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 Calgary2 Medical Officer of Health, Alberta Health services, Calgary Zone

3 Travel Health Services Consultant, Alberta Health Services4 Professor, Community Health Sciences, University of Calgary

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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• Exotic diseases, misdiagnosed• Multiple visits to doctors/ER• Hospitalization/labs/ treatment• Indirect costs: missed work,

suffering, pain...

Affects others back home• Sexually Transmitted Diseases,

measles, & other diseases• Outbreaks

Travel Health in Alberta: Not Publicly Funded

• 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

• Charge fees• No standards

• Urban• Compete price/customization• Physicians, nurses, pharmacists• Varying standards

Alberta Health Services Private Providers

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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

VisionWhy? StrategyWhat? TacticsHow? Outcome

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International Travel, Alberta 2003-2013

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

500000

1000000

1500000

2000000

2500000

3000000

3500000

Tourists & temporary residentsCanadians

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

Service Provided:• Advice based ($)• Client centered ($$)

Strategy Formulation

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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:

• 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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Resources1. Alberta Health Services. Travel Health Services.2. Alberta Health-Notifiable disease guidelines and related documents. Hepatits A. 20133. Bui, Yen Giang, et al. "Cases of malaria, hepatitis A, and typhoid fever among VFRs, Quebec (Canada)." ‐ Journal of travel medicine

18.6 (2011): 373-378.4. CDC Yellow Book. Chapter#8. Advising clients with special needs. 5. Collis, D. J., & Rukstad, M. G. (2008). Can you say what your strategy is?. harvard business review, 86(4), 82-90.6. Encouraging travellers to take preventive measures against travel related communicable diseases: a rapid review of the literature.

Region of Peel, 20137. Enteric Transmission Risk Assessment. Notifiable disease guidelines and related documents, Alberta Health8. 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):e607519. Leggat PA, Franklin R. Risk perception and travelers. J Travel Med 2013 Jan-Feb;20(1):1-2.10. 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-S523.11. Statistics Canada12. Travel Health Capacity Building Working Group http://www.wrha.mb.ca/community/travel/files/Conference13-Presentation-09.pdf13. Zimmer, Rudy. "The Pre travel Visit Should Start With a “Risk Conversation”." ‐ Journal of travel medicine 19, no. 5 (2012): 277-280.