec (Canada)." Journal of travel medicine 18.6 (2011): 373-378. • CDC Yellow Book. Chapter#8. Advising clients with special needs. • Collis, D. J., & Rukstad, M. G. (2008). Can you say what your strategy is?. harvard business review, 86(4), 82-90. • Encouraging travellers to take preventive measures against travel related communicable diseases: a rapid review of the literature. Region of Peel, 2013 • Enteric Transmission Risk Assessment. Notifiable disease guidelines and related documents, Alberta Health • Lee CS, Gregson DB, Church D, Laupland KB, Eckhardt R, Ross T, et al. Population-based laboratory surveillance of imported malaria in metropolitan calgary, 2000-2011. PLoS One 2013 Apr 15;8(4):e60751 • Leggat PA, Franklin R. Risk perception and travelers. J Travel Med 2013 Jan-Feb;20(1):1-2. • Rota, P. A., Brown, K., Mankertz, A., Santibanez, S., Shulga, S., Muller, C. P., ... & Featherstone, D. (2011). Global distribution of measles genotypes and measles molecular epidemiology. Journal of Infectious Diseases, 204(suppl 1), S514-S523. • Statistics Canada • Travel Health Capacity Building Working Group http://www.wrha.mb.ca/community/travel/files/Conference13-Presentation-09.pdf • Zimmer, Rudy. "The Pre‐travel Visit Should Start With a “Risk Conversation”." Journal of travel medicine 19, no. 5 (2012): 277-280.

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