Role of the Pharmacist in Travel Medicine in the United States
The pharmacist is in a unique position to assume the role of a pre-travel health provider. Pharmacists receive extensive disease and infectious disease training in pharmacy school and are honed to be excellent drug and disease counselors. Although some of the diseases and drugs may not have been covered extensively in school, excellent continuing education programs, electronic databases, and textbooks exist to enhance the pharmacist's knowledge.
Although there is little reported in the literature on pharmacist-run travel medicine clinics, pharmacists provide a host of travel health information in the course of their day, whether in community or primary care practice. Depending upon state laws, pharmacists may provide travel health services to varying levels. Extent of collaborative practice and immunization laws will largely determine the scope of services provided. In 44 states, pharmacists are allowed to administer immunizations. Collaborative practice rules are complex and difficult to compare from state to state.
Pharmacists were early adopters of computer technology and thus are comfortable using computer databases and the internet. Various comprehensive and constantly updated electronic databases are available to the pharmacist to use. With collaborative practice agreements and immunization protocols, they can provide vaccination and medications to travelers. Regardless of the extent to which pharmacists may prescribe medications or vaccinate in their state, they can always provide written recommendations for patients to take to their clinicians. These recommendations take a tremendous burden off the physician to research the health risks of the traveler's destination.
An aspect unique to community pharmacy is access and the ability to provide "one stop shopping" convenience. The pharmacy can dispense the medications just ordered and carry a full array of travel supplies. Common travel supplies include insect repellant, mosquito netting, water purifiers, iodine tablets, first aid kits, sunscreens, and international plugs. Common nonprescription medications that are routinely stocked include bismuth subsalicylate, loperamide, meclizine, and melatonin. In the community pharmacy, pharmacists are readily accessible and highly visible. With the literature indicating a low participation rate among travelers in travel clinics, pharmacies may be more successful at catering to this audience.
The reimbursement structure of a travel clinic depends upon the setting. In a primary care clinic, services can be billed incident to the care of a physician provided the physician is on the premises and available for consultation. In a community pharmacy, services are usually provided on a fee-for-service basis for the visit, immunizations, medications, OTC products, and travel supplies.
Providing pre-travel health services is a valuable preventative medicine intervention that can be both challenging and rewarding for the pharmacist. Although pharmacists have not been traditional providers of this service, their skill sets may include counseling, medical informatics, vaccination, disease management, and prescription and nonprescription product selection. All of these skills are essential to the provision of pre-travel health and safety preventative services. In addition, the integration of a travel clinic in a community pharmacy may increase access for patients who might not otherwise have sought pre-travel care.
Dr. Goad is an Associate Professor of Clinical Pharmacy at the University of Southern California School of Pharmacy, Los Angeles, California. He also has a Certificate of Knowledge in Travel Health from ISTM. This article is abridged from Advances in Pharmacy, Volume 2, Number 4, pp 318-324, 2004.
