Pharmacist-initiated interventions in travel health

Heslop, Ian Murray (2015) Pharmacist-initiated interventions in travel health. Professional Doctorate (Research) thesis, James Cook University.

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Abstract

Background: Global tourism has shown an exponential increase over the past decades, with travellers visiting high risk destinations at short notice, often with limited planning. Although at greater risk of morbidity and mortality whilst overseas, only 36-52% of travellers obtain pre-travel health advice, exposing a large number of travellers to travel-related health issues. Since the 1990s, there has been growth in the number of specialist, travel health clinics and increased access to travel health information via the internet. However, in Australia, where the number of full-time, specialist travel health clinics outside state capitals is low, travellers still rely heavily on their GP for pre-travel health advice. In some countries, notably the UK, USA and Canada, community pharmacies routinely offer travel health and immunisation services, not available in Australia. Australian pharmacists may be perceived as an underutilised resource, which could play a greater role in the provision of travel health services. This has informed the main aims of this study, which were to: evaluate the perceptions of stakeholders regarding the role of pharmacists, assess the pharmaceutical care needs of a sample of international travellers, evaluate two learning methods for the delivery of travel health training of pharmacy students, and design and evaluate a proposed model for an Australian, pharmacy-run, travel health advisory service (THAS), which was compliant with current legal and professional guidelines.

Methods: A mixed methodology was used incorporating a variety of techniques such as the use of semi-structured, qualitative interviews and focus groups, the application of a bespoke travel health specific pharmaceutical care model, the use of electronic and postal, cross-sectional, self-completion surveys and the use of a cross-over research model to evaluate and compare two learning methods. Pharmaceutical care needs assessments were used to examine travellers' medication histories for potential pharmaceutical risks (PPRs) and pharmaceutical care issues (PCIs), and a number of descriptive and inferential statistical methods, interpretive thematic analyses and a financial breakeven analysis were used. Finally, a two-tiered travel health advisory service (THAS) was developed, aimed at providing travel health services to mainly lower risk travellers and/or travellers who may not normally obtain pre-travel health services from other providers. The level 1 service involved the pharmacist merely responding to individual travel health enquiries, whereas the level 2 service involved the pharmacist performing comprehensive travel risk assessments for individual clients.

Results and Discussion: The novel application of a pharmaceutical care model identified PPRs and PCIs among a sample of 218 predominantly male, middle-aged international travellers. Only 41.7% (91/218) of the sample obtained pre-travel health advice, mostly from their GP (59.3%, 34/91) or the internet (37.4%, 34/91), while only a few (2.2%, 2/91) used a pharmacist. Although 75.2% (164/218) had no PPRs, a total of 274 PCIs were identified across 61.5% (134/218) of the sample. It was identified that many Australian pharmacists surveyed (68.2%, 174/255) already offer travel health services, although for most (69%, 120/174) the workload was low and a third only respond to clients' travel-related questions. However, 89.1% (227/255) agreed that a role in travel health is appropriate for pharmacists and 72.9% (186/255) were of the opinion that travellers would support pharmacist involvement. Although most respondents (96.9%, 247/255) had no formal training, 86.7% (221/255) agreed that pharmacists providing travel health services should complete an accredited training program. Although aware that many travellers do not seek pre-travel health advice, 52.8% (29/55) of medical practitioners (MPs) opposed extended roles for pharmacists in travel health, whereas travel agents (TAs) were generally more supportive. Comparison of team-based learning (TBL) and web based learning (WBL) in the delivery of a travel health elective subject highlighted the superiority of TBL for developing communication and problem-solving skills and preparing students for clinical practice. However, after completion of the taught component, students concluded that a hybrid approach, incorporating TBL, WBL and some aspects of lecture-based learning (LBL) was preferable. Results from the THAS showed that 85% (39/46) of clients were visiting mainly metropolitan areas and as such, 59.3% (16/27) of level 2 clients were classified as low risk. A number of level 1 and 2 clients (26.3%, 5/19 and 40.7%, 11/27 respectively) were referred to other travel health providers, mainly to their GP for vaccinations. The THAS was rated 1/5 (high quality and very useful) by 81.8% of level 2 clients, and 66.7% of clients who had used other services before other journeys rated them as equal to, or inferior to the THAS. Importantly, all (100%) of level 1 and 2 clients said that they would use and recommend the THAS and 81.9% (9/11) of clients said that they would be willing to pay an average of $32 per visit. The information supplied was used by 85.7% (6/7) of clients who responded to a post travel survey, and more importantly, more than half (51.7%, 4/7) said the advice had altered their behaviour and the precautions they had taken.

Conclusions: This study has highlighted that a significant number of international travellers did not obtain pre-travel health advice and, consistent with other findings, that the pharmacist is an underutilised travel health resource. Although a large number of Australian pharmacists do offer some form of travel health service, few perform full travel health risk assessments, which are more common overseas and thus, their involvement could be greatly expanded. The application of a novel pharmaceutical care model demonstrated a need for a greater emphasis to be placed on the assessment of medication-related risks associated with travel and that pharmacists are ideally trained to perform these assessments. Pharmacists are both accessible and committed to extending their role into travel health and recognise that they need further training and accreditation to perform these roles as part of the health care team. Finally, the study showed that a proposed model for a THAS could be both financially viable and valued by clients, confirming a future expanded role for pharmacists.

Item ID: 41510
Item Type: Thesis (Professional Doctorate (Research))
Keywords: diseases; infections; international travel; medicine; pharmaceutical care; pharmacy; tourism; travel health
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Additional Information:

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 2: Heslop, Ian (2010) The pharmaceutical care risks of international travellers. In: Proceedings of the 100 Years of Tropical Medicine Conference (11), p. 48. From: 100 Years of Tropical Medicine Conference 2010, 11-14 June 2010, Townsville, QLD, Australia.

Appendix 2: Heslop, Ian M., Bellingan, Michelle, Speare, Richard, and Glass, Beverley D. (2014) Pharmaceutical care model to assess the medication-related risks of travel. International Journal of Clinical Pharmacy, 36 (6). pp. 1196-1204.

Appendix 7: Heslop, Ian (2012) Travel health. Australian Pharmacist, 31 (2). pp. 120-126.

Date Deposited: 02 Dec 2015 07:16
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1115 Pharmacology and Pharmaceutical Sciences > 111503 Clinical Pharmacy and Pharmacy Practice @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 50%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 100%
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