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

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.
J o u r n a l o f t h e A m e r i c a n P h a r m a c i s t s A s s o c i a t i o n www.japha.org M a r/apr 2010 • 50:2 • JAPhA • 175
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