Given that more than 10 million Australians traveled overseas last year, could your pharmacy take on a bigger role in travel health?
As more people embark on international travel, not only is travel becoming a more common topic of discussion between customers and pharmacy staff—it could provide a valuable opportunity for pharmacy business.
The scope of practice for pharmacists in travel health varies from country to country, depending on legislation and differences in drug scheduling. For example, Boots UK pharmacies have become a one-stop-shop for travel health, providing pre-travel risk assessments, vaccinations, malaria prevention and even travel insurance.
In fact, an audit of data from Boots’ travel vaccinations and travel health advice services revealed that a large number of people visiting Boots pharmacies chose to pay for vaccines that they could have received free via the British National Health Service (NHS).
Interestingly, 42% were “last minute travellers”, accessing the travel health services 14 days or less before their scheduled departure and close to a quarter of all appointments were made outside of traditional hours and over the weekend.
This might suggest that the accessibility and convenience of community pharmacy makes it a fitting location for travel health services.
Indeed, when looking at “Australian Pharmacists’ Perceptions and Practices in Travel Health”, Ian Heslop et al identified that Australian pharmacists do tend to provide travel-related advice and products as part of their current practice. However, the service often takes an ad hoc nature and is reactive to travellers’ questions, rather than being a proactive offering.
Heslop’s study, which incorporated the responses of 255 Australian pharmacists, revealed that more than two-thirds provided travel-related services but workload was low with most spending less than an hour a week on these services and no formal pre-travel risk assessment being carried out.
Core functions that the pharmacists felt they could perform included:
- Providing travel health advice to people who would not normally seek such advice from their GP
- Supplementing or reinforcing advice given by other healthcare practitioners;
- Advising on travel-related health issues that the GP may not have discussed;
- Referring travelers back to their GP for vaccinations and anti-malarial medication; and
- Supplying traveler first aid kits.
According to the authors, “expanding current practices from simple reactive services responding to travel-related enquiries to comprehensive pre-travel health risk assessments is an opportunity for future practice.”
While most respondents (82.3%) were interested in offering their customers travel health services, lack of time, staffing levels and the need for training were seen as potential barriers.
Understanding travellers’ health-seeking behaviour
More airlines, cheaper flights and the relative ease of booking an overseas vacation have all contributed to the dramatic increase in the number of Aussies travelling internationally.
Of course, greater exposure to foreign foods, cultural sights and new experiences are wonderful but they can come at a price—that is the risk of travel-related diseases and illness.
Although it seems that, despite our hunger for overseas travel, we’re not all that inclined to pre-empt possible health implications or seek travel health advice.
Annelies Wilder-Smith et al conducted a cross-sectional survey among travellers at the departure lounges of five major airports in Australasia (Singapore, Kuala Lumpur, Taipeh, Melbourne and Seoul) whose travel destinations were Asia, Africa or South America.
Of the 2101 respondents (82% Asian, 17% Western), only 31% had sought pre-travel health advice. Fewer than 5% of travellers had been vaccinated in preparation for their trip and only 40% of travellers to malaria-endemic areas carried malaria prophylaxis.
Anita Heywood et al identified a similar attitude among travellers in their study, ‘Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia’.
An online survey, examining the international travel history, travel intentions, infection control behaviours and self-reported vaccination history, was distributed to students enrolled at the University of New South Wales, Sydney.
A total of 1663 respondents completed the online survey with half having travelled internationally in the previous 12 months. Key points included:
- Travellers considerably underestimate the risks associated with travel to developing countries and so there’s a subsequent lack of preparation to avoid infectious disease risks. This is especially the case for younger travellers.
- Compared to international students, domestic students were more likely to implement preventative travel health measures such as purchasing diarrhoeal medication, insect repellent and food avoidance.
- There is a need to improve health seeking behaviour and knowledge of personal susceptibility and travel-health risks in this highly mobile young adult population.
- Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip.
- Strategies are needed for increasing pre-travel health preparation, and particularly for vaccine preventable diseases.
Is pharmacy missing out?
As part of his focus on pharmacy practice and travel health, Ian Heslop, who’s also a clinical pharmacist, looked into travellers’ views on their health risks and whether there is a need for a pharmaceutical care model for travel health.
He conducted interviews with travellers leaving Cairns airport, which revealed the most commonly reported travel-health conditions to be:
- traveller’s diarhoea;
- respiratory tract infections;
- malaria and tropical diseases;
- sexually transmitted diseases;
- vaccine-preventable conditions such as measles or polio; and
- non-infectious, self-limiting condition such as anxiety, jet lag and travel sickness.
Up to a quarter of travellers were unaware of the risk of infectious disease at their destination. More than a third of travellers (38.4%) had a negative attitude towards vaccines, with most of the negativity surrounding side effects, pain and expense.
The First Aid items most commonly carried by those travelling included: aspirin, insect repellent, anti-diarrhoeal medications, insecticide spray, antibiotics, mosquito nets, rehydration salts and sterile needle and syringe kits.
Less than half (41%) of the interviewees obtained pre-travel health advice, with participants younger than 40-years-old identified as being more likely to obtain pre-travel health advice than those aged over 40 years (54% vs 35%).
Most common sources of pre-travel health advice were:
- GPs (59.3%);
- the internet (37.4);
- family and friends (13.2%);
- travel agents (8.8%);
- employer (8.8%);
- specialist travel clinic (4.4%); and
- pharmacists (2.2%).
The major reasons provided by the interviewees for not using the pharmacy as a source of travel health advice were that they were not aware that pharmacists offered travel health services, it was more convenient to use other sources of information (such as online services), or that pharmacies could only offer a limited range of travel health services.
Heslop notes that aside from the fact that the number of international travellers is growing at a fairly rapid rate, “compared to previous decades, travellers are increasingly visiting more unusual and exotic destinations. Increasing numbers of higher risk groups, such as children, the elderly, and immunocompromised individuals, are also travelling overseas.”
He believes that while pharmacists have traditionally provided free travel health advice and information, usually on an ad-hoc basis, the opportunity exists to offer more formal travel health services.
A greater role for pharmacy
Carmen Drive Community Pharmacy in Carlingford, NSW, has become a destination for travel health among local residents. Pharmacist and joint owner Yvonne Nguyen says: “Our customer base incorporates many self-funded retirees and they love to travel.
“They would come into the pharmacy with scripts for multiple items and we’d chat about the destinations they were travelling to. We started asking them to send us a postcard and ended up with a wall full of postcards from all over the world.
“Customers who come to the counter would look at the postcards and ask who had been to all these wonderful places. It turned into a really good conversation starter and it was from there that we decided to specialise in travel health.
“No one else in the vicinity focuses on this area of health, despite the fact that so many people nowadays travel. It was also an area of interest among staff, so we were all keen to expand our knowledge in travel health.
“A customer might come in for anti-malarial medication and we would recommend a mosquito repellent product. From there the conversation would open up and we might identify other health-related items the person might need, depending on the type of holiday they were going on.
“We made an effort to stock more specialised items that may be more pertinent for travellers going to the high-risk areas, such as Travelan or SB 500 probitoic capsules to help prevent traveller’s diarrhoea.
“Offering more specific products provides a point of difference from other retailers. We also thought quite carefully about all the different types of holidays that people go on and devised a list of appropriate travel health items for each one.
“For example, our cruise list contains motion sickness tablets and Hydralyte plus the usual items, like Panadol and Band-Aids.
“Our designated travel section is located near the counter and has all the essentials needed for travelling—pain relief medication, adhesive dressings, insect repellent, antiseptic, antihistamines, anti-diarrheal products as well as sun protection and sunburn relief. It’s all ready to grab from the one spot.”
Nguyen adds, “Our travel section also has an iPad, which is linked to Sanofi’s online travel hub. It features an interactive map that customers can click on to find out what vaccinations, if any, are required for their intended destination.
“People are often drawn to the iPad and this gives us an opportunity to ask them where they are planning on travelling to and assist them with their travel health needs.”
Nguyen says collaborating with local doctors has been an important part of the pharmacy’s travel health offering.
“We have a few local doctors that specialise in certain vaccines such as yellow fever, for example. We have teamed up with them and advised that we’re a travel pharmacy that stocks many of the regular vaccines as well as other travel health items that their patients might need.
“Initiating the conversations and letting local GPs know what services and products you offer is the first step. Now we refer to each other.”
She adds, “Having a specific travel health section does increase the sales of these items, but not to a dramatic amount. However, people know that they can ask us for travel health advice and from there it leads to conversations about other ailments. It’s become a good talking point and a selling point for other sections of the pharmacy.
“In the future, as the regulations around vaccinations start to loosen, I’m hopeful that travel vaccines will be an area of potential expansion for pharmacists.
“In the meantime, the postcards are certainly a source of inspiration for us and our customers. It’s also really nice to have something happy and upbeat to talk about instead of ill health. It’s lovely when customers return from their holidays and come in to tell us all about it.”
Tomorrow, five tips for setting up a successful travel health hub
Heslop IM, et al. Australian pharmacists’ perceptions and practices in travel health. Pharmacy. 2018;6(3):90. www.mdpi.com/2226-4787/6/3/90
Wilder-Smith A, et al. Travel health knowledge, attitudes and practices among Australasian travelers. Journal of Travel Medicine. 2004;11(1):9-15.
Heywood AE, et al. Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia. BMC Infect Dis. 2012;12:43.
Heslop, IM. Pharmacist-initiated interventions in travel health. Professional Doctorate (Research) thesis, James Cook University, 2015. Available here