Travel Medicine In Alberta: Can Public Health Do 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 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 2

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 3

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 ServicesPrivate Providers

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 5 Vision Why? Strategy What? Tactics How? Outcome

International Travel, Alberta Source: Statistics Canada 6

Hepatitis A, Malaria & Typhoid Source, Alberta Health Services 7

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 8

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 9

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

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Strategy Formulation 12 Business opportunity Opportunity to remove barriers

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 13

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 14

Resources 1.Alberta Health Services. Travel Health Services. 2.Alberta Health-Notifiable disease guidelines and related documents. Hepatits A Bui, Yen‐Giang, et al. "Cases of malaria, hepatitis A, and typhoid fever among VFRs, Quebec (Canada)." Journal of travel medicine 18.6 (2011): 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), Encouraging travellers to take preventive measures against travel related communicable diseases: a rapid review of the literature. Region of Peel, Enteric Transmission Risk Assessment. Notifiable disease guidelines and related documents, Alberta Health 8.Lee CS, Gregson DB, Church D, Laupland KB, Eckhardt R, Ross T, et al. Population-based laboratory surveillance of imported malaria in metropolitan calgary, PLoS One 2013 Apr 15;8(4):e Leggat PA, Franklin R. Risk perception and travelers. J Travel Med 2013 Jan-Feb;20(1): 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-S Statistics Canada 12.Travel Health Capacity Building Working Group 13.Zimmer, Rudy. "The Pre‐travel Visit Should Start With a “Risk Conversation”." Journal of travel medicine 19, no. 5 (2012):