Variability of clinical practice decisions on Latin American mobile medical service trips (MSTs)

Abstract

# Background Short-term medical service trips (MSTs) are increasing in popularity, but there is scant evidence evaluating the working competence of volunteer clinicians. Challenges to providing consistent high-quality care include cultural and language barriers, the frequent absence of confirmatory diagnostic tests, and a lack of context-appropriate best practice guidelines. # Methods A questionnaire using case vignettes was used to compare the management strategies of volunteer clinicians for five of the most common diagnoses seen on MSTs in Latin America and the Caribbean (LAC). North American MST-sending organizations were emailed through a publicly-available database of MSTs. Those who consented to participate were sent the link to a questionnaire based in either a LAC context, or a control version based in the context of a North American clinic. # Results There were 24 completed responses to the LAC survey and 13 completed responses to the control questionnaire. For dyspepsia, clinicians commonly selected lifestyle interventions and treatment with either an antacid, H2 antagonist, or proton pump inhibitor (PPI). For acute diarrhea, those completing the LAC context survey were significantly more likely to suggest albendazole(*P=*0.004) and trended towards suggesting metronidazole (*P=*0.117) and zinc (*P=*0.394) more frequently. For URI, clinicians commonly suggested acetaminophen or ibuprofen, and less commonly suggested a saline nasal spray. Those responding to the LAC context survey were significantly less likely to recommend cough drops (*P=*0.036), and significantly more likely to recommend antibiotics (*P=*0.035). For vaginal discharge, clinicians commonly suggested empiric treatment for bacterial vaginosis with metronidazole, and those responding to the LAC context survey were more likely to recommend empiric antibiotic treatment (*P=*0.175) and advice regarding prevention (*P=*0.149) of sexually transmitted infection. For undifferentiated pruritus, clinicians commonly suggested symptomatic treatment with hydrocortisone cream and moisturizing lotion, and those responding to the control questionnaire were significantly more likely to recommend scabicides (*P=*0.039). # Conclusions The treatment decisions of MST clinicians for common diagnoses are often highly variable, highlighting a need for increased attention to pre-departure training, and context-appropriate guidelines for best clinical practice.