Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar

Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar Ayman Al-Dahshan, Nagah Selim, Noora Al-Kubaisi, Ziyad Mahfoud, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2849273/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In an era of globalization, travel-related illnesses have become a focus of public ‎health concern. Pretravel consultation is an effective measure for the prevention travel-related illnesses. ‎ The purpose of this study was to assess the scope of primary care physicians’ (PCP) practice of travel medicine (TM) in Qatar and its associated predictors. Methods This was a cross-sectional study design. A structured questionnaire was used to collect ‎data from all PCPs working in all 27 primary healthcare centers in Qatar.‎ Descriptive and analytic statistics were used as appropriate. ‎A multivariable logistic regression model was constructed to identify predictors of TM practice. Results Three hundred sixty-four PCPs participated in the study with a response rate of 89.2%. Most PCPs (91.1%) reported they provided pretravel consultations of which 72.7% provided < 10 consultations per month and almost half of them reported they spent between 10 and 19 minutes for pretravel consultation. ‎Overall, pretravel advice content and frequency including vaccine and malaria chemoprophylaxis recommendations were inadequate. The significant predictors of high frequency of pretravel consultations (≥ 10/month) included PCPs who had past experience in TM (AOR 2.082, 95% CI: 1.209, 3.585) and multilingual physicians (AOR 2.067, 95% CI: 1.180, 3.619). Patients with chronic diseases and pregnant women ‎ were specific patient groups more frequently counselled about pretravel advice. Frequently encountered post-travel illnesses included travelers’ diarrhea, respiratory diseases, and fever. Conclusions The majority of PCPs provided pretravel consultations. However, the frequency and content of consultations were inadequate. Past experience in TM and multilingual physicians were important predictors of providing a high frequency of pretravel consultation. The findings of this study identified several gaps in PCPs’ TM practice. Specific measures should be designed and implemented to promote ‎healthy travel and reduce the burden of travel-related illnesses in Qatar. travel medicine practice physicians primary healthcare Qatar Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction The primary concern of travel medicine (TM) is the prevention and ‎management of health-related risks and conditions associated with travel [ 1 ]. Globally, international travel has been increasing substantially reaching 1.5 billion in 2019 [ 2 ]. Qatar has witnessed a rapid development in the number of travellers with about 2.1 million arrivals in 2019, an increase of 17% compared to 2018 [ 3 ]. Its strategy has been to establish itself as a unique destination for tourism‎, job opportunities, and world-class sports events. The overall impact of these changes will result in a massive growth in the two-way flow of ‎travellers for business, leisure, and transit purposes [ 3 , 4 ]. Globalization, affordability of travel, and borderless countries across the continent have led to substantial increases in travel for either business or tourism ‎[ 5 ]. ‎Associated with increased travel, the risk of travel-related illnesses has also increased; for instance, 43–79% of travellers who visited developing countries became ill [ 6 ]. Travel-related illness has become a primary concern for public health authorities [ 5 ]. This is particularly of greater concern in the Arab world where primary care is fragmented and travel-related health services are inadequate and ‎not well-established [ 7 ]. Pretravel consultation is an effective intervention in preventing travel-related illnesses and promoting travellers’ health [ 8 ]. It offers travellers a unique opportunity to prepare themselves for any health risks that might arise during their travels and to mitigate these risks [ 9 ]. Therefore, it is vital for primary care physicians (PCPs) to provide all travellers with pretravel consultations tailored to their planned destinations [ 10 ]. They are best suited to practice TM because of their broad scope of training and their skills in counselling and disease prevention. [ 10 ]. Topics that are discussed in any pretravel consultation are widely varied based on the ‎differences in traveller’s characteristics, planned travel destinations, or planned ‎activities. But conventionally they should include advice regarding vaccine-preventable ‎diseases, avoidance of animal and insect bites, malaria chemoprophylaxis, information on food and water-borne diseases, safety measures, guidelines for ‎self-treatment of common illness during travel, and concluding with travel medical ‎insurance [ 11 ].‎ Several worldwide studies have investigated the practice of TM among PCPs since ‎the late ‎‎1980s. A study conducted by Kogelman et al. (2014) in the United States found that more than two-thirds of the PCPs provided pretravel consultation. However, most of them saw only a small number of travellers (> 50/year) [ 12 ]. Another nationwide study in Germany showed that about two-thirds of PCPs saw at least 10 travellers per month with immunizations being the most common practice (95%) in their pretravel consultations, followed by advice on malaria chemoprophylaxis (94%), and risky exposure prophylaxis (41%) [ 13 ]. Few studies, related to TM, have also been conducted in the Arab region. For instance, a study conducted in Oman found that only 58% of the PCPs provided pretravel consultations [ 14 ]. In Qatar, TM services including travel vaccinations and malaria chemoprophylaxis are mainly offered by PCPs practising in Primary Health Care (PHC) centres [ 15 ]. However, there is scant knowledge about the scope of their TM practice and associated factors. Therefore, the purpose of this study was 1) to assess the frequency and content of pretravel advice and associated predictors of providing a higher frequency of pretravel advice among PCPs, and 2) to assess the frequency of counselling specific patient groups about pretravel advice and the frequency of travel-related illnesses in returned travellers. 2. Materials And Methods 2.1 Study design and setting An analytical, descriptive cross-sectional design was used for this study. The study was conducted from March to May 2020 at all 27 PHC centres in Qatar. Primary health care centres are considered the first line of contact with Qatar’s healthcare system for the provision of a broad range of health services including TM services (i.e., travel vaccines and malaria chemoprophylaxis) [ 15 ]. These services are offered by PCPs and are provided free of charge to Qatari citizens and at highly subsidized rates to expatriates‎. 2.2. Study population All PCPs who were on duty at the 27 PHC centres during the study period were invited to participate in the study. Those who were not available at the time of data collection (e.g., were on leave or in quarantine due to COVID-19) were excluded. The estimated sample size was 365 individuals based on 3% error rate, 95% confidence interval, a hypothesis that 50% of PCPs have sufficient practice of TM, and a non-response rate of 20%. The sample size was calculated to obtain a sufficiently precise estimate of the minimum number of study participants to ensure study power. 2.3. Data collection A self-administered questionnaire was used for data collection. The lead investigator (AAD) approached all eligible PCPs individually in their respective clinics and provided a fulsome information about the nature and scope of the study, and invited them to participate. To ensure privacy and confidentiality, the questionnaire was entirely anonymized. Those who consented to participate were given a copy of the questionnaire and instructed to return the completed questionnaires in provided sealed and unmarked envelopes for collection by the researcher. ‎ The present study assessed PCPs’ practice of TM in the past 6-month period (i.e., prior to the data collection date). 2.4. Study questionnaire A structured questionnaire was used for data collection. To ensure the content and face validity of the questionnaire, we followed two steps. First, we conducted an extensive search of the relevant literature. Second, we formed an expert panel of TM experts and Community Medicine consultants to critically review the questionnaire. The questionnaire was in English because it is the main communication language of all physicians in Qatar. ‎The development of the questionnaire also considered its suitability for self-administration. A pilot study was conducted with a convenient sample of 20 PCPs to assess its relevance, clarity, and average duration for its completion. The pilot sample was excluded from the final database. The estimated average time to complete the questionnaire was 18 minutes. The questionnaire is composed of five sections: (i) background and general practice characteristics of PCPs including their age, gender, number of years in general practice, language(s) spoken with patients, postgraduate experience in TM; (ii) frequency of pretravel consultations per month; (iii) content and frequency of selected pretravel ‎‎advice items; ‎(iv) frequency of counselling specific travellers patient groups; and (v) frequency of travel-related illnesses ‎encountered. For the purpose of this study, postgraduate experience in TM was defined as “any engagement in travel medicine practice after graduation from medical school” , and postgraduate training in TM “defined as receiving any postgraduate degree [Diploma, Master, PhD] or training [workshop, ‎certified short course] or having a membership or fellowship of TM related professional ‎organization‎" . 2.5. Statistical analysis Data collected from completed questionnaires were analysed using IBM SPSS Statistics for Windows (version 23, IBM Corp., Armonk, N.Y., USA). Descriptive and analytic statistics were used. For categorical variables, descriptive statistics of frequencies and percentages were calculated. For continuous variables, median and interquartile ranges (IQR) were calculated. For analytical statistics, the Chi-squared test was used for numerical variables. To identify predictors, univariate and multivariable logistic regression analyses were performed to identify predictors of providing high frequency (≥ 10) pretravel consultations per month. Unadjusted and adjusted odds ratios with their 95% CI and p-values were also reported. Statistical significance was considered at p ≤ 0.05 as a cut-off point. 3. Results 3.1. Background characteristics of the study population A total of 364 PCPs completed and returned the questionnaires giving a response rate of 89.2%. The median (IQR) age of the PCPs was 43 (39–49) years. About one-third (31.2%) spoke with patients in three or more languages and more than half (59.1%) had 15 years or more of experience in general practice. While 36.7% of the PCPs had previous experience in TM, only 14.2% had postgraduate training in it. The background characteristics of the participants are shown in Table 1 . Table 1 Distribution of background characteristics of primary care physicians in Qatar (N = 364) Variable Frequency Percent Age <45 years old ≥45 years old 205 139 59.6 40.4 Median (IQR) ‎43 (39–49)‎ Gender Male Female 215 149 59.1 40.9 Number of spoken languages ‎with patients ‎ 1–2 languages ‎ ≥3 languages‎ 249 113 68.8 31.2 Number of years in practice ‎ <15‎ years ‎ ≥15‎ years 146 211 40.9 59.1 Previous experience in travel medicine a No Yes 228 132 63.3 36.7 Postgraduate training in travel medicine ‎ No ‎ Yes 309 51 85.8 14.2 Missing information: age (n = 20), country of medical degree ‎ (n = 19), years in practice (n = 7) a Postgraduate experience in ‎tropical medicine, ‎developing countries, or communicable disease clinic‎ 3.2. Scope of practice in travel medicine Overall, the majority of PCPs (91.1%; 95% CI: 88.3%-94.1%) reported that they provided pretravel consultations to travellers in the past six months. As shown in Fig. 1 , of PCPs who provided pretravel consultations (n = 332; 91.1%), about three-quarters (72.7%) counselled less than 10 patients per month on TM-related issues. The remaining PCPs counselled 10 to 19 travellers per month (17.7%) or 20 or more travellers per month (9.6%). Figure 2 . displays the distribution of PCPs according to their reported duration of pretravel consultations, including both counselling and providing prescriptions. Of PCPs who provided pretravel consultations (n = 332), almost half (48.8%) had spent between 10 and 19 minutes for pretravel consultation. The remaining had spent either less than 10 minutes (42.7%) or 20 minutes or more (8.5%). Table 2 describes the frequency of counselling and type of advice to travellers according to their destination. Among PCPs who offered pretravel consultations (N = 332), the more frequently (i.e., every time and often) reported advice given was about safe water and food (51.1% every time and 33.8% often), traveller’s diarrhea (37.8% every time and 40.5% often), insect bite avoidance (38.5% every time and 39.4% often), and in-flight exercise to prevent deep vein thrombosis (DVT) (36.5% every time and 38.9% often). The less frequently reported advice given was about travel health insurance (13.1% every time and 23.8% often), first aid knowledge (17.6% every time and 28.9% often), Jet lag (19.5% every time and 28.0% often), and risk and prevention of Sexual Transmitted Infections (STIs) (19.0% every time and 32.4% often). Table 2 Frequency of counselling travellers (according to specific destinations) about pretravel advice in the past 6 months in Qatar (N = 332) Variable Every time n (%) Often n (%) Rarely n (%) Never n (%) Safe water and food 169 (51.1) 112 (33.8) 36 (10.9) 14 (4.2) Traveler’s diarrhea 125 (37.8) 134 (40.5) 59 (17.8) 13 (3.9) Insect bite avoidance 127 (38.5) 130 (39.4) 55 (16.7) 18 (5.5) In-flight exercise to prevent DVT 120 (36.5) 128 (38.9) 58 (17.6) 23 (7.0) Animal bite avoidance 105 (32.0) 111 (33.8) 80 (24.4) 32 (9.8) Motion sickness 78 (23.6) 120 (36.4) 89 (27.0) 43 (13.0) Personal safety (e.g. violence, accidents) 77 (23.5) 110 (33.5) 91 (27.7) 50 (15.2) Infection outbreaks at destination 66 (20.1) 120 (36.6) 95 (29.0) 47 (14.3) Finding medical assistance while abroad 60 (18.2) 110 (33.4) 90 (27.4) 69 (21.0) Risk and prevention of STIs 62 (19.0) 106 (32.4) 96 (29.4) 63 (19.3) Jet lag 64 (19.5) 92 (28.0) 103 (31.3) 70 (21.3) First aid knowledge 58 (17.6) 95 (28.9) 105 (31.9) 71 (21.6) Travel health insurance 43 (13.1) 78 (23.8) 102 (31.1) 105 (32.0) DVT: Deep vein thrombosis, STIs: Sexually transmitted infections Table 3 describes the frequency of counselling travellers according to their destinations about main travel vaccines and malaria chemoprophylaxis. Among PCPs who offered pretravel consultations, the more frequently reported advice given was for seasonal flu vaccine (70.0% every time and 21.2% often), hepatitis A vaccine (57.6% every time and 29.7% often), hepatitis B vaccine (47.6% every time and 33.8% often), and malaria chemoprophylaxis (50.6% every time and 30.8% often). On the other hand, the less frequently reported advice given was for pre-exposure prophylaxis of rabies (21.1% every time and 35.5% often), and poliomyelitis vaccine (28.4% every time and 35.8% often). Table 3 Frequency of counselling travellers (according to specific destinations) about travel vaccines and malaria chemoprophylaxis in the past 6 months in Qatar, 2020 (N = 332) Variable Every time n (%) Often n (%) Rarely n (%) Never n (%) Seasonal flu vaccine 231 (70.0) 70 (21.2) 21 (6.4) 8 (2.4) Hepatitis A vaccine 190 (57.6) 98 (29.7) 31 (9.4) 11 (3.3) Hepatitis B vaccine 156 (47.6) 111 (33.8) 47 (14.3) 14 (4.3) Malaria chemoprophylaxis 166 (50.6) 101 (30.8) 46 (14.0) 15 (4.6) Meningococcal vaccine 148 (45.0) 116 (35.3) 51 (15.5) 14 (4.3) Typhoid fever vaccine 160 (48.6) 103 (31.3) 42 (12.8) 24 (7.3) Yellow fever vaccine 109 (33.0) 121 (36.7) 72 (21.8) 28 (8.5) Poliomyelitis vaccine 93 (28.4) 117 (35.8) 75 (22.9) 42 (12.8) Rabies (preexposure prophylaxis) 69 (21.1) 116 (35.5) 88 (26.9) 54 (16.5) 3.3. Counselling of specific patient groups As shown in Fig. 3 , among PCPs who provided pretravel consultations, a high proportion of PCPs provided pretravel consultations to patients with chronic diseases (36.9% every time and 41.7% often) and pregnant women (38.1% every time and 30.5% often). On the other hand, a lower proportion‎ of PCPs counselled children/adolescents or elderly persons. 3.4. Travel-related illnesses in returned travellers Figure 4 shows the frequency of travel-related illnesses in returned travellers. More than three-quarters of PCPs reported more frequent encounters with gastrointestinal (GI) symptoms such as travellers’ diarrhea (36.7% every time and 41.7% often), respiratory diseases (33.3% every time and 43.3% often), or fever. On the other hand, STIs were the least encountered presentations. 3.5. Factors associated with the frequency of pretravel consultations ‎Table 4 shows the comparison between PCPs’ characteristics and the frequency of pretravel consultations‎ per month. Several factors showed statistically significant associations with the frequency of consultations including gender, the number of years in general practice, ‎the number of spoken languages ‎with patients, previous experience in TM, and postgraduate training in TM. Table 4 Relationship of primary care physicians’ characteristics and the frequency of pretravel consultations per month in Qatar (Chi-squared test) (N = 332) Variable Travel medicine consultation p-value < 10‎/month n (%) ≥ 10‎/ month n (%) Age < 45 years old ≥ 45 years old 138 (75.8) 93 (73.8) 44 (24.2) 33 (26.2) 0.688 Gender Female Male 107 (82.3) 135 (68.5) 23 (17.7) 62 (31.5) 0.005* Number of years in practice ‎ <15‎ years ‎ ≥15‎ years 104 (80.0) 138 (70.1) 26 (20.0) 59 (29.9) 0.046* Number of spoken languages with patients 1–2 languages ≥3 languages 172 (77.5) 68 (66.0) 50 (22.5) 35 (34.0) 0.029* Previous experience in TM a No Yes 158 (79.8) 82 (65.6) 40 (20.2) 43 (34.4) 0.005* Postgraduate training in TM No Yes 210 (76.4) 32 (61.5) 65 (23.6) 20 (38.5) 0.022* * Statistically significant; TM: travel medicine a Postgraduate experience in ‎tropical medicine, ‎developing countries, or communicable disease clinic‎ 3.6. Predictors of frequency of pretravel consultations Table 5 displays the results of univariable and multivariable logistic regression analyses. In the univariable analysis, various PCP characteristics were significantly associated with a higher frequency of pretravel consultations (≥ 10/month). These variables included male gender, having 15 years or more in general practice, speaking ‎≥3 languages with patients, having postgraduate experience in TM, and having postgraduate training in TM. The unadjusted OR and 95% CI for these variables are shown in Table 5 .‎ In the multivariable analysis, multilingual physicians (who spoke‎ ≥3 languages‎) were about two times more likely to counsel ≥ 10 patients per month on TM issues compared to those who spoke less than three languages (AOR 2.067, 95% CI: 1.180, 3.619). In addition, PCPs who had postgraduate experience in TM were‎ almost two times more likely to‎ counsel a higher frequency of patients (≥ 10 per month) on TM-related consultations compared PCPs who did not have this work experience (AOR 2.082, 95% CI: 1.209, 3.585). Table 5 Predictors of providing ten‎ or more travel medicine consultations per month among primary care physicians in Qatar, 2020 (N = 332) Variable Unadjusted OR (95% CI) p-value Adjusted OR (95% CI) p-value Age < 45 years old ≥ 45 years old ‎ Reference 1.113 (0.660, 1.876) 0.688 Gender Female Male Reference 2.137 (1.243, 3.672) 0.005* Reference 1.744 (0.980, 3.104) 0.058 Number of years in practice ‎ <15‎ years ‎ ≥15‎ years Reference 1.710 (1.010, 2.896) 0.046* Reference 1.495 (0.850, 2.629) 0.162 Number of spoken languages with patients 1–2 languages ≥3 languages Reference 1.771 (1.058, 2.964) 0.029* Reference 2.067 (1.180, 3.619) 0.011* Previous experience in TM a No Yes Reference 2.071 (1.248, 3.437) 0.005* Reference 2.082 (1.209, 3.585) 0.008* Postgraduate training in TM No Yes Reference 2.019 (1.082, 3.769) 0.022* Reference 1.879 (0.957, 3.689) 0.067 *Statistically significant, OR: Odds ratio, CDC: communicable disease clinic, TM: travel medicine a: Postgraduate experience in ‎tropical medicine, ‎developing countries, or communicable disease clinic‎ 4. Discussion This cross-sectional study aimed to examine TM practices among PCPs working in primary healthcare settings in Qatar, and the predictors of providing a higher frequency of pretravel consultations (≥ 10 per month). The current study showed that most PCPs (91.1%) provided pretravel consultations to patients, which is consistent with other research conducted in the United States of America (USA), Germany (95%), and Switzerland (96%) [ 12 , 13 , 16 ]. In contrast, a study in Oman reported a relatively lower proportion of PCPs (58%) providing pretravel consultation [ 14 ]. 4.1. Pretravel advice: Frequency Regarding the frequency of pretravel consultations, about three-quarters of the PCPs in the present study counselled less than 10 patients per month on TM issues. This is consistent with the findings of Kogelman and colleagues in the USA that the majority of the PCPs (80%) had counselled less than 10 patients each month on TM issues [ 12 ]. However, in comparison, studies in Germany and Australia reported that the majority of PCPs counselled greater than 10 patients per month on TM-related issues [ 13 , 17 ]. Our regression analysis showed several predictors of the high frequency of consultations. One predictor was the multilinguality of the PCPs. Those who spoke‎ three or more languages were significantly more likely to consult a higher number of patients on travel-related issues than those who spoke only one or two languages. A similar finding was reported by the study in Australia by Heywood and colleagues (2015) ‎[ 18 ]. The ability to consult with patients in their preferred language potentially improves communication and trust and promotes change in their travel-related health behaviours [ 9 ]. Such an ability is particularly important in Qatar where the population is highly diverse [ 19 ]. Another predictor of higher frequency of pretravel consultations was PCPs’ postgraduate experience in TM. This is consistent with the findings from the studies in Germany and New Zealand [ 13 , 20 ]. These findings emphasize the importance of training and experience in TM or a related field on the frequency of PCPs’ practice in TM consultations. ‎Providing a high frequency of pretravel consultations‎ (> 10 per month) was found to be a significant predictor of higher TM knowledge among PCPs in Qatar [ 21 ]. 4.2. Pretravel advice: Content and Frequency There have been few studies investigating the nature of advice given by PCPs to travellers and how frequently such advice is provided. In the present study, advice on the prevention and management of travellers’ diarrhea (TD) was given by PCPs every time (38%) and often (41%). In contrast, 85% of PCPs in Germany [ 13 ] and 78% in Oman [ 14 ] had counselled travellers about TD. Advice regarding TD should be provided to all travellers regardless of their destination because it is the most common cause of morbidity in travellers [ 22 ]. Another important topic of pretravel consultation is insect bite avoidance and the associated hazards of malaria infection in certain travel destinations. In this study, such advice was provided by PCPs every time (38%) and often (39%). Other studies in Germany, Oman, and Australia reported comparable findings [ 13 , 14 , 17 ]. It is vitally important that PCPs advise travellers going to malaria-endemic areas about the risks associated with insect bites. An earlier study in Qatar had shown that imported malaria had become increasingly a travel-related hazard from 2008 to 2015 [ 23 ]. On the subject of personal safety such as violence, injury and accidients, only a small proportion of the PCPs provided advice (23% every time and 33% often) against such events. Similar findings have been reported in Australia [ 17 ]. Safety is often a ‎neglected area in ‎TM,‎ but it is one of the ‎most important ‎areas to cover when advising ‎travellers because ‎accidents and ‎injuries are the most ‎common ‎preventable causes ‎of death among ‎them [ 24 ].‎ Finally, STIs are another important element in pretravel consultations [ 24 , 25 ]. Despite this, only 19% of PCPs in the present study provided pretravel advice on the risk and prevention of STIs (every time), which is inconsistent with those found in studies in Germany (43%) and Australia (30%) [ 13 , 17 ]. This could be explained by the sensitivity of the subject of STIs and its associated stigma in a conservative Muslim culture in this region such as Qatar. 4.3. Pretravel advice: Vaccines and Malaria Chemoprophylaxis Overall, there is scarce published data regarding the provision of advice on specific vaccine ‎recommendations. ‎ In the present study, we found that a relatively high proportion of PCPs provided advice on vaccinations against seasonal flu, hepatitis A, hepatitis, meningococcal and typhoid fever. Comparable rates of advice regarding hepatitis A and B were reported in other studies [ 12 , 13 , 16 ]. Similarly, ‎most PCPs in the current study provided advice on malaria chemoprophylaxis which is in line with findings in other international studies [ 13 , 17 ]. In contrast, only about a third of PCPs in this study advised travellers about yellow fever vaccine which is also in line with other studies in the USA and Germany [ 12 , 13 ]. These findings are alarming because of the high risk of mortality associated with yellow fever. This study reported variations in PCPs’ practice of providing advice about specific vaccines. Therefore, PCPs should be encouraged to advise travellers about relevant vaccines depending on planned destinations. 4.4. Counselling specific groups Most PCPs in our study provided pretravel advice to patients with ‎chronic diseases (79%), pregnant women ‎(69%), elderly persons (64%), and children/adolescents (64%). These findings are in line with the study in Germany [ 13 ]. Counselling these vulnerable groups plays an important role in primary care as they could be at a higher risk of acquiring travel-related illness or have contraindications to certain vaccines or medications [ 24 , 26 ]. 4.5. Post-travel consultations In the present study, GI symptoms (e.g., TD) were the most frequent illness (80%) encountered by PCPs ‎among returning travellers. Comparable findings were observed in the study in Germany (88%) and the study in Oman (77%) [ 13 , 14 ]. This is an expected finding knowing that TD is the most predictable travel-related illness [ 24 ]. Respiratory and skin diseases were other common presentations during post-travel consultation in this study in contrast to those reported in the ‎German and Omani studies [ 13 , 14 ]. ‎‎These differences could be explained by the difference in travel destinations and the different characteristics and behaviours of travellers in different countries. In addition, few PCPs in this study encountered STIs among ill-returning travellers. This finding suggests that PCPs should take detailed exposure histories and keep STIs in the differential diagnosis for ill-returning travellers. 4.6. Strengths and limitations This study has a number of strengths. First, the study was the first of its kind to evaluate TM knowledge and its predictors among PCPs working in primary ‎healthcare settings in Qatar. Second, the study achieved a high response rate (91%) despite the high demands placed on PCPs during the COVID-19 pandemic which could be explained by the PCPs’ interest in this topic. Finally, the results of this study represent PCPs’ responses from all 27 PHC centres in Qatar. Thus, the findings may be broadly generalizable to the overall general practice in Qatar. However, the cross-sectional design of this study limits its interpretation of the temporal relationship between the variables. 5. Conclusion The majority of PCPs provided pretravel consultations. However, the frequency of consultations was mostly low. Past experience in TM and multilingual physicians were important predictors of the provision of high frequency of pretravel consultations. Pretravel advice content and frequency including vaccine and malaria chemoprophylaxis recommendations were inadequate. Travelers’ diarrhea, respiratory problems and fever were predominant travel-related issues seen ‎by PCPs.‎ The findings of this study identified several gaps in PCPs’ TM practice. These potentially place travellers at high risk of acquiring TM-related diseases. Our findings will inform policy makers to design and implement specific measures, such as training and ‎best practice guidelines, for PCPs to standardize TM-related practice. Moreover, considering the culturally diverse population in Qatar, the use of professional medical interpreters when providing pretravel consultation‎s and multilanguage information materials should be encouraged to overcome language barriers and enable effective counseling. Such measures may potentially promote ‎healthy travel and reduce the burden of travel-related illnesses in Qatar.‎ Abbreviations DVT: Deep Vein Thrombosis GI‎: Gasterointestinal IQR: ‎Interquartile Ranges PCP: Primary Care Physician‎ PHC‎: Primary Health Care STIs: Sexual Transmitted Infections TD: Travellers’ Diarrhea TM: Travel Medicine Declarations Ethics approval and consent to participate Ethical approval for this research was obtained from the Institutional Review Boards (IRB) of the Hamad Medical Corporation [Reference number: MRC-01-19-324] and the Primary Health Care Corporation [Reference number: PHCC/DCR/2020/01/002]. All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). All the participants were asked to consent at the beginning of the questionnaire. Consent for publication Not applicable Availability of data and materials The datasets are available from the corresponding author on reasonable request. Competing interests The authors have no relevant financial or non-financial interests to disclose. Funding This research was supported by the Medical Research Centre at Hamad Medical Corporation [grant numbers: MRC-01-19-324]. Open Access funding is provided by Qatar National Library. The funder had no role in study design, data collection and analysis, interpretation of data and in writing the manuscript. Authors’ contributions AAD: conceptualization, methodology, data collection, formal analysis, funding acquisition, project administration and writing - original draft. NS: ‎ writing, reviewing and supervising. VK: writing, reviewing ‎and supervision. ZM: formal analysis. Acknowledgements We would like to thank the primary care physicians for their valuable participation in this study. References Y.T. Aba, A. Gagneux-Brunon, C. Andrillat, P. Fouilloux, F. Daoud, C. Defontaine, et al. Travel medicine consultation: An opportunity to improve coverage for routine vaccinations, Medecine & Maladies Infectieuses, vol. 49, no. 4, 06, pp. 257-263. United Nations World Tourism Organization. Growth in international tourist arrivals continues to outpace the economy. 2020. Qatar National Tourism Council. 2018 Annual Tourism Performance Report. 2020; Available at: https://www.qatartourism.com/content/dam/qatar-tourism/2019-Tourism-Performance-Report.pdf. Accessed June 24, 2022. Frost & Sullivan & Insights Middle East. Shaping the future of travel in the Gulf Cooperation Council: Big travel effects, pp. Marcch 12, 2019. United Nations World Tourism Organization. International Tourism Results 2017: the highest in seven years. Communications. 2018; Available at: http://media.unwto.org/press-release/2018-01-15/2017-international-tourism-results-highest-seven-years. Accessed February 19, 2021. Grieve S, Steffen R. Epidemiology: Morbidity and Mortality in Travelers. 2020; Available at: https://www.sciencedirect.com/science/article/pii/B9780323546966000021. United Nations Sustainable Developmental Group. Policy Brief: The Impact of COVID-19 on the Arab Region An Opportunity to Build Back Better. Sanford C, McConnell A, Osborn J. The Pretravel Consultation. Am Fam Physician 2016 Oct 15;94(8):620-627. Gherardin T. The pre-travel consultation - an overview. Aust Fam Physician 2007 ‎‎05;36(5):300-303.‎ Abu Salem M, Mahrous OAA, Gabr I. Role of family physician in healthcare for persons traveling abroad. ‎Menufia Med J 2015;28:587-590.‎ Aw B, Boraston S, Botten D, Cherniwchan D, Fazal H, Kelton T, et al. Travel medicine: what's involved? When to refer? Canadian Family Physician 2014 Dec;60(12):1091-1103. Kogelman L, Barnett ED, Chen LH, Quinn E, Yanni E, Wilson ME, et al. Knowledge, Attitudes, and Practices of US Practitioners Who Provide Pre-Travel Advice. J Travel Med 2014 Mar;21(2):104-114. G. Ropers, G. Krause, van Beest Holle, Mirna, Du Ry, K. Stark and F. Tiemann. Nationwide ‎Survey of the Role of Travel Medicine in Primary Care in Germany, Journal of Travel Medicine, ‎vol. 11, no. 5, Sep, pp. 287-294. ‎ Kurup PJ, Al Abri SS, Al Ajmi F, Khamis HA, Singh J. Knowledge, attitude and practice of travel medicine among primary care physicians in Oman: the need for intervention. East Mediterranean Health J 2019 01;25(1):40-46. Primary Health Care Corporation. Primary Health Care Corporation: Health Centers. 2018; Available at: https://www.phcc.qa/portal_new/index/index.php?limit=home#. Accessed February 19, 2022. Hatz C, Krause E, Grundmann H. Travel advice: a study among Swiss and German general practitioners. Tropical Medicine & International Health 1997 Jan;2(1):6-12. Thava Seelan S, Leggat PA. Referral of travellers from Australia by general practitioners for travel health advice. Travel Medicine & Infectious Disease 2003 Aug;1(3):185-188. Heywood AE, Forssman BL, Seale H, MacIntyre CR, Zwar N. General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives. J Travel Med 2015 Nov;22(6):368-374. Qatar Census 2020 Results (2020) Census 2020. Available at: https://www.psa.gov.qa/en/statistics1/StatisticsSite/Census/census2020/Pages/default.aspx (Accessed: February 12, 2023). Leggat PA, Heydon JL, Menon A. Training, experience and interest of general practitioners in travel medicine in New Zealand. Journal of Travel Medicine 1999 Jun;6(2):60-65. Al-Dahshan, A., Selim, N., Al-Kubaisi, N., Mahfoud, Z., & Kehyayan, V. (2022). Primary ‎care physicians’ knowledge of travel vaccine and malaria chemoprophylaxis and associated ‎predictors in Qatar. Plos one, 17(3), e0265953.‎ Bradley AC. CDC health information for international travel. Oxford: Oxford University Press; 2017. Farag E, Bansal D, Chehab MAH, Al-Dahshan A, Bala M, Ganesan N, et al. Epidemiology of Malaria in the State of Qatar, 2008-2015. Mediterranean Journal of Hematology & Infectious Diseases 2018;10(1):e2018050. World Health Organization. International travel and health . 2012. Roupa Z, Zikos D, Vasilopoulos A, Diomidous M. Common Health Risks, Required Precautions of Travelers and their Customs Towards the Use of Travel Medicine Services. Materia Sociomedica 2012;24(2):131-134. Starr M, Hagmann SHF. Travel medicine and the child traveler: Challenges for pediatric health providers in a globalized world. Travel Medicine & Infectious Disease 2020 Mar;34:101644. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2849273","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":194398052,"identity":"5430ad70-af4c-42b6-b2b7-bdbdcc9b4752","order_by":0,"name":"Ayman Al-Dahshan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYFAC5gYJxgaGBCDjGIgLZBMEjDAtbGkka+ExI04Lf/vBxhs/d9Tl8c/u+fbgZ46dbAN78gO8WiTOJDZb9p45XCxx5+x2w95tycYNPM8M8FtzILFNgrftQGLDjdxtErzbmBMbJBLwa5E//7BN8m9bXeL8GznPJP9uqwdqSf+AV4vBjcQ2ad425sQNN3LYpHm3HQZqycFvi+GNh83Wsm2HEzfeSDOTlt123LiN500BXi1y55MP3nwLdNi8G8nPJN9uq5btZ0/fgFcLJmADxRGpgAwto2AUjIJRMKwBAPbBUeiTLvVvAAAAAElFTkSuQmCC","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ayman","middleName":"","lastName":"Al-Dahshan","suffix":""},{"id":194398054,"identity":"ae97559f-d244-485e-b982-8a055e0123ec","order_by":1,"name":"Nagah Selim","email":"","orcid":"","institution":"Cairo University Kasr Alainy Faculty of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nagah","middleName":"","lastName":"Selim","suffix":""},{"id":194398056,"identity":"d03669a3-e088-4743-8225-9ac6def6b668","order_by":2,"name":"Noora Al-Kubaisi","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Noora","middleName":"","lastName":"Al-Kubaisi","suffix":""},{"id":194398058,"identity":"6f115aab-c840-49fb-ba8b-7f2fd7e44647","order_by":3,"name":"Ziyad Mahfoud","email":"","orcid":"","institution":"Weill Cornell Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ziyad","middleName":"","lastName":"Mahfoud","suffix":""},{"id":194398061,"identity":"b4bb870a-8024-47c6-9840-3cf46fd696fa","order_by":4,"name":"Vahe Kehyayan","email":"","orcid":"","institution":"University of Doha for Science \u0026 Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Vahe","middleName":"","lastName":"Kehyayan","suffix":""}],"badges":[],"createdAt":"2023-04-22 20:29:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2849273/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2849273/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":36339120,"identity":"e7524089-46f9-4676-bf0b-59cdbcdfedb3","added_by":"auto","created_at":"2023-04-26 17:46:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32626,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of primary care physicians according to the frequency of pretravel consultation per month in Qatar (N=332)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2849273/v1/028cc23721ccfe639b01eea4.jpg"},{"id":36339653,"identity":"3c19e562-5e6b-480b-81a3-65df51331c15","added_by":"auto","created_at":"2023-04-26 17:54:56","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30546,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of primary care physicians according to the duration of pretravel consultation in Qatar (N=332)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2849273/v1/accd049235f9da44379626f3.jpg"},{"id":36339123,"identity":"6857404e-fd4d-484c-89a9-a0206a25f5d3","added_by":"auto","created_at":"2023-04-26 17:46:56","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54939,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of counselling specific patient groups about pretravel advice in the past 6 months in Qatar, 2020 (N=332)\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2849273/v1/f3db8ec15c7527b3035453af.jpg"},{"id":36339122,"identity":"226c6319-8740-4c0a-9e2e-231fb08df576","added_by":"auto","created_at":"2023-04-26 17:46:56","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":61573,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of travel-related illnesses ‎encountered by primary care physicians in the past 6 months in Qatar, 2020 (N=364)\u003c/p\u003e\n\u003cp\u003eGI: Gastrointestinal, STIs: Sexually transmitted infections\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2849273/v1/bde06b8cfbca1b1311143192.jpg"},{"id":36453005,"identity":"cf2eb59a-e1b3-45e6-b5ed-c6a5c1b32eac","added_by":"auto","created_at":"2023-04-29 05:59:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":621261,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2849273/v1/5e628f13-76ca-4f46-bcd9-391b114a38e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe primary concern of travel medicine (TM) is the prevention and \u0026lrm;management of health-related risks and conditions associated with travel [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, international travel has been increasing substantially reaching 1.5\u0026nbsp;billion in 2019 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Qatar has witnessed a rapid development in the number of travellers with about 2.1\u0026nbsp;million arrivals in 2019, an increase of 17% compared to 2018 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Its strategy has been to establish itself as a unique destination for tourism\u0026lrm;, job opportunities, and world-class sports events. The overall impact of these changes will result in a massive growth in the two-way flow of \u0026lrm;travellers for business, leisure, and transit purposes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobalization, affordability of travel, and borderless countries across the continent have led to substantial increases in travel for either business or tourism \u0026lrm;[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. \u0026lrm;Associated with increased travel, the risk of travel-related illnesses has also increased; for instance, 43\u0026ndash;79% of travellers who visited developing countries became ill [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Travel-related illness has become a primary concern for public health authorities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This is particularly of greater concern in the Arab world where primary care is fragmented and travel-related health services are inadequate and \u0026lrm;not well-established [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePretravel consultation is an effective intervention in preventing travel-related illnesses and promoting travellers\u0026rsquo; health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It offers travellers a unique opportunity to prepare themselves for any health risks that might arise during their travels and to mitigate these risks [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, it is vital for primary care physicians (PCPs) to provide all travellers with pretravel consultations tailored to their planned destinations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. They are best suited to practice TM because of their broad scope of training and their skills in counselling and disease prevention. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Topics that are discussed in any pretravel consultation are widely varied based on the \u0026lrm;differences in traveller\u0026rsquo;s characteristics, planned travel destinations, or planned \u0026lrm;activities. But conventionally they should include advice regarding vaccine-preventable \u0026lrm;diseases, avoidance of animal and insect bites, malaria chemoprophylaxis, information on food and water-borne diseases, safety measures, guidelines for \u0026lrm;self-treatment of common illness during travel, and concluding with travel medical \u0026lrm;insurance [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u0026lrm;\u003c/p\u003e \u003cp\u003eSeveral worldwide studies have investigated the practice of TM among PCPs since \u0026lrm;the late \u0026lrm;\u0026lrm;1980s. A study conducted by Kogelman et al. (2014) in the United States found that more than two-thirds of the PCPs provided pretravel consultation. However, most of them saw only a small number of travellers (\u0026gt;\u0026thinsp;50/year) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Another nationwide study in Germany showed that about two-thirds of PCPs saw at least 10 travellers per month with immunizations being the most common practice (95%) in their pretravel consultations, followed by advice on malaria chemoprophylaxis (94%), and risky exposure prophylaxis (41%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Few studies, related to TM, have also been conducted in the Arab region. For instance, a study conducted in Oman found that only 58% of the PCPs provided pretravel consultations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Qatar, TM services including travel vaccinations and malaria chemoprophylaxis are mainly offered by PCPs practising in Primary Health Care (PHC) centres [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, there is scant knowledge about the scope of their TM practice and associated factors. Therefore, the purpose of this study was 1) to assess the frequency and content of pretravel advice and associated predictors of providing a higher frequency of pretravel advice among PCPs, and 2) to assess the frequency of counselling specific patient groups about pretravel advice and the frequency of travel-related illnesses in returned travellers.\u003c/p\u003e"},{"header":"2. Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and setting\u003c/h2\u003e \u003cp\u003eAn analytical, descriptive cross-sectional design was used for this study. The study was conducted from March to May 2020 at all 27 PHC centres in Qatar. Primary health care centres are considered the first line of contact with Qatar\u0026rsquo;s healthcare system for the provision of a broad range of health services including TM services (i.e., travel vaccines and malaria chemoprophylaxis) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These services are offered by PCPs and are provided free of charge to Qatari citizens and at highly subsidized rates to expatriates\u0026lrm;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study population\u003c/h2\u003e \u003cp\u003eAll PCPs who were on duty at the 27 PHC centres during the study period were invited to participate in the study. Those who were not available at the time of data collection (e.g., were on leave or in quarantine due to COVID-19) were excluded. The estimated sample size was 365 individuals based on 3% error rate, 95% confidence interval, a hypothesis that 50% of PCPs have sufficient practice of TM, and a non-response rate of 20%. The sample size was calculated to obtain a sufficiently precise estimate of the minimum number of study participants to ensure study power.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data collection\u003c/h2\u003e \u003cp\u003eA self-administered questionnaire was used for data collection. The lead investigator (AAD) approached all eligible PCPs individually in their respective clinics and provided a fulsome information about the nature and scope of the study, and invited them to participate. To ensure privacy and confidentiality, the questionnaire was entirely anonymized. Those who consented to participate were given a copy of the questionnaire and instructed to return the completed questionnaires in provided sealed and unmarked envelopes for collection by the researcher. \u0026lrm; The present study assessed PCPs\u0026rsquo; practice of TM in the past 6-month period (i.e., prior to the data collection date).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Study questionnaire\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA structured questionnaire was used for data collection. To ensure the content and face validity of the questionnaire, we followed two steps. First, we conducted an extensive search of the relevant literature. Second, we formed an expert panel of TM experts and Community Medicine consultants to critically review the questionnaire. The questionnaire was in English because it is the main communication language of all physicians in Qatar. \u0026lrm;The development of the questionnaire also considered its suitability for self-administration. A pilot study was conducted with a convenient sample of 20 PCPs to assess its relevance, clarity, and average duration for its completion. The pilot sample was excluded from the final database. The estimated average time to complete the questionnaire was 18 minutes.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire is composed of five sections: (i) background and general practice characteristics of PCPs including their age, gender, number of years in general practice, language(s) spoken with patients, postgraduate experience in TM; (ii) frequency of pretravel consultations per month; (iii) content and frequency of selected pretravel \u0026lrm;\u0026lrm;advice items; \u0026lrm;(iv) frequency of counselling specific travellers patient groups; and (v) frequency of travel-related illnesses \u0026lrm;encountered. For the purpose of this study, postgraduate experience in TM was defined as \u003cem\u003e\u0026ldquo;any engagement in travel medicine practice after graduation from medical school\u0026rdquo;\u003c/em\u003e, and postgraduate training in TM \u003cem\u003e\u0026ldquo;defined as receiving any postgraduate degree [Diploma, Master, PhD] or training [workshop, \u0026lrm;certified short course] or having a membership or fellowship of TM related professional \u0026lrm;organization\u0026lrm;\"\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e \u003cp\u003eData collected from completed questionnaires were analysed using \u003cem\u003eIBM SPSS Statistics for Windows\u003c/em\u003e (version 23, IBM Corp., Armonk, N.Y., USA). Descriptive and analytic statistics were used. For categorical variables, descriptive statistics of frequencies and percentages were calculated. For continuous variables, median and interquartile ranges (IQR) were calculated. For analytical statistics, the Chi-squared test was used for numerical variables. To identify predictors, univariate and multivariable logistic regression analyses were performed to identify predictors of providing high frequency (\u0026ge;\u0026thinsp;10) pretravel consultations per month. Unadjusted and adjusted odds ratios with their 95% CI and p-values were also reported. Statistical significance was considered at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;0.05 as a cut-off point.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1. Background characteristics of the study population\u003c/h2\u003e\n\u003cp\u003eA total of 364 PCPs completed and returned the questionnaires giving a response rate of 89.2%. The median (IQR) age of the PCPs was 43 (39\u0026ndash;49) years. About one-third (31.2%) spoke with patients in three or more languages and more than half (59.1%) had 15 years or more of experience in general practice. While 36.7% of the PCPs had previous experience in TM, only 14.2% had postgraduate training in it. The background characteristics of the participants are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of background characteristics of primary care physicians in Qatar (N\u0026thinsp;=\u0026thinsp;364)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercent\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003e\u0026lt;45 years old\u003c/p\u003e\n\u003cp\u003e\u0026ge;45 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003cp\u003e139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e59.6\u003c/p\u003e\n\u003cp\u003e40.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedian (IQR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lrm;43 (39\u0026ndash;49)\u0026lrm;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e215\u003c/p\u003e\n\u003cp\u003e149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e59.1\u003c/p\u003e\n\u003cp\u003e40.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of spoken languages \u0026lrm;with patients\u003c/p\u003e\n\u003cp\u003e\u0026lrm; 1\u0026ndash;2 languages\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026ge;3 languages\u0026lrm;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e249\u003c/p\u003e\n\u003cp\u003e113\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e68.8\u003c/p\u003e\n\u003cp\u003e31.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of years in practice\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026lt;15\u0026lrm; years\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026ge;15\u0026lrm; years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003cp\u003e211\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e40.9\u003c/p\u003e\n\u003cp\u003e59.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious experience in travel medicine\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e228\u003c/p\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e63.3\u003c/p\u003e\n\u003cp\u003e36.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostgraduate training in travel medicine\u003c/p\u003e\n\u003cp\u003e\u0026lrm; No\u003c/p\u003e\n\u003cp\u003e\u0026lrm; Yes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e309\u003c/p\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e85.8\u003c/p\u003e\n\u003cp\u003e14.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eMissing information: age (n\u0026thinsp;=\u0026thinsp;20), country of medical degree \u0026lrm; (n\u0026thinsp;=\u0026thinsp;19), years in practice (n\u0026thinsp;=\u0026thinsp;7)\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003ePostgraduate experience in \u0026lrm;tropical medicine, \u0026lrm;developing countries, or communicable disease clinic\u0026lrm;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2. Scope of practice in travel medicine\u003c/h2\u003e\n\u003cp\u003eOverall, the majority of PCPs (91.1%; 95% CI: 88.3%-94.1%) reported that they provided pretravel consultations to travellers in the past six months. As shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, of PCPs who provided pretravel consultations (n\u0026thinsp;=\u0026thinsp;332; 91.1%), about three-quarters (72.7%) counselled less than 10 patients per month on TM-related issues. The remaining PCPs counselled 10 to 19 travellers per month (17.7%) or 20 or more travellers per month (9.6%).\u003c/p\u003e\n\u003cp\u003eFigure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. displays the distribution of PCPs according to their reported duration of pretravel consultations, including both counselling and providing prescriptions. Of PCPs who provided pretravel consultations (n\u0026thinsp;=\u0026thinsp;332), almost half (48.8%) had spent between 10 and 19 minutes for pretravel consultation. The remaining had spent either less than 10 minutes (42.7%) or 20 minutes or more (8.5%).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e describes the frequency of counselling and type of advice to travellers according to their destination. Among PCPs who offered pretravel consultations (N\u0026thinsp;=\u0026thinsp;332), the more frequently (i.e., every time and often) reported advice given was about safe water and food (51.1% every time and 33.8% often), traveller\u0026rsquo;s diarrhea (37.8% every time and 40.5% often), insect bite avoidance (38.5% every time and 39.4% often), and in-flight exercise to prevent deep vein thrombosis (DVT) (36.5% every time and 38.9% often). The less frequently reported advice given was about travel health insurance (13.1% every time and 23.8% often), first aid knowledge (17.6% every time and 28.9% often), Jet lag (19.5% every time and 28.0% often), and risk and prevention of Sexual Transmitted Infections (STIs) (19.0% every time and 32.4% often).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFrequency of counselling travellers (according to specific destinations) about pretravel advice in the past 6 months in Qatar (N\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEvery time\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOften\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRarely\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNever\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSafe water and food\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e169 (51.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e112 (33.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e36 (10.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (4.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTraveler\u0026rsquo;s diarrhea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e125 (37.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e134 (40.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e59 (17.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e13 (3.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInsect bite avoidance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e127 (38.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e130 (39.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55 (16.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18 (5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIn-flight exercise to prevent DVT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (36.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e128 (38.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58 (17.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e23 (7.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnimal bite avoidance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e105 (32.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e111 (33.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80 (24.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32 (9.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMotion sickness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78 (23.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (36.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e89 (27.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43 (13.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePersonal safety (e.g. violence, accidents)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e77 (23.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110 (33.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e91 (27.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50 (15.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInfection outbreaks at destination\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66 (20.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (36.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95 (29.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFinding medical assistance while abroad\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60 (18.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e110 (33.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e90 (27.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69 (21.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRisk and prevention of STIs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e62 (19.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e106 (32.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e96 (29.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e63 (19.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJet lag\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e64 (19.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e92 (28.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e103 (31.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70 (21.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFirst aid knowledge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e58 (17.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e95 (28.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e105 (31.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e71 (21.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTravel health insurance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43 (13.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78 (23.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e102 (31.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e105 (32.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eDVT: Deep vein thrombosis, STIs: Sexually transmitted infections\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e describes the frequency of counselling travellers according to their destinations about main travel vaccines and malaria chemoprophylaxis. Among PCPs who offered pretravel consultations, the more frequently reported advice given was for seasonal flu vaccine (70.0% every time and 21.2% often), hepatitis A vaccine (57.6% every time and 29.7% often), hepatitis B vaccine (47.6% every time and 33.8% often), and malaria chemoprophylaxis (50.6% every time and 30.8% often). On the other hand, the less frequently reported advice given was for pre-exposure prophylaxis of rabies (21.1% every time and 35.5% often), and poliomyelitis vaccine (28.4% every time and 35.8% often).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eFrequency of counselling travellers (according to specific destinations) about travel vaccines and malaria chemoprophylaxis in the past 6 months in Qatar, 2020 (N\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEvery time\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOften\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRarely\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNever\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSeasonal flu vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e231 (70.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e70 (21.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21 (6.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8 (2.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHepatitis A vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e190 (57.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e98 (29.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31 (9.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHepatitis B vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e156 (47.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e111 (33.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47 (14.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMalaria chemoprophylaxis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e166 (50.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e101 (30.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46 (14.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e15 (4.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMeningococcal vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e148 (45.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e116 (35.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51 (15.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (4.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTyphoid fever vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e160 (48.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e103 (31.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42 (12.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24 (7.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYellow fever vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e109 (33.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e121 (36.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e72 (21.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e28 (8.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoliomyelitis vaccine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e93 (28.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e117 (35.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75 (22.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42 (12.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRabies (preexposure prophylaxis)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e69 (21.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e116 (35.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e88 (26.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54 (16.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3. Counselling of specific patient groups\u003c/h2\u003e\n\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, among PCPs who provided pretravel consultations, a high proportion of PCPs provided pretravel consultations to patients with chronic diseases (36.9% every time and 41.7% often) and pregnant women (38.1% every time and 30.5% often). On the other hand, a lower proportion\u0026lrm; of PCPs counselled children/adolescents or elderly persons.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003e3.4. Travel-related illnesses in returned travellers\u003c/h2\u003e\n\u003cp\u003eFigure\u0026nbsp;4 shows the frequency of travel-related illnesses in returned travellers. More than three-quarters of PCPs reported more frequent encounters with gastrointestinal (GI) symptoms such as travellers\u0026rsquo; diarrhea (36.7% every time and 41.7% often), respiratory diseases (33.3% every time and 43.3% often), or fever. On the other hand, STIs were the least encountered presentations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e3.5. Factors associated with the frequency of pretravel consultations\u003c/h2\u003e\n\u003cp\u003e\u0026lrm;Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows the comparison between PCPs\u0026rsquo; characteristics and the frequency of pretravel consultations\u0026lrm; per month. Several factors showed statistically significant associations with the frequency of consultations including gender, the number of years in general practice, \u0026lrm;the number of spoken languages \u0026lrm;with patients, previous experience in TM, and postgraduate training in TM.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eRelationship of primary care physicians\u0026rsquo; characteristics and the frequency of pretravel consultations per month in Qatar (Chi-squared test) (N\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTravel medicine consultation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u0026lrm;/month\u003c/p\u003e\n\u003cp\u003en \u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;10\u0026lrm;/\u003cstrong\u003emonth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;45 years old\u003c/p\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;45 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e138 (75.8)\u003c/p\u003e\n\u003cp\u003e93 (73.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e44 (24.2)\u003c/p\u003e\n\u003cp\u003e33 (26.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.688\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e107 (82.3)\u003c/p\u003e\n\u003cp\u003e135 (68.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e23 (17.7)\u003c/p\u003e\n\u003cp\u003e62 (31.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.005*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of years in practice\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026lt;15\u0026lrm; years\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026ge;15\u0026lrm; years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e104 (80.0)\u003c/p\u003e\n\u003cp\u003e138 (70.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e26 (20.0)\u003c/p\u003e\n\u003cp\u003e59 (29.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.046*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of spoken languages with patients\u003c/p\u003e\n\u003cp\u003e1\u0026ndash;2 languages\u003c/p\u003e\n\u003cp\u003e\u0026ge;3 languages\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e172 (77.5)\u003c/p\u003e\n\u003cp\u003e68 (66.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e50 (22.5)\u003c/p\u003e\n\u003cp\u003e35 (34.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.029*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious experience in TM\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e158 (79.8)\u003c/p\u003e\n\u003cp\u003e82 (65.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e40 (20.2)\u003c/p\u003e\n\u003cp\u003e43 (34.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.005*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostgraduate training in TM\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e210 (76.4)\u003c/p\u003e\n\u003cp\u003e32 (61.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e65 (23.6)\u003c/p\u003e\n\u003cp\u003e20 (38.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.022*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e* Statistically significant; TM: travel medicine\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003ePostgraduate experience in \u0026lrm;tropical medicine, \u0026lrm;developing countries, or communicable disease clinic\u0026lrm;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003e3.6. Predictors of frequency of pretravel consultations\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e displays the results of univariable and multivariable logistic regression analyses. In the univariable analysis, various PCP characteristics were significantly associated with a higher frequency of pretravel consultations (\u0026ge;\u0026thinsp;10/month). These variables included male gender, having 15 years or more in general practice, speaking \u0026lrm;\u0026ge;3 languages with patients, having postgraduate experience in TM, and having postgraduate training in TM. The unadjusted OR and 95% CI for these variables are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u0026lrm;\u003c/p\u003e\n\u003cp\u003eIn the multivariable analysis, multilingual physicians (who spoke\u0026lrm; \u0026ge;3 languages\u0026lrm;) were about two times more likely to counsel\u0026thinsp;\u0026ge;\u0026thinsp;10 patients per month on TM issues compared to those who spoke less than three languages (AOR 2.067, 95% CI: 1.180, 3.619). In addition, PCPs who had postgraduate experience in TM were\u0026lrm; almost two times more likely to\u0026lrm; counsel a higher frequency of patients (\u0026ge;\u0026thinsp;10 per month) on TM-related consultations compared PCPs who did not have this work experience (AOR 2.082, 95% CI: 1.209, 3.585).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePredictors of providing ten\u0026lrm; or more travel medicine consultations per month among primary care physicians in Qatar, 2020 (N\u0026thinsp;=\u0026thinsp;332)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUnadjusted OR\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdjusted OR\u003c/p\u003e\n\u003cp\u003e(95% CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;45 years old\u003c/p\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;45 years old\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lrm;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.113 (0.660, 1.876)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.688\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e2.137 (1.243, 3.672)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.005*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.744 (0.980, 3.104)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.058\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of years in practice\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026lt;15\u0026lrm; years\u003c/p\u003e\n\u003cp\u003e\u0026lrm; \u0026ge;15\u0026lrm; years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.710 (1.010, 2.896)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.046*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.495 (0.850, 2.629)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.162\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNumber of spoken languages with patients\u003c/p\u003e\n\u003cp\u003e1\u0026ndash;2 languages\u003c/p\u003e\n\u003cp\u003e\u0026ge;3 languages\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.771 (1.058, 2.964)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.029*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e2.067 (1.180, 3.619)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.011*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious experience in TM\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e2.071 (1.248, 3.437)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.005*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e2.082 (1.209, 3.585)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.008*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostgraduate training in TM\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e2.019 (1.082, 3.769)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.022*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReference\u003c/p\u003e\n\u003cp\u003e1.879 (0.957, 3.689)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.067\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*Statistically significant, OR: Odds ratio, CDC: communicable disease clinic, TM: travel medicine\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003ea: Postgraduate experience in \u0026lrm;tropical medicine, \u0026lrm;developing countries, or communicable disease clinic\u0026lrm;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis cross-sectional study aimed to examine TM practices among PCPs working in primary healthcare settings in Qatar, and the predictors of providing a higher frequency of pretravel consultations (\u0026ge;\u0026thinsp;10 per month). The current study showed that most PCPs (91.1%) provided pretravel consultations to patients, which is consistent with other research conducted in the United States of America (USA), Germany (95%), and Switzerland (96%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In contrast, a study in Oman reported a relatively lower proportion of PCPs (58%) providing pretravel consultation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Pretravel advice: Frequency\u003c/h2\u003e \u003cp\u003eRegarding the frequency of pretravel consultations, about three-quarters of the PCPs in the present study counselled less than 10 patients per month on TM issues. This is consistent with the findings of Kogelman and colleagues in the USA that the majority of the PCPs (80%) had counselled less than 10 patients each month on TM issues [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, in comparison, studies in Germany and Australia reported that the majority of PCPs counselled greater than 10 patients per month on TM-related issues [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur regression analysis showed several predictors of the high frequency of consultations. One predictor was the multilinguality of the PCPs. Those who spoke\u0026lrm; three or more languages were significantly more likely to consult a higher number of patients on travel-related issues than those who spoke only one or two languages. A similar finding was reported by the study in Australia by Heywood and colleagues (2015) \u0026lrm;[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The ability to consult with patients in their preferred language potentially improves communication and trust and promotes change in their travel-related health behaviours [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such an ability is particularly important in Qatar where the population is highly diverse [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother predictor of higher frequency of pretravel consultations was PCPs\u0026rsquo; postgraduate experience in TM. This is consistent with the findings from the studies in Germany and New Zealand [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings emphasize the importance of training and experience in TM or a related field on the frequency of PCPs\u0026rsquo; practice in TM consultations.\u003c/p\u003e \u003cp\u003e\u0026lrm;Providing a high frequency of pretravel consultations\u0026lrm; (\u0026gt;\u0026thinsp;10 per month) was found to be a significant predictor of higher TM knowledge among PCPs in Qatar [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Pretravel advice: Content and Frequency\u003c/h2\u003e \u003cp\u003eThere have been few studies investigating the nature of advice given by PCPs to travellers and how frequently such advice is provided. In the present study, advice on the prevention and management of travellers\u0026rsquo; diarrhea (TD) was given by PCPs every time (38%) and often (41%). In contrast, 85% of PCPs in Germany [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and 78% in Oman [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] had counselled travellers about TD. Advice regarding TD should be provided to all travellers regardless of their destination because it is the most common cause of morbidity in travellers [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother important topic of pretravel consultation is insect bite avoidance and the associated hazards of malaria infection in certain travel destinations. In this study, such advice was provided by PCPs every time (38%) and often (39%). Other studies in Germany, Oman, and Australia reported comparable findings [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is vitally important that PCPs advise travellers going to malaria-endemic areas about the risks associated with insect bites. An earlier study in Qatar had shown that imported malaria had become increasingly a travel-related hazard from 2008 to 2015 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the subject of personal safety such as violence, injury and accidients, only a small proportion of the PCPs provided advice (23% every time and 33% often) against such events. Similar findings have been reported in Australia [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Safety is often a \u0026lrm;neglected area in \u0026lrm;TM,\u0026lrm; but it is one of the \u0026lrm;most important \u0026lrm;areas to cover when advising \u0026lrm;travellers because \u0026lrm;accidents and \u0026lrm;injuries are the most \u0026lrm;common \u0026lrm;preventable causes \u0026lrm;of death among \u0026lrm;them [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u0026lrm; Finally, STIs are another important element in pretravel consultations [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Despite this, only 19% of PCPs in the present study provided pretravel advice on the risk and prevention of STIs (every time), which is inconsistent with those found in studies in Germany (43%) and Australia (30%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This could be explained by the sensitivity of the subject of STIs and its associated stigma in a conservative Muslim culture in this region such as Qatar.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Pretravel advice: Vaccines and Malaria Chemoprophylaxis\u003c/h2\u003e \u003cp\u003eOverall, there is scarce published data regarding the provision of advice on specific vaccine \u0026lrm;recommendations. \u003cb\u003e\u0026lrm;\u003c/b\u003eIn the present study, we found that a relatively high proportion of PCPs provided advice on vaccinations against seasonal flu, hepatitis A, hepatitis, meningococcal and typhoid fever. Comparable rates of advice regarding hepatitis A and B were reported in other studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, \u0026lrm;most PCPs in the current study provided advice on malaria chemoprophylaxis which is in line with findings in other international studies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In contrast, only about a third of PCPs in this study advised travellers about yellow fever vaccine which is also in line with other studies in the USA and Germany [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These findings are alarming because of the high risk of mortality associated with yellow fever. This study reported variations in PCPs\u0026rsquo; practice of providing advice about specific vaccines. Therefore, PCPs should be encouraged to advise travellers about relevant vaccines depending on planned destinations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Counselling specific groups\u003c/h2\u003e \u003cp\u003eMost PCPs in our study provided pretravel advice to patients with \u0026lrm;chronic diseases (79%), pregnant women \u0026lrm;(69%), elderly persons (64%), and children/adolescents (64%). These findings are in line with the study in Germany [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Counselling these vulnerable groups plays an important role in primary care as they could be at a higher risk of acquiring travel-related illness or have contraindications to certain vaccines or medications [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.5. Post-travel consultations\u003c/h2\u003e \u003cp\u003eIn the present study, GI symptoms (e.g., TD) were the most frequent illness (80%) encountered by PCPs \u0026lrm;among returning travellers. Comparable findings were observed in the study in Germany (88%) and the study in Oman (77%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This is an expected finding knowing that TD is the most predictable travel-related illness [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Respiratory and skin diseases were other common presentations during post-travel consultation in this study in contrast to those reported in the \u0026lrm;German and Omani studies [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. \u0026lrm;\u0026lrm;These differences could be explained by the difference in travel destinations and the different characteristics and behaviours of travellers in different countries. In addition, few PCPs in this study encountered STIs among ill-returning travellers. This finding suggests that PCPs should take detailed exposure histories and keep STIs in the differential diagnosis for ill-returning travellers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.6. Strengths and limitations\u003c/h2\u003e \u003cp\u003eThis study has a number of strengths. First, the study was the first of its kind to evaluate TM knowledge and its predictors among PCPs working in primary \u0026lrm;healthcare settings in Qatar. Second, the study achieved a high response rate (91%) despite the high demands placed on PCPs during the COVID-19 pandemic which could be explained by the PCPs\u0026rsquo; interest in this topic. Finally, the results of this study represent PCPs\u0026rsquo; responses from all 27 PHC centres in Qatar. Thus, the findings may be broadly generalizable to the overall general practice in Qatar. However, the cross-sectional design of this study limits its interpretation of the temporal relationship between the variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe majority of PCPs provided pretravel consultations. However, the frequency of consultations was mostly low. Past experience in TM and multilingual physicians were important predictors of the provision of high frequency of pretravel consultations. Pretravel advice content and frequency including vaccine and malaria chemoprophylaxis recommendations were inadequate. Travelers\u0026rsquo; diarrhea, respiratory problems and fever were predominant travel-related issues seen \u0026lrm;by PCPs.\u0026lrm;\u003c/p\u003e \u003cp\u003eThe findings of this study identified several gaps in PCPs\u0026rsquo; TM practice. These potentially place travellers at high risk of acquiring TM-related diseases. Our findings will inform policy makers to design and implement specific measures, such as training and \u0026lrm;best practice guidelines, for PCPs to standardize TM-related practice. Moreover, considering the culturally diverse population in Qatar, the use of professional medical interpreters when providing pretravel consultation\u0026lrm;s and multilanguage information materials should be encouraged to overcome language barriers and enable effective counseling. Such measures may potentially promote \u0026lrm;healthy travel and reduce the burden of travel-related illnesses in Qatar.\u0026lrm;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDVT: Deep Vein Thrombosis\u003c/p\u003e\n\u003cp\u003eGI\u0026lrm;: Gasterointestinal\u003c/p\u003e\n\u003cp\u003eIQR: \u0026lrm;Interquartile Ranges\u003c/p\u003e\n\u003cp\u003ePCP: Primary Care Physician\u0026lrm;\u003c/p\u003e\n\u003cp\u003ePHC\u0026lrm;: Primary Health Care\u003c/p\u003e\n\u003cp\u003eSTIs: Sexual Transmitted Infections\u003c/p\u003e\n\u003cp\u003eTD: Travellers\u0026rsquo; Diarrhea\u003c/p\u003e\n\u003cp\u003eTM: Travel Medicine\u003cstrong\u003e\u003cbr /\u003e \u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this research was obtained from the Institutional Review Boards (IRB) of the Hamad Medical Corporation [Reference number: MRC-01-19-324] and the Primary Health Care Corporation [Reference number: PHCC/DCR/2020/01/002]. All methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). All the participants were asked to consent at the beginning of the questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Medical Research Centre at Hamad Medical Corporation [grant numbers: MRC-01-19-324]. Open Access funding is provided by Qatar National Library. The funder had no role in study design, data collection and analysis, interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAAD: conceptualization, methodology, data collection, formal analysis, funding acquisition, project administration and writing - original draft. NS: \u0026lrm; writing, reviewing and supervising. VK: writing, reviewing \u0026lrm;and supervision. ZM: formal analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the primary care physicians for their valuable participation in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eY.T. Aba, A. Gagneux-Brunon, C. Andrillat, P. Fouilloux, F. Daoud, C. Defontaine, et al. Travel medicine consultation: An opportunity to improve coverage for routine vaccinations, Medecine \u0026amp; Maladies Infectieuses, vol. 49, no. 4, 06, pp. 257-263. \u003c/li\u003e\n\u003cli\u003eUnited Nations World Tourism Organization. Growth in international tourist arrivals continues to outpace the economy. 2020.\u003c/li\u003e\n\u003cli\u003eQatar National Tourism Council. 2018 Annual Tourism Performance Report. 2020; Available at: https://www.qatartourism.com/content/dam/qatar-tourism/2019-Tourism-Performance-Report.pdf. Accessed June 24, 2022.\u003c/li\u003e\n\u003cli\u003eFrost \u0026amp; Sullivan \u0026amp; Insights Middle East. Shaping the future of travel in the Gulf Cooperation Council: Big travel effects, pp. Marcch 12, 2019. \u003c/li\u003e\n\u003cli\u003eUnited Nations World Tourism Organization. International Tourism Results 2017: the highest in seven years. Communications. 2018; Available at: http://media.unwto.org/press-release/2018-01-15/2017-international-tourism-results-highest-seven-years. Accessed February 19, 2021.\u003c/li\u003e\n\u003cli\u003eGrieve S, Steffen R. Epidemiology: Morbidity and Mortality in Travelers. 2020; Available at: https://www.sciencedirect.com/science/article/pii/B9780323546966000021.\u003c/li\u003e\n\u003cli\u003eUnited Nations Sustainable Developmental Group. Policy Brief: The Impact of COVID-19 on the Arab Region An Opportunity to Build Back Better.\u003c/li\u003e\n\u003cli\u003eSanford C, McConnell A, Osborn J. The Pretravel Consultation. Am Fam Physician 2016 Oct 15;94(8):620-627.\u003c/li\u003e\n\u003cli\u003eGherardin T. The pre-travel consultation - an overview. Aust Fam Physician 2007 \u0026lrm;\u0026lrm;05;36(5):300-303.\u0026lrm;\u003c/li\u003e\n\u003cli\u003eAbu Salem M, Mahrous OAA, Gabr I. Role of family physician in healthcare for persons traveling abroad. \u0026lrm;Menufia Med J 2015;28:587-590.\u0026lrm;\u003c/li\u003e\n\u003cli\u003eAw B, Boraston S, Botten D, Cherniwchan D, Fazal H, Kelton T, et al. Travel medicine: what\u0026apos;s involved? When to refer? Canadian Family Physician 2014 Dec;60(12):1091-1103.\u003c/li\u003e\n\u003cli\u003eKogelman L, Barnett ED, Chen LH, Quinn E, Yanni E, Wilson ME, et al. Knowledge, Attitudes, and Practices of US Practitioners Who Provide Pre-Travel Advice. J Travel Med 2014 Mar;21(2):104-114.\u003c/li\u003e\n\u003cli\u003eG. Ropers, G. Krause, van Beest Holle, Mirna, Du Ry, K. Stark and F. Tiemann. Nationwide \u0026lrm;Survey of the Role of Travel Medicine in Primary Care in Germany, Journal of Travel Medicine, \u0026lrm;vol. 11, no. 5, Sep, pp. 287-294. \u0026lrm;\u003c/li\u003e\n\u003cli\u003eKurup PJ, Al Abri SS, Al Ajmi F, Khamis HA, Singh J. Knowledge, attitude and practice of travel medicine among primary care physicians in Oman: the need for intervention. East Mediterranean Health J 2019 01;25(1):40-46.\u003c/li\u003e\n\u003cli\u003ePrimary Health Care Corporation. Primary Health Care Corporation: Health Centers. 2018; Available at: https://www.phcc.qa/portal_new/index/index.php?limit=home#. Accessed February 19, 2022.\u003c/li\u003e\n\u003cli\u003eHatz C, Krause E, Grundmann H. Travel advice: a study among Swiss and German general practitioners. Tropical Medicine \u0026amp; International Health 1997 Jan;2(1):6-12.\u003c/li\u003e\n\u003cli\u003eThava Seelan S, Leggat PA. Referral of travellers from Australia by general practitioners for travel health advice. Travel Medicine \u0026amp; Infectious Disease 2003 Aug;1(3):185-188.\u003c/li\u003e\n\u003cli\u003eHeywood AE, Forssman BL, Seale H, MacIntyre CR, Zwar N. General Practitioners\u0026apos; Perception of Risk for Travelers Visiting Friends and Relatives. J Travel Med 2015 Nov;22(6):368-374.\u003c/li\u003e\n\u003cli\u003eQatar Census 2020 Results (2020) Census 2020. Available at: https://www.psa.gov.qa/en/statistics1/StatisticsSite/Census/census2020/Pages/default.aspx (Accessed: February 12, 2023).\u003c/li\u003e\n\u003cli\u003eLeggat PA, Heydon JL, Menon A. Training, experience and interest of general practitioners in travel medicine in New Zealand. Journal of Travel Medicine 1999 Jun;6(2):60-65.\u003c/li\u003e\n\u003cli\u003eAl-Dahshan, A., Selim, N., Al-Kubaisi, N., Mahfoud, Z., \u0026amp; Kehyayan, V. (2022). Primary \u0026lrm;care physicians\u0026rsquo; knowledge of travel vaccine and malaria chemoprophylaxis and associated \u0026lrm;predictors in Qatar. Plos one, 17(3), e0265953.\u0026lrm;\u003c/li\u003e\n\u003cli\u003eBradley AC. CDC health information for international travel. Oxford: Oxford University Press; 2017.\u003c/li\u003e\n\u003cli\u003eFarag E, Bansal D, Chehab MAH, Al-Dahshan A, Bala M, Ganesan N, et al. Epidemiology of Malaria in the State of Qatar, 2008-2015. Mediterranean Journal of Hematology \u0026amp; Infectious Diseases 2018;10(1):e2018050.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. International travel and health . 2012.\u003c/li\u003e\n\u003cli\u003eRoupa Z, Zikos D, Vasilopoulos A, Diomidous M. Common Health Risks, Required Precautions of Travelers and their Customs Towards the Use of Travel Medicine Services. Materia Sociomedica 2012;24(2):131-134.\u003c/li\u003e\n\u003cli\u003eStarr M, Hagmann SHF. Travel medicine and the child traveler: Challenges for pediatric health providers in a globalized world. Travel Medicine \u0026amp; Infectious Disease 2020 Mar;34:101644.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"travel medicine, practice, physicians, primary healthcare, Qatar","lastPublishedDoi":"10.21203/rs.3.rs-2849273/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2849273/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn an era of globalization, travel-related illnesses have become a focus of public ‎health concern. Pretravel consultation is an effective measure for the prevention travel-related illnesses. ‎ The purpose of this study was to assess the scope of primary care physicians’ (PCP) practice of travel medicine (TM) in Qatar and its associated predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study design. A structured questionnaire was used to collect ‎data from all PCPs working in all 27 primary healthcare centers in Qatar.‎ Descriptive and analytic statistics were used as appropriate. ‎A multivariable logistic regression model was constructed to identify predictors of TM practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree hundred sixty-four PCPs participated in the study with a response rate of 89.2%. Most PCPs (91.1%) reported they provided pretravel consultations of which 72.7% provided \u0026lt; 10 consultations per month and almost half of them reported they spent between 10 and 19 minutes for pretravel consultation. ‎Overall, pretravel advice content and frequency including vaccine and malaria chemoprophylaxis recommendations were inadequate. The significant predictors of high frequency of pretravel consultations (≥ 10/month) included PCPs who had past experience in TM (AOR 2.082, 95% CI: 1.209, 3.585) and multilingual physicians (AOR 2.067, 95% CI: 1.180, 3.619). Patients with chronic diseases and pregnant women ‎ were specific patient groups more frequently counselled about pretravel advice. Frequently encountered post-travel illnesses included travelers’ diarrhea, respiratory diseases, and fever.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of PCPs provided pretravel consultations. However, the frequency and content of consultations were inadequate. Past experience in TM and multilingual physicians were important predictors of providing a high frequency of pretravel consultation. The findings of this study identified several gaps in PCPs’ TM practice. Specific measures should be designed and implemented to promote ‎healthy travel and reduce the burden of travel-related illnesses in Qatar.\u003c/p\u003e","manuscriptTitle":"Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-26 17:46:51","doi":"10.21203/rs.3.rs-2849273/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c90cb8dd-c030-439d-8ecc-17d1eeb8a2d5","owner":[],"postedDate":"April 26th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-04-29T05:59:22+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-26 17:46:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2849273","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2849273","identity":"rs-2849273","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}