Have you waited until the last minute to get a travel health assessment and the appropriate medications prior to your long-anticipated vacation? Busy working and have an upcoming trip? No time to see someone during your work hours?
I recently returned from a three-week vacation to South America with my wife, Jo. Since many of you may also be vacationing this winter, it’s an ideal time to visit a clinical pharmacist who specializes in travel health.
Before our trip, my wife and I went to The Travel Health Network, located off the main street in the city of St Albert, Alberta. We entered the warm, welcoming waiting room, which was half-filled with families. The vibrant area had comfortable seats, coffee, and water; not what we have come to expect in health care! The Travel Health Network is a pharmacist-owned traveler’s health consultation service, the vision of Christina Bascom (BSc.Pharm, Diploma in Travel Medicine, ATM RCPS(Glasg)).
After my painless shots (the non-alcoholic kind), I chatted with Christina about her pharmacist-led, one-stop travel health shop.
Joseph Blais: Let’s start with your practice. How did you get into travel medicine?
Christina Bascom: In 2010, I started looking into getting the Foundation in Travel Medicine from the Royal College of Physicians and Surgeons in Glasgow. In 2011, I finished the Foundation, a four-month course, which is like a teaser. I then decided to challenge the Certificate in Travel Health (CTH) from the International Society of Travel Medicine, and I passed, which was awesome!
I was working at large chain retail pharmacy and was really limited as to how much clinical work I could do, because at that time I didn’t have my APA [additional prescribing authorization]. I was able to administer injections but I didn’t have a lot of time to dedicate to travel health as a pharmacist working alone in a busy dispensary. After I received my CTH, I felt that I still needed more knowledge and training to do an adequate risk assessment and an effective full travel consult. I decided to take the Diploma in Travel Medicine (DTM), which is a full-year course at the College of Physicians and Surgeons in Glasgow. It is a distance-learning program with a few weeks of residential commitments on campus.
There are multiple research assignments, exams, a structured clinical examination and an original piece of research to meet the requirements. It was challenging, working full time with three kids. But it really helped me do an adequate health assessment. I left community pharmacy in December 2012 and finished my diploma in February 2013. A great friend and colleague encouraged me to open up my own travel clinic. Her praise for the field made it sound appealing especially as all I wanted to do at this point was travel health.
With the mentorship of my friend and the support of my family, I opened the Travel Health Network in March of 2013. It took a little bit of time and a lot of stress, but I haven’t looked back. Travel health is definitely what I’m meant to do, and I strive to provide the best to my clients.
JB: How did you go about getting your additional prescribing authorization, and how does prescribing fit into your clinic?
CB: I was working on my application after I had left my community pharmacy practice, and had the required case studies. Working with another travel medicine practitioner, I was able to develop further cases and from there I built up my portfolio. It was really just a matter of taking the time to compile the documentation and write it up.
Being able to prescribe has made a significant impact in my ability to offer a full service travel clinic. My clients can have their consult and their vaccinations in a single visit and can take prescriptions I’ve written for any medications needed to their pharmacy of choice. There is no need to see another provider to get the prescription for their vaccines or for any medications they may need to travel safe and healthy.
JB: For the average person, how does pharmacist prescribing help them?
CB: It helps clients save time and money.
For some clinics, protocols allow administration of vaccines but then the patient is directed to visit their family physician to get their antibiotics for traveler’s diarrhea, or their anti-malarial tablets.
Travel health is a non-insured health benefit. So they pay to see a travel consultant, and then they pay to have their doctor prescribe the recommended medications. So it is two stops for the patient and some patients have difficulty seeing their physicians in a timely fashion. It can be frustrating for clients.
JB: What are the barriers to having a fully independent pharmacist clinic?
CB: The barriers for my practice are that we require a medical director to operate in our clinic. We are multi-disciplinary in that we have a physician who is the medical director and that allows me to act as a consultant under a physician medical director. We have registered nurses who administer vaccines, which allow us to serve younger children, as pharmacists can’t vaccinate children 5 years of age and under. If I wanted to open up a travel clinic on my own, it would have to be opened as a dispensary (pharmacy) which would incur additional costs and restrictions to the services we can offer to our clients.
Thankfully, I have a great physician who is willing to work with us at the clinic. It’s a great partnership that has worked out, but it is still a barrier.
JB: So you’ve mentioned the nurse and the physician. How did you go about building that team?
CB: I have three nurses that now work for me. My first nurse walked over from the nearby Boston Pizza one day, gave me her number and said, ‘I want to do something different!’
My nurses all work elsewhere, in hospitals or home-care, and this is something they do in addition to their regular jobs.
As far as the physician, the initial partnership was with a colleague I met through the travel medicine program. When his path went in a different direction I met with local physicians asking if they would be interested in working in the travel clinic. Thankfully, we found a great doctor here in St. Albert to partner with.
JB: If there is one key take-home message you want to relay to people, what would you say?
CB: I have a saying in my clinic:
‘It’s never too late to vaccinate or to educate yourself on traveling safe and healthy.’ Because I have so many people who come to me and say ‘I’m leaving in a week, it’s too late’.
JB: Just like me!
CB: It’s never too late. Some vaccines can offer protection quicker than most people realize. But most importantly, education on risk and management is half the battle. If you know what to do when something happens, it’s just a blip on your radar, as opposed to something that could end your trip. It’s not the end of the world if you know what to do.
Even if you are on the way to the airport, it’s never too late. That’s my little pearl.
JB: I think the model here is really unique. Did you have any other thoughts you wanted to share?
CB: I think another challenge in travel medicine is there’s so much misinformation out there. There’s so much advertising, for example with Dukoral, that people don’t know just what the risks are and how effective the vaccines are. Or people who’ve had two doses of Twinrix five years ago, thinking they have to now start over again.
There’s just so much information that people don’t have as far as vaccinations go. People come in here with preconceived notions of what they should have. It’s a great opportunity for education. As a pharmacist, I often hear: ‘well my doctor told me this’, and while sometimes it’s sound advice, sometimes it isn’t and you have to overcome the patient’s ideas and perceptions. General practitioners have a very broad scope of knowledge, and they refer their patients to a cardiologist, or to an internist etc. for specialized care. It’s just as important that patients be referred to someone who specializes in travel medicine. Travel medicine is something you should be immersed in everyday in order to provide great advice to your travelers.
JB: Do you run into a lot of myths, misperceptions, or anti-vaccine sentiment?
CB: We do get people who are anti-vaccine. For example, we get a lot of clients whose parents completely deferred their childhood immunizations. Now they are adults and they want to travel, so it’s a lot of education. Good on these travellers for coming in. We try to update them on all their routine vaccinations and educate them about vaccines.
One thing I stress is that I will never make a person vaccinate. I’m not going to convince someone I’m right, who already thinks that I’m wrong. I give people as much information as I can and I don’t pressure them. Required vaccines like yellow fever may affect their ability to cross borders into certain countries and this may affect their travel plans. I will recommend other vaccines to keep my travelers safe, but I’m not going to pressure someone to vaccinate. That’s their decision in the end. I also ensure that they are provided with advice on other ways to stay healthy whether or not they choose to vaccinate.
There will always be individuals who don’t believe in vaccines. In some cases they just don’t have the information they need to make an informed decision.
JB: I went through your travel consultation process, but briefly do you want to walk us through the services you offer?
CB: The patient experience! Obviously, you get to talk to me and I do my best to provide education, write your prescriptions, and make recommendations. My nurses will offer you more information on the vaccines that are recommended, and then administer the vaccination if you choose to go ahead. We do have travel products. We have insecticide treated mosquito nets, insect repellants, compression socks, electrolytes etc. We’ve got a good array of products to help you travel safe and healthy.
In the future we are also planning for our physician to offer offshore oil and gas medicals for those individuals and groups working overseas in the oil industry.
JB: The vaccines are usually covered with private insurance. Do you do private billing?
CB: We don’t do private billing but we give full invoices with the DINs [Drug Identification Numbers] for manual submission into third-party plans and we’ve never had any issues.
JB: I also see you have requisitions to order blood work.
CB: The majority of our requisitions are to order blood work for students who are going into nursing, medical, veterinary, or U.S. schools. We’ll check for confirmation of their measles, mumps, rubella, and varicella immunity. We will do that for their school medical reports.
Occasionally, we will check for rabies titers for animal health practitioners, or confirm immunity to Hepatitis A for travelers who were born in an endemic country but now live in Canada and are returning to their birth country to visit friends and relatives.
JB: What is the best way to get in touch with you?
CB: The best way is to book an appointment online or by calling the clinic. You can also find us on Facebook and Twitter! We tend to be open evenings and some Saturdays to make it easier for those who work weekdays.
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