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

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.
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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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