The quality of travel clinics in the Netherlands.

BACKGROUND: In 1996, the Dutch National Coordination Center for Travelers' Health Advice (LCR) was established to improve uniformity in health advice to travelers and in the quality of national vaccination centers. In this study, we evaluate the influence of LCR guidelines on the quality of travel clinics in the Netherlands. METHODS: In 1997 and 2001, questionnaires regarding implementation of LCR quality criteria were sent to the Dutch travel clinics where most travel advice is given. In 2003, the Health Care Inspectorate surveyed all Dutch yellow fever vaccination centers including those surveyed in 1997 and 2001. The data yielded by all three surveys were included in our assessment. RESULTS: The response rate was 78, 84, and 100% in 1997, 2001, and 2003, respectively. Between 1997 and 2001, the number of travel clinics with 5,000 visitors or more increased. The LCR quality criteria are widely implemented: of the criteria surveyed in this study, 11/14 (79%) were implemented in more than 80% of the clinics in 2003. Between 1997 and 2003, vaccine management improved (eg, registration of batch numbers and monitoring of refrigerators); in more clinics, physicians were present in case of emergency and advice given by nurses was more often checked daily, but this is still only in 52% of the travel clinics. Although two thirds of the professionals working in travel medicine are nurses, only 55% of them were adequately trained in this specialty. CONCLUSIONS: Between 1997 and 2003, the LCR quality guidelines are widely implemented, but implementation can still be improved. To further improve the quality of travel clinic staff, the LCR recently started certification of basic and refresher courses for physicians and nurses working in travel medicine and now registers those completing such courses.

Dutch travel health nurses: prepared to prescribe?

BACKGROUND: In travel medicine, as in other specialties, independent prescribing of medication has traditionally been the domain of practitioners like physicians, dentists, and midwives. However, a 2011 ruling in the Netherlands expands independent prescribing and introduces supplementary prescribing by nurses, with expected implementation over the next few years. As specialist nurses will not be eligible for independent prescribing, this study addresses supplementary prescribing, specifically by travel health nurses. Such nurses will work in partnership with an independent prescriber, usually a physician. After the physician evaluates a patient's condition and needs, the nurse may prescribe from an open or limited formulary. This supplementary approach seems appropriate in travel medicine, which is highly protocolized. A questionnaire survey was conducted to assess whether travel health nurses themselves aspire and feel competent to prescribe, and what training they might need. METHODS: All travel health nurses in the Netherlands received a questionnaire seeking their anonymous response. RESULTS: The response rate was 58%. Self-reported compliance with protocols and quality criteria was high; 82% of respondents aspire to prescribe and 77% feel competent to prescribe. Of the latter, 22% indicated that ongoing access to a doctor would remain important, and 14% preferred to prescribe under certain conditions like a restricted number of medicines. The reason most frequently given for not feeling competent was the need for additional education before obtaining prescribing rights (40%). Aspiration to prescribe was the only significant predictor for feeling competent to prescribe (odds ratios: 6.8; 95% confidence intervals: 3.5-13). Of all the responding nurses, 95% reported one or more educational needs related to prescribing, particularly in pharmacology. CONCLUSIONS: Most Dutch travel health nurses aspire to prescribe and feel competent for the supplementary approach, but require further education before the approach is implemented in travel medicine.

Does registration of professionals improve the quality of travelers' health advice?

BACKGROUND: The objectives of the Dutch National Coordination Center for Travelers' Health Advice (LCR) are to improve the uniformity of travelers' health advice in the Netherlands and to enhance its quality. The LCR offers national guidelines and quality criteria, as well as a telephone consultation service, where health professionals can pose questions regarding travel medicine. Since 2005, a register for qualified travel health professionals has been in place. We studied the quality and relevance of the telephone consultations, to see whether there was a difference between registered as qualified and nonregistered health professionals. METHODS: Telephone questions regarding pretravel advice were logged in September 2007. The questions were categorized as basic or advanced and compared by the profession of the caller, type of institution, and LCR registration of the responsible physician. RESULTS: In 2007, 85% of travel clinic physicians, 42% of general practitioners, and 31% of travel clinic nurses were registered with the LCR. A total of 146 telephone consultations were included in the analysis. Significantly more callers from travel clinics posed advanced questions than those from general practices [odds ratio (OR) 7.6; 95% confidence interval (CI): 3.6-16.1; p= 0.000]. More callers who were registered asked advanced questions, although this difference was not significant (OR 1.7; 95% CI: 0.9-3.3; p= 0.124). Assistants from general practices asked significantly less advanced questions than physicians or nurses. CONCLUSIONS: Opening a register for travel health professionals has led to a large increase of professionals who follow courses and register as travel health professionals. A positive association was found between the quality of the questions and the registration of the responsible physician. The quality of travel health advice given in general practices needs increased attention.