Implementing Pharmacy-Based Travel Health Services: Insight and Guidance from Frontline Practitioners

PURPOSE In California, the passage of SB493 in July of 2013 was a milestone in advancing pharmacy practice. Among other things, the new legislation allows pharmacists to provide routine immunizations without a protocol and furnish medications for international travelers for conditions not requiring a diagnosis. When developing a pharmacist-run travel health service, consideration must be given to multiple important factors, including pharmacist training, physician partnership, logistics, from scheduling to documentation, and the resources necessary to provide a travel health service.5 This article sets out to provide guidance and insight to pharmacists seeking to implement a travel health service. SUMMARY Travel health requires providers with knowledge regarding epidemiology, transmission, and prevention of travel-associated infectious diseases, a complete understanding of vaccine indications and procedures, and prevention and management of noninfectious travel-associated health risks. Pharmacists seeking to implement travel health services need to seek out appropriate resources for pharmacist training, workflow and logistical considerations, and travel health-specific resources to optimally provide this service. CONCLUSION The traveling population is at significant risk for travel-related diseases, but only a small number actually get the advice, vaccines and medications they need. With the passage of SB493 in California, the 40,000 registered pharmacists and 6,000 pharmacies across California could provide the essential access, convenience and expertise that a growing traveling population needs to stay healthy while abroad. Whether in a community pharmacy or ambulatory care clinic, pharmacists must ensure they can provide or arrange for personalized, comprehensive travel health services

Vaccine Epidemiology and Decision-Making: A Bryant Student Focus

The Centers for Disease Control and Prevention estimate that influenza has resulted in between 9.2 and 35.6 million illnesses and between 12,000 and 56,000 deaths annually since 2010 (1). Annual influenza vaccination remains to be the most effective way in controlling the spread and symptom severity of influenza infections (1). Influenza infections are especially virulent on college campuses as a dense population of students interact in close quarters such as shared housing, bathrooms, dining halls, classrooms, and social activities (2). Despite influenza vaccinations being safe, effective, easily accessible to Bryant University students, and free of cost, many students choose not to receive an annual vaccination. A survey and interviews were conducted among Bryant University students to: determine the vaccination rate of students on campus; determine reasons why students did or did not decide to receive this season’s flu vaccination; and analyze how the vaccination rates and decision-making of students affect the overall health of the Bryant University campus. Based on the survey data, only 25.15% of Bryant University students participating in the survey had received a vaccination this year, and only a small fraction of these individuals were vaccinated at the Health Services clinics. This incredibly low vaccination rate among the Bryant University student body has severe consequences for the students, University, healthcare system, and even the surrounding communities. This research discusses the importance of vaccination, impact of influenza on Bryant students’ health, the reasons for the low vaccination rate on campus, and describes potential ways to enhance student participation in on-campus vaccination clinics

Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

Why don't adolescents finish the HPV vaccine series? A qualitative study of parents and providers

PURPOSE: To understand why adolescents who initiate the HPV vaccine series fail to complete all three shots. METHODS: Semi-structured interviews were performed with parents/guardians of 11-17 year old daughters and pediatric primary care providers in one inner-city public clinic and three private practices to determine why girls who received at least one dose of the HPV vaccine did or did not complete the series. The number of shots received was confirmed by electronic medical record review. Content analysis was used to identify themes related to series completion. RESULTS: 65 parents/guardians participated: 37 whose daughters received 1 or 2 doses of HPV vaccine and 28 whose daughters completed 3 doses. Most (n=24, 65%) parents/guardians failed to complete the series because they thought the clinics would remind them of subsequent doses. 9 (24%) cited logistical barriers. 4 (11%) decided to stop the vaccine series. 33 providers participated: 24 physicians, 3 nurse practitioners, and 6 registered nurses. 52% of providers told parents to schedule appointments, 41% scheduled the second dose at the time the first dose was given, and 7% tried to immunize patients when they returned for other appointments; providers confirmed that few parents chose to stop the series. No practice had a system in place to ensure series completion. CONCLUSIONS: Most failure to complete the HPV vaccine series occurred because providers expected parents to make appointments while parents expected to be reminded. Increased use of reminder/recall systems and clear communication of expectations regarding appointment scheduling could improve completion rates

The Update, September 7, 2009

The Update is a bi-weekly web newsletter published by the Iowa Department of Public Health's Bureau of Family Health. It is posted the second and fourth week of every month, and provides useful job resource information for departmental health care professionals, information on training opportunities, intradepartmental reports and meetings, and additional information pertinent to health care professionals

Pharmacy-Based Travel Health Services in the United States

The aim of this paper is to review pharmacy laws and regulations, pharmacist training, clinic considerations, and patient care outcomes regarding pharmacy-based travel health services in the United States. Pharmacists and pharmacies in the United States are highly visible and accessible to the public, and have long been regarded as a source for immunization services. As international travel continues to increase and grow in popularity in this country, there is a pressing need for expanded access to preventative health services, including routine and travel vaccinations, as well as medications for prophylaxis or self-treatment of conditions that may be acquired overseas. In the United States, the scope of pharmacy practice continues to expand and incorporate these preventable health services to varying degrees on a state-by-state level. A literature review was undertaken to identify published articles on pharmacist- or pharmacy-based travel health services or care in the United States. The results of this paper show that pharmacists can help to increase access to and awareness of the need for these services to ensure that patients remain healthy while traveling abroad, and that they do not acquire a travel-related disease while on their trip. For those pharmacists interested in starting a travel health service, considerations should be made to ensure that they have the necessary training, education, and skill set in order to provide this specialty level of care, and that their practice setting is optimally designed to facilitate the service. While there is little published work available on pharmacy or pharmacist-provided travel health services in the United States, outcomes from published studies are positive, which further supports the role of the pharmacist in this setting

Literature Review - the vaccine supply chain

Vaccination is one of the most effective ways to prevent the outbreak of an infectious disease. This medical intervention also brings about many logistical quest

A cluster randomized controlled trial of a modified vaccination clinical reminder for primary care providers

Objective: Adult vaccination rates in the United States fall short of national goals, and rates are particularly low for Black Americans. We tested a provider-focused vaccination uptake intervention: a modified electronic health record clinical reminder that bundled together three adult vaccination reminders, presented patient vaccination history, and included talking points for providers to address vaccine hesitancy. Method: Primary care teams at the Atlanta Veterans Affairs Medical Center, who saw 28,941 patients during this period, were randomly assigned to receive either the modified clinical reminder (N = 44 teams) or the status quo (N = 40 teams). Results: Uptake of influenza and other adult vaccinations was 1.6 percentage points higher in the intervention group, which was not statistically significant (CI = [-1.3, 4.4], p = 0.28). The intervention had similar effects on Black and White patients and did not reduce the disparity in vaccination rates between these groups. Conclusion: Provider-focused interventions are a promising way to address vaccine hesitancy, but they may need to be more intensive than a modified clinical reminder to have appreciable effects on vaccination uptake