Variability in malaria prophylaxis prescribing across Europe: a Delphi method analysis.
BACKGROUND
The indications for prescribing malaria chemoprophylaxis lack a solid evidence base that results in subjectivity and wide variation of practice across countries and among professionals.


METHODS
European experts in travel medicine, who are members of TropNetEurop, participated in a survey conducted using the Delphi method. This technique aims at evaluating and developing a consensus through iterations of questionnaires, controlled feedback, and statistical group responses.


RESULTS
A first questionnaire, including questions about controversial issues in prescribing malaria prophylaxis, required responses on a visual scale between 1 and 10. The questionnaire included issues on problematic prescribing, characteristics of drugs, relevance of geography, and importance of insect bite prevention. The repeat questionnaire with the group response from the first round revealed an increasing consensus on most issues. A second survey considered 14 practical scenarios (including two internal standards) and investigated preferred choice of prophylaxis. A significant consensus was noted in 8 of 14 scenarios, which did not increase after a second round. The analysis revealed a wide variation in prescribing choices with preferences grouped by region of practice, and a greater willingness to prescribe in northern and southern Europe than in central Europe. The second round showed a 9.5% change of opinion.


CONCLUSIONS
The study shows that improving the evidence base on efficacy and tolerability and risk of malaria for prescribing chemoprophylaxis is needed as is further discussion across Europe to achieve harmonization of prescribing practice.
Calleri
Guido
G
Department of Infectious Diseases, Travel Medicine Unit, Amedeo di Savoia Hospital, Torino, Italy. calleri@asl3.to.it
Behrens
Ron H
RH
Bisoffi
Zeno
Z
Bjorkman
Anders
A
Castelli
Francesco
F
Gascon
Joaquim
J
Gobbi
Federico
F
Grobusch
Martin P
MP
Jelinek
Tomas
T
Schmid
Matthias L
ML
Niero
Mauro
M
Caramello
Pietro
P
D000349:Africa; D000962:Antimalarials / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D018890:Chemoprevention / Q000706:statistics & numerical data*; D003697:Delphi Technique; D005060:Europe; D006801:Humans; D007194:India; D008288:Malaria / Q000517:prevention & control*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014195:Travel
D000962:Antimalarials