Transcript Travel Medicine In Alberta: Can Public Health Do more? Silvina Mema1, Judy MacDonald2, Rudy Zimmer3, David Strong2, Lynn McIntyre4 Public Health and Preventive Medicine,

Travel Medicine In Alberta:
Can Public Health Do more?
Silvina Mema1, Judy MacDonald2, Rudy Zimmer3,
David Strong2, Lynn McIntyre4
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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
Travel Health & International Travel
• Travel Health is concerned with*:
– Prevention of infectious diseases and environmental risks
– Personal safety and responsible travel
– Early identification and care of 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
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The Sick Returned Traveller
Costs money
Affects others back home
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• Sexually Transmitted Diseases,
measles, & other diseases
• Outbreaks
Exotic diseases, misdiagnosed
Multiple visits to doctors/ER
Hospitalization/labs/ treatment
Indirect costs: missed work,
suffering, pain...
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Travel Health in Alberta:
Not Publicly Funded
Alberta Health Services
Private Providers
• Urban and rural
• Urban
• Operate at full capacity
• Compete price/customization
• Publicly funded vaccines
• Nurses (overseen by physician)
• Provincial algorithm
• Access to medical records
• See 35-45% of all clients
• Charge fees
• No standards
• Physicians, nurses, pharmacists
• Varying standards
Review of Travel Health Program
Purpose:
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Define the role of public health
Identify challenges and opportunities
Develop a vision for a new and improved travel health
program
Why?
Vision
What? Strategy
How?
Tactics
Outcome
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International Travel, Alberta 2003-2013
3500000
3000000
2500000
2000000
Tourists & temporary residents
Canadians
1500000
1000000
500000
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Source: Statistics Canada
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Hepatitis A, Malaria & Typhoid 2003-2012
Source, Alberta Health Services
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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
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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
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Strategy Formulation
Target group:
• Population
• High risk
Strategy Formulation
Service Provided:
• Advice based ($)
• Client centered ($$)
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Strategy Formulation
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Strategy Formulation
Business opportunity
Opportunity to remove barriers
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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
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Thank you!
Acknowledgements:
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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
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Resources
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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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