By Jack Kohane
Whether for trekkers taking the road less travelled or intrepid hikers braving the urban jungle, pharmacists are the ideal go-to resource for health-conscious explorers.
“As travellers are increasingly becoming aware of the need for vaccines and prescription therapy to stay healthy during travel, and as pharmacists’ scope continues to expand related to administering vaccines and prescribing, today’s pharmacy operation is well suited to apply this expanding scope to the travel health category,” says Dr. Sherilyn Houle, BSP (University of Saskatchewan), PhD (University of Alberta). “While the specialty of travel medicine is relatively new, pharmacists have been involved in the care of travellers for years, often in the form of non-prescription recommendations for sun and insect bite protection, travellers’ diarrhea, and motion sickness.”
Travel medicine is a growing area in pharmacy practice. When the scope of practice for pharmacists expanded to include independent prescribing and administering injections in Alberta in 2007, a number of pharmacies there began to develop expertise in travel health and became designated Yellow Fever Vaccination Centres (regulated by the Public Health Agency of Canada). In December, 2016, Ontario expanded the scope of pharmacist-administered injections to include vaccines against 13 diseases in addition to influenza, with a focus on vaccines used for travel. “Travellers are becoming more aware of the importance of pre-travel consultations to ensure healthy travel abroad, and this points to a category sure to continue to grow in the pharmacy profession,” emphasizes Houle.
Travel is on the rise – and so is the need for pharmacist advice
And the drive to ramble both near and far is on the ascent. According to the Ottawa-based Canadian Tourism Research Institute (CTRI), outbound leisure travel among Canadians is forecast to grow at a 4 percent average annual rate until 2020. Additionally, more than one-quarter (26.5 percent) of those planning to travel abroad (outside of Canada and the U.S.) this summer intend to visit a doctor or medical clinic prior to the trip to get vaccinated and/or to obtain medications.
Port Coquitlam, BC pharmacist Ajit Johal feels the profession is ready to commit to the category. “Pharmacists have the knowledge and are accessible to patients seeking pre-travel advice,” says the Clinical Services Coordinator for Wilson Pharmacy, who has obtained his Certificate in Travel Health (CTH) and recently created “Travel Rx” (www.travelrx.ca), a pharmacy-based travel health service. “When it comes to travel health and medicine … pharmacists are an ‘underutilized’ resource,” he argues, pointing out that part of the problem may be that pharmacists may lack confidence in travel medicine. “Time constraints and a dearth of available resources contribute to this phenomenon,” he contends.
Johal advises pharmacists to get immersed in travel medicine. “Don’t wait to read a book or take a course. When a patient asks you to help with travel recommendations, don’t tell them to go to a travel clinic, take the time to look stuff up. It is worth the investment in the long run.” He recommends having a robust system for ordering and tracking travel vaccine inventory, consistently carrying vaccines such as Hepatitis A and typhoid. “Know which vaccines are required for departing travellers,” he counsels. “And market to your local physicians, many of whom will be happy to refer patients to you for travel consultations.”
Travel Medicine, he also notes, is a key segue into paid consultations and further expanded scope for pharmacists. “The public needs to become more aware of the clinical skills of the pharmacist, and travel consultations are a great way to demonstrate this.”
Be proactive in getting more education
Pharmacists need to be prepared and proactive to help keep their travelling patients healthy, according to Louis Lamarche (B.Pharm., Ph.D), head of public health for Valneva Canada, headquartered in Kirkland, QC, the maker of Ixiaro (prevention of Japanese encephalitis) and Dukoral, indicated for the prevention of cholera and Enterotoxigenic E. coli (ETEC) diarrhea. “We (Valneva) are working in partnership with pharmacists and pharmacy organizations to support pharmacists’ role in travel health and travel immunizations,” he points out.
Valneva provides patient educational material such as brochures and posters to assist pharmacists in informing their patients about how to prevent certain infectious diseases during travel. Lamarche adds that pharmacists require the appropriate training (for example, provincial training requirements, International Society of Travel Medicine (ISTM) Certificate in Travel Health, and CPS Education Program for Immunization Competencies). “As a greater number of pharmacists gain experience in administering travel immunizations, some travel vaccines such as the Japanese encephalitis, rabies and yellow fever vaccines that were once offered primarily in travel clinics will also be more readily available from community pharmacies specializing in travel health.”
To keep current with global health news, Sherilyn Houle directs pharmacists to consult such resources as Travax (www.travax.com), an up-to-date online library of travel medicine literature, teaching sheets, and country-specific profiles; and Tropimed (www.tropimed.com), a software tool for healthcare pros working in travel medicine.
Top travel takeaways
#1 Go over your patients’ itineraries with them. A detailed itinerary is important in determining what vaccines may be required and offering an assessment of malaria risk.
#2 Ask travellers when they are departing and the duration of their travel, as this may influence vaccination schedules that can be completed in time and risks from long-term exposure.
#3 Discuss their planned itinerary, with particular focus on travel at altitude, diving, contact with animals, or visiting rural regions.
#4 Consider their current health status and how that may influence their susceptibility to travel-related complications (e.g., pregnancy, travelling with children, cardiovascular disease, diabetes, immunodeficiency).
#5 Schedule a med review. If there’s a time when patients need a list and accompanying medication review, this is it!
#6 Make sure all OTC items for travel are in stock, including antidiarrheals, mosquito repellants, sunscreens, and minor ailment medications.
The travel bug that bit Jason Kmet landed him in such exotic destinations as Morocco, Vietnam and Argentina. As a licensed pharmacist, however, Kmet knew the travel bugs that bite many visitors could land them in the hospital.
By donalee Moulton
Photography by David Watt
“I realized providing travel medicine services was a good area for a pharmacist,” says Kmet. “It seemed like an excellent fit with the skills required of a pharmacist. You review where patients are going, when they are going, and their medical history. There is no diagnosis.”
Before offering any travel services, Kmet explored the field and went on to successfully write the International Society of Travel Medicine exam in Budapest, Hungary. “I embarked on getting involved in this world,” he says. “I quickly realized this is what I really want to do.
Armed with a greater understanding of travel medicine and the expanding scope of practice in Alberta, Kmet opened Polaris Travel Clinic and Pharmacy in Airdrie. It’s unlike any pharmacy you’ve seen. The clinic, once a doctor’s office, still retains the same medical look. There is a waiting room, a reception area, and appointment rooms. There are only about three shelves of medications – antibiotics and other travel-related medicine – and routine prescriptions are not filled here. Patients visit the clinic by appointment only.
“I’ve never seen a pharmacy anywhere like ours. It runs like a doctor’s office,” says Kmet. “I didn’t want to open just another pharmacy.”
The uniqueness reflects the distinct needs of individuals looking to prepare themselves for travel. Kmet and his team do pre-travel health consultations, administer vaccines, dispense travel-related prescriptions, offer over-the-counter medications, and carry other products relating to travel health such as mosquito bed nets, insect repellents, and sunscreen. Polaris has even been certified by the Public Health Agency of Canada as a Yellow Fever Vaccination Centre.
Most pharmacists will not likely immerse themselves in travel medicine to the extent Kmet has, but offering some travel medicine services holds significant potential to attract new customers and strengthen relationships with existing patients. The starting point, says Kmet, is education. “It is really important to establish credibility. You need to do some training.”
That training sends an important message to patients – and to other healthcare professionals, who are an important source of referrals. “Getting additional training helps to show others in the healthcare team that you have made an effort to learn something about this area,” notes Kmet. “If you really want to make this part of your practice, you need to get the knowledge; then you need to be able to show that you have the knowledge.”
Advertising is an important means of letting the community know about the range of services you offer. Kmet, for example, runs print ads and promotes services and products on the pharmacy’s website. He also gets involved in community events such as parades. As well, for every travel vaccine given at the clinic, $1 is donated to charity.
“We want the public to know about us,” says Kmet.
Awareness will encourage patients to visit your pharmacy for their travel medicine needs, but it’s the service you provide that will keep them coming back – and prompt them to recommend you. For Kmet, going above and beyond is business as usual. “You need to verify the vaccine is appropriate, but I also look at where people are going, what they will need and why. It’s all within the pharmacist’s skill set, but it’s a twist on what we usually do.”
Expect more such twists in the future. As pharmacists’ scope of practice expands across the country there are greater and diverse opportunities to provide service to patients. “There are going to be more and more niche markets for pharmacists,” says Kmet. “We’ve taken it to the next level.”
Jason Kmet’s 3 top travel pharmacy tips
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