A Comparison of Pharmacist Travel-Health Specialists' versus Primary Care Providers' Recommendations for Travel-Related Medications, Vaccinations, and Patient Compliance in a College Health Setting

Authors

  • Melissa J. Durham Pharm D,

    Corresponding author
    1. Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
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  • Jeffery A. Goad Pharm D,

    1. Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
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  • Lawrence S. Neinstein MD,

    1. Department of Pediatrics and Medicine, University Park Health Center, Los Angeles, CA, USA
    2. Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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  • Mimi Lou MS

    1. Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California School of Pharmacy, Los Angeles, CA, USA
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  • Abstract presented at the 11th Conference of the International Society of Travel Medicine, May 24 to 28, 2009, in Budapest, Hungary.

Melissa J. Durham, Pharm D, University of Southern California School of Pharmacy, 1985 Zonal Avenue, Los Angeles, CA 90033, USA. E-mail: mdurham@usc.edu

Abstract

Background. Pretravel medication and vaccination recommendations and receipt were compared between primary care providers (PCPs) without special training and clinical pharmacists specializing in pretravel health.

Methods. A retrospective chart review of patients seen for pretravel health services in a pharmacist-run travel clinic (PTC) compared to PCPs at a University Student Health Center. Vaccine/medication recommendations were assessed for consistency with national/international guidelines. Medical/pharmacy records were queried to determine the receipt of medications/vaccinations.

Results. The PTC recommended antibiotics for travelers' diarrhea were given more often when indicated (96% vs 50%, p < 0.0001), and patients seen in the PTC received their medications more often (75% vs 63%, p = 0.04). PCPs prescribed more antibiotics for travelers' diarrhea that were inconsistent with guidelines (not ordered when indicated 49% vs 6%, p < 0.0001 and ordered when not indicated 21% vs 3%, p < 0.0001). The PTC prescribed antimalarials more often when indicated (98% vs 81%, p < 0.0001), while PCPs prescribed more antimalarials that were inconsistent with guidelines (not ordered when indicated 15% vs 1%, p < 0.0001 and ordered when not indicated 19% vs 2%, p < 0.0001). The PTC ordered more vaccines per patient when indicated (mean = 2.77 vs 2.31, p = 0.0012). PTC patients were more likely to receive vaccines when ordered (mean = 2.38 vs 1.95, p = 0.0039). PCPs recommended more vaccines per patient that were inconsistent with guidelines (not ordered when indicated: mean = 0.78 vs 0.12, p < 0.0001, ordered when not indicated: mean 0.18 vs 0.025, p < 0.0001).

Conclusions. A pharmacist-run pretravel health clinic can provide consistent evidence-based care and improve patient compliance compared to PCPs without special training. Pretravel health is a dynamic and specialized field that requires adequate time, resources, and expertise to deliver the best possible care.

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