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. 2022 Feb 21;106(4):1156-1162.
doi: 10.4269/ajtmh.21-1037. Print 2022 Apr 6.

Military and Civilian Sector Practice Patterns for Short-Term Travelers' Diarrhea Self-Treatment in Adults

David R Stagliano  1   2 , Huai-Ching Kuo  3   4 , Jamie A Fraser  3   4 , Indrani Mitra  3   4 , Eric C Garges  5 , Mark S Riddle  6 , David R Tribble  3 , Patrick W Hickey  2
Affiliations

Military and Civilian Sector Practice Patterns for Short-Term Travelers' Diarrhea Self-Treatment in Adults

David R Stagliano et al. Am J Trop Med Hyg. .

Abstract

The Deployment and Travel Medicine Knowledge, Attitude, Practice and Outcomes Study investigates the various clinician and traveler contributions to medical outcomes within the U.S. Military Health System. Travelers' diarrhea is among the most common travel-related illnesses, making travelers' diarrhea self-treatment (TDST) important for traveler health. A cohort of 80,214 adult travelers receiving malaria chemoprophylaxis for less than 6 weeks of travel were identified within the U.S. Department of Defense Military Health System Data Repository. Associated prescriptions for TDST medications within 2 weeks of chemoprophylaxis prescriptions were identified. Prescription patterns were compared by service member versus beneficiary status and site of care, military facility versus civilian facility. At military facilities, medical provider demographics were analyzed by clinical specialty and categorized as travel medicine specialists versus nonspecialists. Overall, there was low prescribing of TDST, particularly among civilian providers and military nonspecialists, despite guidelines recommending self-treatment of moderate to severe travelers' diarrhea. This practice gap was largest among service member travelers, but also existed for beneficiaries. Compared with nonspecialists, military travel medicine specialists were more likely to prescribe a combination of an antibiotic and antimotility agent to beneficiaries, more likely to provide any form of TDST to service members, and more likely to prescribe azithromycin than quinolones when using antibiotics. Our study suggests that enhancing provider knowledge and use of travelers' diarrhea treatment recommendations combined with improved access to formal travel medicine services may be important to increase the quality of care.

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Figures

Figure 1.
Figure 1.
Quarterly trends of the proportion of antibiotics prescribed at civilian vs. military facilities.
Figure 2.
Figure 2.
Quarterly trends of the proportion of antibiotics prescribed at military facilities between travel medicine specialists compared with nonspecialists.
See this image and copyright information in PMC

References

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    1. Department of Defense , 2020. Military Infectious Diseases Research Program. Available at: https://mrdc.amedd.army.mil/index.cfm/program_areas/medical_research_and.... Accessed June 12, 2020.