title: Variability in malaria prophylaxis prescribing across Europe: a Delphi method analysis.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Travel Medicine Unit, Amedeo di Savoia Hospital, Torino, Italy. calleri@asl3.to.it
authors.forename: Guido
authors.initials: G
authors.lastname: Calleri
authors.forename: Ron H
authors.initials: RH
authors.lastname: Behrens
authors.forename: Zeno
authors.initials: Z
authors.lastname: Bisoffi
authors.forename: Anders
authors.initials: A
authors.lastname: Bjorkman
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gascon
authors.forename: Federico
authors.initials: F
authors.lastname: Gobbi
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
authors.forename: Tomas
authors.initials: T
authors.lastname: Jelinek
authors.forename: Matthias L
authors.initials: ML
authors.lastname: Schmid
authors.forename: Mauro
authors.initials: M
authors.lastname: Niero
authors.forename: Pietro
authors.initials: P
authors.lastname: Caramello
mesh_terms: 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
chemical_list: D000962:Antimalarials