Measuring outcomes of a pharmacist-run travel health clinic located ...

SPECIAL FEATURE
Abstract
Objectives: To describe the acceptance and refusal rates of travel-related vaccine
and medication recommendations in a pharmacist-run travel health clinic, to
evaluate the change in patient understanding of travel-related issues, to determine
patient satisfaction with this clinic, and to determine factors influencing both patient
acceptance and satisfaction.
Setting: Southern California (Claremont) between July 2007 and October 2008.
Practice description: Hendricks Pharmacy is an independently owned community
pharmacy that is part of the Good Neighbor Pharmacy Provider Network. The
pharmacy offers a range of services including home delivery, compounding, and blood
glucose, blood pressure, and cholesterol screenings.
Practice innovation: Comprehensive pharmacist-run travel health clinic.
Main outcome measures: Patient acceptance and refusal rates of pharmacistmade
recommendations, changes in patient understanding of travel-related issues
resulting from pharmacist counseling, and patient satisfaction with this travel health
clinic.
Results: In a sample of 283 patients, overall patient acceptance of pharmacistmade
recommendations was 84.7%. The primary reason for patient refusal of a recommendation
was self-perceived low risk for infection. A subsample of patients (n =
82) completing a patient satisfaction survey found that 96% were satisfied with their
overall visit. Patient satisfaction with the clinic and pharmacist services was correlated
with overall patient acceptance.
Conclusions: The high rate of patient acceptance and satisfaction with this clinic
supports adoption of pharmacists as nontraditional providers of travel health services.
Keywords: Independent community pharmacy, travel health, and immunizations.
J Am Pharm Assoc. 2010;50:174–180.
doi: 10.1331/JAPhA.2010.09204
174 • JAPhA • 50:2 • M a r/apr 2010
Measuring outcomes of
a pharmacist-run travel
health clinic located in an
independent community
pharmacy
Karl M. Hess, Chih-Wei Dai, Brian Garner, and Anandi V. Law
www.japha.org
Received October 31, 2009, and in revised
form January 24, 2010. Accepted for publication
January 28, 2010.
Karl M. Hess, PharmD, is Assistant Professor
of Pharmacy Practice and Administration,
College of Pharmacy, Western University of
Health Sciences, Pomona, CA. Chih-Wei Dai,
PharmD, was a community pharmacy practice
resident, College of Pharmacy, Western
University of Health Sciences, Pomona,
CA, at the time this study was conducted;
he is currently Clinical Pharmacist, Ralphs
Grocery Stores, Los Angeles. Brian Garner,
PharmD, is owner and pharmacist in charge,
Hendricks Pharmacy, Claremont, CA. Anandi
V. Law, BPharm, PhD, is Associate Professor
of Pharmacy Practice and Administration
and Department Chair, College of Pharmacy,
Western University of Health Sciences, Pomona,
CA.
Correspondence: Karl M. Hess, PharmD,
College of Pharmacy, Western University
of Health Sciences, 309 E. Second St., Pomona,
CA 91766. Fax: 909-469-5539. E-mail:
khess@westernu.edu
Disclosure: The authors declare no conflicts
of interest or financial interests in any
product or service mentioned in this article,
including grants, employment, gifts, stock
holdings, or honoraria.
Funding: Initial funding of this clinic was
made possible by the Community Pharmacy
Foundation. Funding of this research project
was made possible by the APhA Foundation.
Previous presentation: American Pharmacists
Association Annual Meeting, San Antonio,
TX, April 3–6, 2009.
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From 1999 to 2009, approximately 290 million visits
were made by U.S. citizens to overseas international
destinations such as the European Union, the Caribbean,
Asia, Central and South America, Oceania, the Middle
East, and Africa. 1 The World Health Organization recommends
that travelers “consult a travel medicine practitioner or physician
four to eight weeks before departure in order to allow
sufficient time for optimal immunization schedules to be completed.”
2 Despite this recommendation, many travelers do not
seek the advice of their physician or other health care provider
to learn about and protect themselves from otherwise preventable
food-, water-, and vector-borne diseases before departure
from the United States. Furthermore, approximately 22% to
64% of American travelers report some health problem that
might have otherwise been prevented during travel (e.g., diarrhea,
respiratory infections, dermatological conditions);
however, less than 10% actually seek medical attention while
traveling. 3
A survey conducted in 2004 indicated that only 36% of
travelers sought travel health advice before departing the
United States. Among individuals who did not seek advice, 22%
did not perceive a need to do so, 20% did not perceive a risk
At a Glance
Synopsis: The current work describes the experiences
of a pharmacist-run travel health clinic at an
independent community pharmacy in southern California.
Insight is provided into patient acceptance of pharmacist-made
recommendations, reasons for refusal of
recommendations, effect on self-reported understanding
of travel-related issues, and satisfaction with the
clinic. Among 283 patients, overall acceptance of pharmacist-made
recommendations was 84.7%. The primary
reason for patient refusal of a recommendation
was self-perceived low risk for infection. A satisfaction
survey among 82 patients found that 96% were satisfied
with their overall visit. Patient satisfaction with
the clinic and pharmacist services was correlated with
overall patient acceptance.
Analysis: The authors believe that this travel
health service can be reproduced within other independent
community pharmacies, especially when a strong
collaboration exists among the travel clinic pharmacist,
pharmacy store owner, and supervising physician.
The highest rate of patient acceptance was for the yellow
fever vaccine (96.8%), probably because the majority
of patients in this clinic were traveling to yellow
fever endemic areas within South America and Africa,
for which yellow fever vaccination normally would be
indicated and recommended. For independent community
pharmacies to more broadly implement similar
travel health clinics, further study of the costs associated
with starting up and maintaining such clinics as
well as their profitability is necessary.
PHARMACIST-RUn TRAvEL HEALTH CLInIC SPECIAL FEATURE
of illness at their travel destination, and 10% were too busy to
either make an appointment or keep their scheduled appointment.
4 The results of this survey indicate that few Americans
are aware of the medical issues that surround international
travel and the need for protection against bothersome (e.g.,
travelers’ diarrhea, cutaneous larva migrans) and potentially
fatal (e.g., yellow fever, malaria, rabies) travel-related diseases.
Community pharmacists can play a vital role in patient education
and disease prevention because of their high visibility
and accessibility to the general public in local communities. In
most states, collaborative practice laws exist that allow pharmacists
to administer routine and travel-related vaccines and/
or to furnish medications to their patients under a physiciansupervised
collaborative practice protocol. As a result, community
pharmacies can offer a unique experience whereby
patients can receive all necessary vaccines, oral medications,
and other travel supplies, as well as in-depth patient education
regarding their travel plans, in one clinic appointment. Properly
marketed and advertised, community pharmacy–based travel
health clinics may help to increase the overall percentage
of individuals seeking travel health advice and may help to increase
public awareness of the multitude of diseases that can
occur during travel and the importance of preventing them.
Hendricks Pharmacy is an independently owned community
pharmacy that is part of the Good Neighbor Pharmacy Provider
Network. It is located in and has been serving the needs
of the greater Claremont, CA, area for more than 50 years. The
clientele of the pharmacy consists largely of college students
and retirees who use the pharmacy not only for its traditional
dispensing, home delivery, and compounding services but also
for receiving routine immunizations such as influenza, hepatitis
B, and tetanus booster. In addition, the pharmacy offers
screenings and patient education for common diseases such
as diabetes, hypertension, and dyslipidemia. In July 2007,
Hendricks Pharmacy established an international travel health
clinic that follows a pharmacist–physician collaborative practice
protocol. The clinic is located in a completely private area
within the pharmacy and has all necessary supplies and equipment
(e.g., syringes, sharps containers, biohazard waste containers,
separate refrigerator/freezer with vaccines, computer
with Internet access) contained in it to help facilitate patient
care activities. Further, the clinic is adjacent to and has direct
access to the main pharmacy and dispensing areas to help facilitate
workflow between locations. This clinic usually cares
for patients within a radius of 15 miles from the pharmacy,
as the clinic is the only one of its kind in the immediate area;
however, patients have come from as far away as 100 miles for
care in isolated cases. After the pharmacist’s consultation in
the travel health clinic, the patient’s insurance plan is billed
for services rendered; however, most patients pay out of pocket
because travel-related vaccines and medications are not
generally covered by insurance. The international travel health
clinic has been made visible in large part because of extensive
marketing and promotion through in-store flyers and posters,
mailed advertisements and letters, and physician detailing.
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SPECIAL FEATURE PHARMACIST-RUn TRAvEL HEALTH CLInIC
The pharmacist–physician collaborative practice protocol
under which the clinic operates allows the pharmacists, community
pharmacy residents, and student pharmacists at Hendricks
Pharmacy to administer all necessary vaccines and to
furnish appropriate travel-related medications to patients before
their departure. In addition, the clinic is recognized as an
official yellow fever vaccination center by the Centers for Disease
Control and Prevention. The clinic’s director (K.M. Hess)
completed a community pharmacy practice residency focused
largely on travel health and is currently a full-time pharmacy
practice faculty member who teaches in the area of immunizations
and travel health. He also holds the Certificate in Travel
Health (CTH) from the International Society of Travel Medicine
(ISTM). According to ISTM, the CTH “recognizes individual excellence
in knowledge in the field of travel medicine, associated
with pre-travel care and consultation.” 5 The clinic is staffed
with one to two pharmacists, two to three student pharmacists,
and a community pharmacy practice resident; however,
most consultations are done by K.M. Hess. The goals of this
clinic are to help improve patient health status by educating
patients about health and personal risks such as malaria, travelers’
diarrhea, and other non–vaccine-preventable diseases,
as well as advising them on good health practices to prevent
food-, water-, and vector-borne diseases while traveling.
During the study period (July 2007 to October 2008), 283
patients were seen at this pharmacist-run travel health clinic
for advice and recommendations regarding a variety of destinations
ranging from Western Europe to Sub-Saharan Africa.
The majority of the patients’ travel destinations were located
within South America or Africa, where a need may have existed
for vaccinating them against yellow fever. During this time period,
more than 700 travel-related vaccines and medications
were either administered or dispensed according to the clinic’s
collaborative practice protocol.
Few reports appear in the literature regarding pharmacist-run
travel health clinics in the United States. Two previous
studies described a pharmacist-run telepharmacy-based travel
clinic service that predominately serves members of a large
health maintenance organization. 6,7 Another study described
the implementation of a pretravel health program within a local
supermarket chain. 8 To our knowledge, no published study
has evaluated patient outcomes and satisfaction associated
with a pharmacist-run travel health clinic within the independent
community pharmacy setting. Patient satisfaction with
travel-related services provided by a primary care provider
was evaluated in another study, which found that satisfaction
was associated with receiving care in one location; however,
no objective measurement of satisfaction was included. 9
Objectives
We sought to examine the effectiveness of a pharmacist-run
travel health clinic by analyzing patient acceptance and refusal
rates to pharmacist-made recommendations, changes
in patient understanding of travel-related issues, and patient
satisfaction with this travel health clinic. Finally, we aimed to
explore factors influencing these outcomes.
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Methods
This study consisted of both a retrospective review of all patient
records and a prospective survey of all patients who made
appointments in the travel health clinic during the study period
(from July 31, 2007, to October 31, 2008; n = 283). Institutional
review board approval was obtained from the primary
author’s institution.
A retrospective review of patient records was conducted
by analyzing all pharmacist-made recommendations that were
logged into the clinic’s database, which is continually updated
after each patient visit. This database contains information on
each patient, including their age, gender, destination of travel,
and all recommendations made by the pharmacist and acceptance
or refusal of these recommendations by patients. All
pharmacist-made recommendations were derived from a systematic
evidence-based review of well-established, commonly
used, and frequently updated Internet-based travel medicine
programs (e.g., Travax, Tropimed, TravelCare) and from each
patient’s specific travel itinerary obtained from their travel history
form, which was submitted to the clinic before their scheduled
visit. Patients obtained this travel history form by downloading
it from the pharmacy’s website (www.hendrickspharmacy.com).
Descriptive analysis of the retrospective data from
patients seen at the travel clinic was conducted to determine
the rate of acceptance of pharmacist-made recommendations
per vaccination type and overall across all vaccinations. Acceptance
was calculated as the ratio of number of administered
vaccines to vaccines recommended by the pharmacist.
Correlational analyses were conducted to test the likelihood
that acceptance of one type of travel vaccine was related to acceptance
of others.
In addition, an exploratory survey was developed to help
evaluate patient satisfaction with the services provided by
the clinic, possible reasons for refusal of any recommendation
made, and patient understanding of travel-related issues.
Multiple-choice questions on a four-point Likert-type scale (1,
strongly disagree; 2, disagree; 3, agree; 4, strongly agree) were
used to determine patient understanding of travel-related issues
and patient satisfaction with the travel health clinic. Openended
questions were used to determine patient perceptions
of the travel health clinic. The survey was reviewed by a panel
for face and content validity and was initially administered by
the investigators via phone from a private office during normal
business hours between 9:00 am and 5:00 pm. Three separate
attempts were made to reach patients by phone during this survey
stage, which lasted for approximately 2 months. Patients
who could not be reached by phone after three call attempts
or who opted to take a written survey instead received their
survey in the mail to complete at home. Patients who received
a mailed survey were given approximately 2 weeks to complete
it. All mailed surveys included a self-addressed stamped envelope.
As an incentive for completing the survey, all respondents
were enrolled in a drawing for one of six gasoline cards, each
worth $50.
Prospective data collected from patients via the survey
were analyzed using descriptive statistics to obtain satisfac-
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tion scores and mean differences in understanding before and
after pharmacist consultation. Student’s t tests were conducted
to compare between these means. Scores from survey items
measuring satisfaction were averaged, with each item weighted
equally for an overall measure of satisfaction. This summary
measure was correlated with an item that asked overall satisfaction
with the clinic. Overall patient acceptance with recommendations
was correlated with the summary satisfaction
score. All analyses were conducted at a significance level of
alpha = 0.05. Reliability (internal consistency) of the survey
scale was measured using Cronbach’s alpha. An exploratory
factor analysis via principal component analysis of the satisfaction
items was conducted using varimax rotation to examine
whether the survey measured the aspects of satisfaction that it
intended to measure (clinic- and pharmacist-specific items, in
addition to the four-item measure of understanding of travelrelated
vaccines).
Results
Retrospective database review
Complete information was obtained from the deidentified clinic
database for 283 patients who were seen by the travel clinic
pharmacist during the study period. The mean (±SD) age of the
sample was 47.21 ± 19.52 years, and approximately 59% of
the patients were women. This coincides with the average age
of travelers reported by the U.S. Travel Association. 10 The top
travel destinations are featured in Figure 1 and trended toward
South America and Africa. The overall acceptance rate for
pharmacist-made recommendations was approximately 85%
and ranged from 67% for polio to 97% for yellow fever (Figure
2). Acceptance rate of the yellow fever vaccine was also significantly
associated with acceptance for five other vaccinations
(hepatitis A, tetanus/diphtheria/pertussis, intramuscular and
oral typhoid, and meningococcal).
Prospective survey
Of the satisfaction surveys mailed to all 283 patients, complete
data were obtained from 82 patients for an effective response
rate of 29%. A nonresponse post hoc analysis was undertaken
to determine possible differences between survey respondents
and nonrespondents to help explain our low response
rate. This analysis revealed that age, gender, and acceptance
rates to vaccines were not significantly different between these
groups. Survey respondents were mostly women (69.2%),
were aged 52.23 ± 19 years, were reasonably educated (high
school graduate or above), were mostly white, and had a median
income that was higher than the median household income
in the United States. 11 Survey respondents also appeared
to reasonably resemble the average U.S. traveler in terms of
age (average 46 years), education (39% with college degree),
and income (median higher than U.S. average). 10 Of the 82 respondents,
52% named perception of low risk of contracting a
travel-related disease as the reason for refusing pharmacistmade
recommendations (Figure 3). A considerable increase in
self-reported understanding of travel-related issues based on
pharmacist consultation occurred for all four items (mean dif-
PHARMACIST-RUn TRAvEL HEALTH CLInIC SPECIAL FEATURE
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Country
Reasons for refusal
Thailand
Chile
Ecuador
Argentina
Brazil
Peru
Tanzania
Perceived low risk for disease contraction
Interested only in yellow fever vaccination
Cost
Did not like getting vaccines and/or taking
medications
Not confident in pharmacist
recommendations
Not recommended by others (e.g., health
care providers, friends, relatives)
Concerned about possible adverse effects
17
17
20
22
0 10 20 30 40 50 60
3
3
7
7
31
14
14
34
Number of visits
Figure 1. Most commonly reported travel destinations by patients
Products recommended
Total
Malaria medication
Polio
Yellow fever
Meningococcal
IM typhoid
PO typhoid
Hepatitis A
66.7
71.4
77.7
76.5
52
0 10 20 30 40 50 60
Percent
79.4
84.7
50
94.2
96.8
0 20 40 60 80 100 120
Acceptance rate (%)
Figure 2. Patient acceptance rates for travel-related vaccines and
medications
Abbreviations used: IM, intramuscular; PO, by mouth.
Multiple recommendations are possible for each patient.
Malaria medications include atovaquone/proguanil, mefloquine, chloroquine, and
doxycycline.
Figure 3. Reasons for refusal of pharmacist-made recommendations
(n = 82)
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SPECIAL FEATURE PHARMACIST-RUn TRAvEL HEALTH CLInIC
ference ranged from 0.5 to 1.3 on a four-point Likert-type scale
of agreement; Table 1). Based on nine items, satisfaction with
the clinic was 3.68 ± 0.45 (range 3.62–3.84). Overall patient
acceptance of the pharmacist’s recommendations among the
survey respondents was significantly correlated with overall
satisfaction (P = 0.021).
Reliability of the satisfaction scale measured using Cronbach’s
alpha was 0.92 (Table 2). Exploratory factor analysis of
the satisfaction items revealed two factors consisting of items
that measured similar concepts that correlated with each other.
These factors were convenience of clinic services and quality
of interaction with pharmacist (Table 3). Only one item (“I
was able to receive all the vaccines and/or medications that I
needed/wanted for my travel during my appointment”) loaded
highly onto a factor to which it did not appear to belong. The
four items that measured knowledge loaded onto a third factor
when added into the analysis.
Discussion
Although pharmacist-run travel health clinics in the United
States have been previously reported in the literature, none
have described the pharmacist’s activity and impact within the
independent community pharmacy setting. The current study
provides insight into patient acceptance of pharmacist-made
Table 1. Change in self-reported understanding following pharmacist consultation (n = 78)
Score before consultation Score after consultation
Survey item
Mean ± SD
Mean ± SD P
I understood how to use my travel medication(s) correctly
I understood the possible adverse effects of my travel medication(s)
2.51 ± 1 3.82 ± 0.39

sociated with outbreaks in most places of the world, and unless
travel was to a specific country or region of the world where
these diseases are endemic, the risk for infection is considered
less than 0.0001% per month of travel to a developing country.
12
The yellow fever vaccine had the highest rate of patient
acceptance (96.8%) and may have resulted from several reasons.
The majority of patients in this clinic traveled to yellow
fever endemic areas within South America and Africa, where
yellow fever vaccination normally would be indicated and recommended.
However, other patients may have required the
vaccine because of International Health Regulations because
they were traveling through a country with risk of yellow fever
on their way to another country and did not have a medical
contraindication to vaccination (e.g., pregnancy, allergy to
eggs or gelatin, immune suppression, thymus disorder). The
fact that yellow fever vaccine is sometimes required for travel
may have caused patients to decline other vaccines or medications,
thereby reducing our overall patient acceptance rate.
However, receipt of yellow fever vaccine predicted acceptance
of five other vaccines.
The primary reason for patient refusal of a recommendation
was self-perceived low risk for infection (52%). Secondary
reasons for refusal included interest only in the yellow fever
vaccine and cost (14% for each). Cost was a factor because
patients typically paid out-of-pocket for this service. Other reasons
for refusal, as indicated in Figure 3, ranked lower and,
interestingly, nonconfidence in the pharmacist’s recommendations
occurred in 7% of responses. Patient refusal may also
result from a host of factors, such as past travel experiences,
planned activities during travel, or length of stay at destination;
however, further analysis is required to determine the source
of this perception.
PHARMACIST-RUn TRAvEL HEALTH CLInIC SPECIAL FEATURE
Limitations
Our prospective survey had an overall response rate of 29%,
which may be attributable to the fact that this study was implemented
1 year or more after patients visited our clinic. In addition,
because travel health services generally involve only one
visit to a provider, many patients likely did not recall their specific
visit to our clinic. Therefore, our survey results may not be
applicable to our larger patient population of 283 individuals
who made an appointment in the travel health clinic during the
study period. Furthermore, those who completed this survey
are subject to recall bias because surveys were based on visits
anywhere from 6 months to 1 year before initiation of this
study. In addition, those who completed the survey may have
been more satisfied with their visit and therefore more likely
to complete the survey than others, resulting in a self-selection
bias. Patient satisfaction may have also been the result of the
patient’s commuting distance to the travel health clinic, which
was not factored into our analysis. Analysis of open-ended responses
did not reveal any pattern in the responses that could
be meaningfully categorized. Lastly, our results may not be
generalizable to the larger population of U.S. travelers given
the localization of the sample.
Conclusion
This study examined the outcomes of a comprehensive pharmacist-run
travel health clinic within an independent community
pharmacy and found a high rate of patient acceptance
and satisfaction with the clinic, which supports the adoption of
U.S. pharmacists as nontraditional providers of travel health
services. Despite limitations of this study, the authors believe
that this service can be reproduced within other independent
community pharmacies, especially when a strong collaboration
exists among the travel clinic pharmacist, pharmacy store
Table 3. Principal component analysis: Item loadings
Rotated component matrix Component
Quality of interaction Convenience of
Survey item
It was easy to contact the travel clinic to obtain initial information before making an
with pharmacist clinic services
appointment. 0.153 0.821a The travel clinic’s hours of operation were convenient for me. 0.162 0.843a I was seen in a timely manner upon my arrival to the travel clinic. 0.351 0.674a I was able to receive all the vaccines and/or medications that I needed/wanted for my travel
during my appointment. 0.792b The travel clinic pharmacist explained things in a way that was clear and understandable to
0.202
me. 0.892b If I had any additional questions about my medication(s), vaccine(s), or other issues, my
0.233
questions were answered by the travel clinic pharmacist to my satisfaction. 0.908b 0.193
The counseling provided to me by the travel clinic pharmacist was useful/helpful. 0.833b 0.311
The travel clinic pharmacist was professional in his interactions with me. 0.940b 0.165
I was satisfied with my overall visit at the travel clinic. 0.881b Extraction method: principal component analysis.
Rotation method: Varimax with Kaiser Normalization. Note: rotation converged in three iterations.
aThese survey items belong to the component “convenience of clinic services.”
bThese survey items belong to the component “quality of interaction with pharmacist.”
0.299
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SPECIAL FEATURE PHARMACIST-RUn TRAvEL HEALTH CLInIC
owner, and supervising physician. However, for independent
community pharmacies to more broadly implement similar
travel health clinics, further study of the costs associated with
starting up and maintaining such clinics as well as their profitability
is necessary.
References
1. International Trade Administration Office of Travel and Tourism
Industries. US outbound travel by world regions. Accessed at
http://tinet.ita.doc.gov/research/monthly/departures/index.html,
October 12, 2009.
2. World Health Organization. vaccine preventable diseases and
vaccines. Accessed at www.who.int/ith/ITH2009Chapter6.pdf,
October 12, 2009.
3. Steffen R. Epidemiology: morbidity and mortality in travelers. In:
Keystone JS, Ed. Travel medicine. London: Elsevier; 2004:5–12.
4. Hamer DH, Conner BA. Travel health knowledge, attitudes,
and practices among United States travelers. J Travel Med.
2004;11:23–6.
5. International Society of Travel Medicine. Travel medicine examination:
about the program. Accessed at www.istm.org, October
16, 2009.
180 • JAPhA • 50:2 • M a r/apr 2010
www.japha.org
6. Jackson AB, Humphries TL, nelson KM, Helling DK. Clinical
pharmacy travel medicine services: a new frontier. Ann Pharmacother.
2004;38:2160–5.
7. Helling DK, nelson KM, Ramirez JE, Humphries TL. Kaiser Permanente
Colorado Region Pharmacy Department: innovative
leader in pharmacy practice. J Am Pharm Assoc. 2006;46:67–76.
8. Gatewood SBS, Stanley DD, Goode K. Implementation of a comprehensive
pretravel health program in a supermarket chain
pharmacy. J Am Pharm Assoc. 2009;49:660–9.
9. Backer H, Mackell S. Potential cost-savings and quality improvement
in travel advice for children and families from a centralized
travel medicine clinic in a large group-model health maintenance
organization. J Travel Med. 2001;8:247–53.
10. U.S. Travel Association. U.S. travel market overview: demographics.
Accessed at www.tia.org/researchpubs/us_overview_
demographics.html, October 23, 2009.
11. U.S. Census Bureau. State and county quick facts. Accessed at
http://quickfacts.census.gov/qfd/states/00000.html, October 28,
2009.
12. Steffen R, Amitirigala I, Mutsch M. Health risks among travelers:
need for regular updates. J Travel Med. 2008;15:145–6.
Enchanted reflections • Lake Navajo, UT • June 1, 2009 • Allison Anne Welder
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