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

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
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 • 177
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)
177 3/1/10 12:49 PM