Travel Medicine Advanced Competency Training for Pharmacists

How long does the travel health consultation take?

1 hour

3 parts to the travel consult

review travel history form

basic preventative measures

itinerary specific disease / condition recommendations

itinerary specific disease / condition recommendations

prevention by routine of transmission

travelers diarrhea

malaria (if applicable)

Travel Medicine Advice

vaccines

avoidance of insects

malaria chemoprophylaxis

prevention and self treatment of travelers diarrhea

responsible personal behavior

STI

medical care / insurance

Reasons for injury during travel

CV

vehicle accidents

Animals can cause (disease)

rabies

avian

monkeypox

leptospirosis

Coughing / sneezing can be linked to

influenza

measles

meningoccal meningitis

TB

COVID

Food and / or water can cause

travelers diarrhea

Hep A

typhoid fever

cholera

polio

Insect bites can cause

malaria

dengue fever

zika

chikungunya

yellow fever

Japanese fever

tick bites

Immunizations 3 R

Routine vaccines (rec for everyone)

Recommended (risk profile, based on exposure, itinerary,)

Required (legally required vaccines in order for you to travel)

What vaccines are required for travel?

cannot get travel visa if you dont have vaccine:

polio

yellow fever

meningococcal

What is the acceptance rate of pharmacists recommendations for travel vaccines?

85% acceptance rate

Why do people decline vaccine recommendations?

perceived low risk for disease (52%)

How to investigate itinerary?

online maps

resources

commercial software programs

print out copy of all information for patient education

Determine travelers needs

by determining travelers risk of disease for specific location and activities

What information do you need from patient?

travel itinerary

destinations? activities? transportation? accommodations

previous immunizations

health conditions

medication use

allergies

What color book is from the CDC and tells us what vaccines are needed for travel?

yellow

What method is a strategy that ensures the patient understands what you told them?

teach back method

When is malaria transmitted?

night time

What non drug prevention can you recomend to avoid AMS?

climb slow

What drug prevention strategy could you use and what would be the regimen?

Acetazolamide

When should you have a travel clinic consult pre-trip?

4-6 weeks before

How long does it take for vaccines to kick in ?

2 weeks

How long is the incubation for Hep A virus?

a few weeks

First dose of HepA gives how much protection? (2 doses total)

gives 90% protection

Hep B schedule

0, 1, and 6 months

Accelerated Hep B Schedule

0, 7, 21-30 days, and a booster at 12 months

Oral HepB

4 capsules over 1 week

must be in fridge

Basic Preventative Measures

water

food

mosquitos

Water while traveling

backpacker in india, staying in hostels

trekking and camping in Nepal

--> drink bottled water, filter systems, iodine tabs, boil water

Food while traveling

vegetables are washed in tap water

not being cooked

carrying pathogens

Mosquitos

don't like high altitude

cold environment

don't thrive out at sea

Travel Clinic Flow

Travel Hx

Assess

Educate

Vaccinate

Pharmacy

Travel Hx

- patient completes

- pharmacists prepare for visit

(15-30 mins)

Assess

- review travel hx form with patient

- plus verbal hx

Educate

- medical

- evironment

- safety and security

Vaccinate

- Provide VIS

- document

(15 mins)

Pharacy (travel clinic flow)

- rx/OTC

- supplies

- payment

(15 mins)

Steps to Implement the Practice

- training and access to resources

- collaborative practice agreements in place

- stock appropriate supplies (vaccines, meds, equipment, OTC)

- establish documentation system and forms

- establish workflow / schedule/ consultation area

- begin marketing your service and seeing patients

Self Treatable conditions

travelers diarrhea

altitude sickness

jet lag

motion sickness

URI

UTI

bacterial skin infection

vaginal yeast infection

HIV PEP

malaria SBET

To prevent illness (prophylaxis)

IGIM (hep A protection)

influenza prophylaxis

leptospirosis

malaria

travelers diarrhea

DVT

Approach to Limitation in Scope of Practice

consultation - no state limits

vaccines

RX medications

labs

supplies

Support Staff Roles

techs can perform many activities:

schedule/ reminder calls

having travelers complete paperwork, assist with locating immunization records

enter documentation

distribute vaccine info statements

billing

Marketing your Travel Health Service

regular physician referrals

in store marketing strategies

area business with international travel needs

area colleges with travel abroad programs

travel agencies

local immigrant orgs

local and state health depts

Cipro x 3 days

not infectious treatment

3 day dose = travel

fluoroquinolone are usually not recommended for travel

Chloroquine

- increased resistance

- should not be prescribed as much for anti malarial