One study of US travelers found that 49% of all deaths were due to cardiovascular events, much more than deaths due to accidents and infectious causes combined.[21] Others have described unique challenges to chronic disease management associated with travel.[22-28] However, it is unclear if management of chronic medical conditions might also be impacted by VFR travel. It is anticipated that VFR travelers may experience poorer control of cardiovascular selleck chemical risk factors such as blood pressure, blood glucose, and lipid profile during their trips. In addition, serum levels of drugs with
a narrow therapeutic window, such as warfarin, may be inadequately monitored, leading to increased risk of complications. The purpose of this study was to conduct a retrospective review to investigate the impact of VFR travel on health with a particular focus on markers of chronic disease management: hemoglobin A1c, low density lipoprotein (LDL), systolic blood pressure (SBP), diastolic
blood pressure (DBP), body mass index (BMI), serum creatinine (SCr), and international normalized ratio (INR). This investigation was approved by the Institutional Review Board of the University of Washington. All subjects in the study receive primary care services at a clinic serving adult, first-generation immigrants and refugees residing in King County, Washington. The clinic is associated with an academic medical center and visits were conducted by attending physician, medicine resident, physician’s assistant, or clinical pharmacist. selleckchem All patient visits were conducted face-to-face with the assistance of a professional interpreter owing to
the limited English proficiency of the study patient population. Travel health services are routinely offered in the clinic and two of the attending physicians have specific training in travel medicine. A retrospective chart review was performed on patients engaged in VFR travel between January 1, 2003 and December 31, 2010. Candidates for the study were identified by searching the electronic medical record for clinic notes in which travel was identified as the primary reason for the visit. Additional candidates were Urocanase identified by reviewing the clinic’s pharmacy dispensing records for patients who received the drug doxycycline. This strategy was chosen because virtually all of the clinic’s patients who travel to malaria-endemic regions use doxycycline for malaria prophylaxis, as it represents the most affordable choice for those with limited incomes traveling for prolonged time periods in chloroquine-resistant areas. Inclusion criteria for the study included age ≥18, travel ≥21 days to a low-income country, documentation of a travel health counseling visit within the 6-month time period before the beginning of travel, and at least one additional visit within 6 months of return from travel.