May 12, 2025 • 31 mins
Travel health is more than just vaccines—pharmacists play a crucial role in protecting patients from preventable illnesses with essential immunizations, OTC medications, and prescription therapies. This episode explores the key components of a successful travel clinic, from vaccine recommendations to counseling on travel-related health risks. Tune in to learn how you can expand your impact and help travelers stay safe and healthy on their journeys.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Regina Richardson, PharmD
Pharmacist
Bremo Pharmacy
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify key vaccines, OTC medications, and prescription therapies recommended for travelers based on destination-specific health risks.
2. Explain the pharmacist's role in providing travel health services, including patient counseling, risk assessment, and preventive care strategies.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-160-H01-P
Initial release date: 5/12/2025
Expiration date: 5/12/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Hey, CE Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, Josh Kinsey, and, as always, I'm excited about
our conversation today.
Traveling opens the door to newexperiences, but it also comes
with health risks thatpharmacists are uniquely
positioned to help prevent.
In this episode, we'll discussessential vaccines, medications
(00:32):
and counseling strategies toensure travelers stay healthy
before, during and after theirjourney.
It's so great to have ReginaRichardson with us for today's
guest for this episode.
Regina, thanks for joining us.
Speaker 2 (00:45):
Thank you for having me.
Speaker 1 (00:46):
Yeah.
So for our learners out there,Regina, go ahead and take a
couple of minutes and introduceyourself.
Tell us a little bit about yourpractice site and maybe why
you're passionate about today'stopic.
Speaker 2 (00:57):
Sure.
So I am originally from Ohioand I attended Ohio Northern
University.
Since graduating I have livedin Richmond, virginia, and I've
worked for a retail pharmacy andnow I work at Brimo Pharmacy,
which is a local independenthere in Richmond.
Our practice site is unique.
(01:20):
We like to think of ourselvesas cutting edge, so we try to do
all the new and great thingsthat are coming in pharmacy, and
one of those is we have atravel clinic.
So one of my colleagues,probably almost 10 years ago,
had the idea to start a travelclinic.
It started very small and nowit has grown to where we get
(01:44):
referrals almost every day ofpatients who are traveling and
looking for our services.
So I love to travel myself andI have had challenges in the
past, you know, finding what Ineeded for travel, and so I
think it's great to have theservice and offer education and
(02:04):
medication that patients need.
Speaker 1 (02:06):
Yeah, that's awesome and I would assume that there
probably aren't that manypharmacies or travel clinics
nearby.
You said that you get a lot ofreferrals, so I would imagine
you probably get probably 60, 90mile radius of referrals, if
not more sometimes with things.
Speaker 2 (02:24):
So yeah, there definitely are people who come
from fairly far away.
There is a large travel health.
That's all they do.
It's not a pharmacy.
They, I think, have somerestrictions on insurance that
you know, kind of pushes peopleto use us.
Speaker 1 (02:41):
Yeah, well, that's great.
Well, that's great, well,thanks again, regina, for taking
time out of your schedule.
I can see that you are at work,I know you're at work, so I
appreciate you, and also yourstaff, for allowing you the time
to step away and join us forthis episode so we're grateful.
Well, without further ado, let'sjump into some of our topic for
(03:02):
today.
So one thing I want to talkabout it's been a long time
since I've traveled abroad I'vebeen on a few trips here and
there but probably a couple ofdecades since I've been like
overseas per se.
So I feel like I'm not evenreally in the know anymore.
So I'm looking forward tolearning more about things.
But just remind us what aresome of the common risks and
(03:24):
preventable illnesses that areassociated with international
travel?
What are the ones that you allsee the most of that you're
treating patients for?
Speaker 2 (03:33):
I think the risks fall into two categories.
The one is things that peoplecontract from contaminated food
and water.
And the other is mostly mosquitoborne but insect borne
infections.
So you know, in your bucket offood and water borne illnesses
(03:55):
there's I mean there's tons ofthings obviously that you can
run into Viruses, viruses,bacteria, parasites.
The things that we really lookat preventing are hepatitis A
and typhoid.
Those are, you know, whatvaccines exist to prevent.
And then we also really try toset people up with an antibiotic
(04:20):
to treat an infection shouldthey get one for their trip?
Antibiotic to treat aninfection, should they get one
for their trip.
And then the other bucket ofthings are insect-borne or
mosquito-borne illnesses.
So yellow fever and malaria aredefinitely the most common.
Speaker 1 (04:34):
The most common and what I guess regions or areas
are we looking at to where thoseare of concern, Like if
someone's going to London,England, over the summer, like,
is that a concern?
Or are we looking at, you know,certain regions and areas of
things where we have problems?
Speaker 2 (04:52):
Yeah, so the biggest, so most of Europe, especially
Western Europe, doesn't reallythere's not a lot of concern
there Beyond what you would beconcerned about here in the
United States, sure.
Sure concern there, beyond whatyou would be concerned about
here in the United States.
So our most common patient isgoing to Asia, especially
Southeast Asia, Africa and Southand Central America.
(05:15):
Those are the places where theyhave these infections and
things where we want to providethem some prevention before they
go.
Speaker 1 (05:23):
Sure.
So if that's the region whereyour patients are traveling,
then those are the moments whereyou can jump in as a pharmacist
with some counseling, somerecommendations, some reminders
Great.
So what?
Obviously, our listeners arepharmacists, so we always like
to make sure that we'rehighlighting the role that they
(05:44):
have in this.
So what are some of the thingsthat pharmacists can do in this
space?
Obviously, dispense medicationis one of the things, but like
specifically talk about whatexactly can they dispense?
What are some of the thingsthat go along with the
prevention and the treatment,and then some of the counseling
(06:05):
you know, I think is probablykey.
Speaker 2 (06:06):
So so yeah, as pharmacists, um we have a
protocol in place to um toprescribe and administer travel
vaccines with the doctor.
Our um state we, you know wecan prescribe and administer
routine vaccines, but travel iskind of exempt from that.
(06:29):
So we have a protocol thatincludes travel vaccines, so
that you know anytime a patientyou know was asking about them
or maybe they request onevaccine they say they're
traveling we can kind of assessand make those recommendations
in the moment.
Speaker 1 (06:45):
Sure.
Speaker 2 (06:45):
So basically like oh, you're going here and you
thought you only needed this,but you actually need this too,
so yeah, yes, If you're seeingrequests for things that are
typically for travel, that couldbe an opportunity for
pharmacists to kind of step in.
Or even if you receive aprescription for an
anti-malarial medication.
I mean, that is pretty muchonly used for travel.
(07:07):
So yeah you might be prompted toask do you have all your
vaccines?
Is this, you know, somethingthat we can help you with?
And then also, yeah, justcounseling on the medication.
So making sure patientsunderstand that you know if they
have an anti-malarialmedication, making sure they
understand how to take it, thatit's for prevention.
(07:29):
It doesn't guarantee that theywon't get malaria, unfortunately
, so they still have to useother precautions.
You know, like traveler'sdiarrhea antibiotics, those are
not going to prevent them fromgetting sick.
It's for them to take if theyare getting sick or if they do
get sick.
So you know being the person toprovide that additional
education when they pick uptheir medication.
Speaker 1 (07:51):
Yeah, the clarity over you know this antibiotic
prescription is only if you needit, like don't just start
taking this when you, when youget to your destination or
whatever.
So yeah, so we talked a littlebit about destination specific
risks.
So some of the regions and someof the areas where we're
looking at those things and Ilove the fact that you kind of
(08:12):
divided it into two buckets.
I think that's super helpful toremember what are some of the
patient specific factors that weshould consider as well?
Speaker 2 (08:22):
I think that when it comes to foodborne know,
foodborne illness andcontaminated water, that kind of
thing, you just want to be alittle bit more cautious.
Perhaps provide additionaldoses of antibiotics if someone
is immunocompromised or you knowan older patient who might have
more complications from sometype of infectious diarrhea, or
(08:47):
you know GI infection?
You also might counsel that theyshould seek medical attention a
little bit sooner than maybe ayounger, healthier person who
might recover on their own or beless susceptible to dehydration
.
The same kind of thoughtprocess goes along with
(09:07):
something we haven't talkedabout yet, which is altitude
sickness.
That's something that we don'tdo all the time, but sometimes
we have patients who areclimbing Mount Everest or Mount.
Kilimanjaro or just going toplaces like Peru is an example
where people are typically goingto high altitudes.
People who are older are goingto be more susceptible to some
(09:30):
of those things.
So just making sure theyunderstand the risks and that
their preventative medication isreally important.
Speaker 1 (09:38):
Yeah, you made me think of something that I'll ask
here when we were talking aboutdosing and if they're an older
patient and if they'reimmunocompromised and whatnot.
Are we also do dosage, and youdon't have to get into specifics
, obviously, but I assumedosages differ based on the age
of the patient as well.
(09:58):
You know, like, if we have ateenager going on a mission trip
or something with that, do youhave to consider okay, they only
get three days of ofantibiotics, whereas somebody
else would get five or whatever?
Are there?
Are there specifications there,or is it pretty much across the
board?
Speaker 2 (10:13):
The guideline for traveler's diarrhea is pretty
uniform.
It's really only weight-based.
Um the only time we reallydeviate is if someone we
typically recommend azithromycin, so if someone has an allergy,
is usually the only time wedeviate and pick a different
agent For anti-malarialmedication.
(10:35):
That is also usually onlyweight-based, so for children
the dose is different, butadults typically get the same
dose.
I think there is acontraindication for people with
very severe renal impairment,but I mean for the most part I
(10:57):
forget the actual number, butfor the most part the patients
that we're seeing are not inthat category.
But if they were, then thatjust isn't an agent that they
could take.
Speaker 1 (11:08):
Gotcha.
So there are specifics to lookat, like you said just with in
general, for dispensingmedications.
You're going to be looking atallergies and weight-based and
things like that.
Okay, that's good, that'shelpful.
What about timelines?
So I know that some people arenot as organized as I would call
myself and so they may not beplanning their trip ahead, you
(11:30):
know, six months in advance orwhatever.
Like when should people, ifthey were to ask you about it,
if you don't have a full fledgedtravel clinic in your pharmacy,
and they're just asking you foradvice, like when should they
be getting certain vaccines?
I assume there are schedulesbased for all of them.
And when should they, you know,any sort of preventative
treatment?
Is there certain timelines thatthey should be following?
Speaker 2 (11:54):
I usually tell people that earlier is always better
because I mean I think theshortest you know the shortest
efficacy for the vaccines thatwe typically recommend is the
typhoid vaccine, but it's goodfor two years.
So I mean you can't get themtoo early.
I guess is my point in sayingthat it's usually recommended to
(12:16):
get vaccines 10 to 14 daysbefore entering wherever you're
going, so that gives your bodytime to have an immune response.
Speaker 1 (12:26):
Yeah, that's really what I was asking.
I guess I didn't set you upvery great with that one, but
that's what I meant was likeyou've got it, though, thank you
for reading my mind, but that'swhat I meant was like is there
a period of it needs to takethis long to work?
You know that kind of thing?
So the lane superior?
Yeah, so that's perfect, that'sso.
(12:47):
Two to 10 to 14 days is typical.
Are there any that are longerthan that or specific?
Speaker 2 (12:54):
Not to my knowledge.
The malaria medication that wetypically recommend is Malarone
and that only needs to be takentwo days before you start, at
two days before you start, attwo days before you enter where
you're going, so that you know,gives people some time, you know
.
I think that if patients aretraveling, you know starting the
(13:16):
process before the 14 days tomake sure you know the pharmacy
has everything you need and thedoctor needs to be involved and
things like that.
But yeah, getting the vaccines14 days before will ensure that
an immune response has happenedby the time you're traveling.
Speaker 1 (13:31):
Yeah.
So it doesn't have to be youknow, it doesn't need to be
someone who would pre-plan likeI would, you know, five to six
months in advance.
We're not talking about thosekind of pre-planners, but we
need at least two to three weeksnotice.
So okay, that's helpful.
So on that note, you'vementioned some already but some
(13:52):
additional opportunities forpharmacists to kind of be
involved in this space.
So you mentioned that yourstore has a full-fledged clinic.
So in my mind when I heartravel clinic, I immediately
think of, like this extra littlespace over in the corner.
That's just about travel.
Is that how it works?
Or is it literally just thefact that you have the knowledge
and the protocol and all thatkind of stuff?
Like, give us a little bit ofinsight as to how kind of you're
set up at your practice site, Iguess.
Speaker 2 (14:14):
Yeah, we have.
We have a clinic room at ourpharmacy.
That's, you know, out in thestore.
It is its own room, its ownspace, it's private, so we do
all kinds of things in there.
That's where we do all of ourappointments.
Travel is just one part of that.
So patients submit a formonline and, you know, give us
(14:37):
all their information wherethey're going.
We ask, you know, certainhealth-related questions and
then we determine what they need.
We reach out to their doctorfor the malaria, traveler's
diarrhea or altitude sicknessmedication, if those are needed,
and then when they come in, wegive them the education and then
(14:58):
give them any vaccines thatthey need.
Speaker 1 (15:00):
Okay, so I guess my point there was it doesn't have
to be a dedicated space.
So if someone else, if anotherstore is offering immunization
services in general, thatpatient specific space could
also serve for a travel clinicas well, correct?
Speaker 2 (15:18):
Yeah, I think any space that is set aside for you
to give immunizations or counsela patient could be utilized for
yes for travel.
Speaker 1 (15:27):
Perfect.
Yep, you've touched a littlebit on some of the education
points and how counseling issuper important and whatnot.
What are some of those nuancesLike?
What are some of the thingsthat we absolutely want to be
sure that we are counseling on?
Are there specific side effectsfrom some of the medications
that we need to alert people toso that they aren't alarmed?
(15:50):
Or if it's something thatthey're taking by mouth that
they don't stop taking becauseadherence is key?
You know, like, what are someof those high key counseling
points, pain point medicationsthat need counseling?
Speaker 2 (16:01):
I think the malaria medication is really important.
Sometimes it does cause anupset stomach for patients, so
we usually tell them to take itwith food.
We also frequently will havepediatric patients who need
malaria medication.
It's only available in a tablet, so we counsel on crushing it,
(16:21):
mixing it with food, but thenpatients should receive the
medication right after that.
It shouldn't be like mixed andset aside for later.
That's something that we counselon For malaria medication, it's
important that they take onetablet a day for the entire trip
and then they also have tocontinue for seven days after
(16:42):
they come back.
Yes, because there are certaintypes of malaria that can be
latent and present later on.
So taking it after they comeback is really important For the
traveler's diarrhea antibiotics.
We make sure they know.
You know this is for treatment,this is not for maybe.
Like I just ate something thatdidn't really agree with me and
(17:05):
my stomach's a little bit queasy.
This is you have maybe somecramping, fever, diarrhea,
vomiting.
That's not getting better.
We also make sure theyunderstand that an antibiotic is
obviously for a bacterialinfection, but there's parasites
and other things that might bepresent.
Parasites and other things thatmight be present, and if this
(17:29):
antibiotic does nothing for yourinfection, you will need to you
know, seek treatment at yourdestination because, they will
have what's best for treatingthose types of things.
Speaker 1 (17:37):
Right, and unfortunately some of that is, I
imagine.
But it's almost like catch 22,where it's like you got sick
from the water and now you aredehydrated and you need to
hydrate, but like you know.
So I would imagine that thatcould become problematic.
Do you all offer any sort ofguidance there, or is that kind
of the situation where you'relike you need to seek medical
(17:57):
care because it needs toprobably be?
Speaker 2 (18:00):
replenished.
Do we offer education ondehydration?
Speaker 1 (18:03):
Yeah, like how would you hydrate in an area that you
got sick from the water to beginwith?
Yes, that's true.
Speaker 2 (18:11):
So part of our education is just about drinking
the water generally.
So I think it can bechallenging because there's no
way to know the water qualityeverywhere and it kind of also
depends on where they're stayingand what's provided for people
who are traveling.
But we normally counseleveryone that when there's a
(18:35):
doubt, make sure you're drinkingbottled water, avoiding ice
because it can be made withcontaminated water, also
understanding that you might bevisiting your family or your
friends who are drinking thewater with no issues.
However, they are accustomed todrinking that water, so you
know when the water that you aredrinking has just different
(18:58):
microbes in it in differentplaces and if you've grown up
there that's something thatyou're, you know, you're used to
, so someone coming fromsomewhere else might have, you
might have a reaction or getsick from the same water.
So we do go over just generalwater and food safety as part of
our education.
Speaker 1 (19:16):
Yeah, no, I think that's probably what I mean.
You've given some great pointsand they're all resonating, but
that one to me really resonatesbecause it's almost like oh well
, so-and-so is drinking it, soyou know I'm in their house, so
it must be fine.
So that's really key to alsorealize.
Yeah, that's great, greatadvice.
One thing that you mentionedand I meant to talk about this
(19:39):
earlier and I didn't because youmentioned like it depends on
where you're going and whatever.
So what if you're going into anarea that is usually of high
concern with water quality?
You know, like we have a, youhave a lot of issues in this
area, but you're, you're goingon and it's an all-inclusive
resort or you know somethinglike that.
(19:59):
Is there still a concern?
Or are we assuming that thosequote unquote elevated places,
you know resort style things orwhatever that they're filtering
properly?
Or should there still be greatconcern there?
Speaker 2 (20:17):
I think with food and water, you have to trust the
information that's available toyou as a traveler.
So you should probably ask Alot of times.
People are traveling withgroups or you know they have
travel agents or tour guides,things like that.
So asking those questions toyou, know the people that are
the most knowledgeable aboutwhere you're going?
Speaker 1 (20:38):
Yeah.
Speaker 2 (20:38):
And then.
But you also have to be okay,like with trusting their answer.
So I usually say when in doubt,bottled water.
However, you know, if there'sinformation that says we use a
special filtration system orsomething like that in our
resort, then I think you, youknow you can trust it.
It varies so much, I thinkwater is something that's really
(21:01):
difficult because you don'talways have all the information
as the person giving them advice.
Speaker 1 (21:07):
Yeah, no, that's great, that's great advice.
I just wondered if there was adifferent approach in your
protocol based on that, and itsounds as though I mean what
you've given me is exactly thatLike you need to ask the
questions, listen to the answersand then that allows you to
make informed decisions as towhether or not you want to trust
it or if you just want to besuper cautious, and yeah so on
(21:29):
on our form that we havepatients fill out.
Speaker 2 (21:32):
One of the questions is about where are you staying A
?
Hotel Are you camping Are youstaying with friends, because
there are certain things thatyou are more likely to get if
you're staying, you know,somewhere that doesn't have air
conditioning, like there's moremosquitoes that are going to be
there.
So you have to take all ofthose things into consideration.
Speaker 1 (21:54):
Yeah, If you're sleeping in a tree house under
the stars, you're going to bemore susceptible to yes you want
to make sure you have mosquitonets and stuff like that, as
opposed to an air conditionedhotel.
Speaker 2 (22:05):
You know the risk.
Speaker 1 (22:11):
Exactly that makes sense.
So those are again.
So it's important for forpharmacists to ask the right
questions too, and it soundslike your.
Your intake form is verythorough, and I think that that
is a recurring theme that we'reseeing with you is that?
You know, we asked them thisalready and that's how we know
to to guide our consultations,which is great.
Okay, yeah, so let's talk aboutsome of the challenges.
(22:33):
Let's do that in our last fewminutes here.
So some of the challenges thatyou might encounter are any of
the vaccine schedules complex,like is it difficult to get in
all the doses, especially if youhave a late comer?
Or is it you know that theyhave to come back for a second
dose?
And if they don't come backwithin a certain period, then
you know, like some of thosekind of issues where it's like,
(22:54):
oh, you got to start over againor whatever.
So are there any concerns likethat with any of the travel
vaccines?
Speaker 2 (23:00):
For the most part, it's fairly straightforward.
So, our most common vaccinesare hepatitis A, which is two
doses one and then one in sixmonths.
However, the first dose doesgive really good coverage for
the short term.
So, that first dose is going tousually cover that person for
their trip, and then we dorecommend that they come back
(23:24):
after six months to get theirsecond dose for lifetime
immunity.
Speaker 1 (23:28):
But that one is not they wouldn't need to plan ahead
six months to come get thefirst-.
No, right, okay, yeah.
Speaker 2 (23:33):
Yeah, because their first dose does give them Is one
Right, okay, yeah, yeah,because their first dose is what
covers them.
Speaker 1 (23:36):
Okay, yeah.
Speaker 2 (23:38):
The second one is typhoid, so that's just one dose
.
It lasts for two years, so thatone's very straightforward.
The other one that is reallycommon is yellow fever.
They recently, within the lastcouple of years, have changed
the guidelines on yellow fever,so one vaccine provides lifetime
coverage.
(23:59):
That one yellow fever is thetrickiest vaccine because
there's a card that you have togive patients and certain
countries require the card, sowe have to make sure we're
filling it out correctly, thatthey meet all the requirements.
There's also a medical waiverthat some patients can get.
So it's a live vaccine.
(24:19):
So there's, you know, patientswho have immuno, who are
immunocompromised, might not beeligible to get it.
Also, patients over the age of60 are more likely to have some
adverse effects, likely to havesome adverse effects which can
actually be very serious.
So there's like a viscerotropicis what it's called adverse
(24:40):
event.
It's like can cause multipleorgan failure.
Speaker 1 (24:44):
Wow.
Speaker 2 (24:44):
And there's also a neurologic, I guess, side effect
you could say that can bereally severe.
So making sure we identifywhich patients should and should
not get.
Speaker 1 (24:54):
The vaccine is important, yeah, very important.
So another concern orpotentially with vaccines is
sometimes the quantity in whichthey come.
So is this something that youcan just offer on a whim, or do
you really have to double downbecause you're going to have to
buy 10 yellow fevers or you knowwhat I mean 10 doses of that?
(25:15):
So if you can speak to a littlebit of kind of how that's
packaged and whatnot, that wouldbe helpful.
Speaker 2 (25:20):
Yeah, that's actually a challenge that we had in the
early days of our travel clinicwhen we had not as many patients
.
So typhoid luckily comes as asingle dose, so that one's easy.
Hepatitis A and B are routineenough that you would probably
or you could use the doses.
Yellow fever does come as apack of five.
(25:42):
You also have to get special, Iguess, registration as a site,
because you have to get a stampto give the cards.
And then I'm trying to think ofother ones.
The one that we've had we usedto have a challenge with was the
polio vaccine, because it's amulti-dose vial and we always
operated under the assumptionthat after 28 days you had to
(26:04):
discard it.
However, that's actually notthe case.
We were able to findinformation that that vaccine is
good for the life until theexpiration date on the bottle.
Speaker 1 (26:16):
So that is helpful.
Speaker 2 (26:17):
Yeah, that's really helpful, okay, so that's been
really helpful in us being ableto offer that, you know, for
more patients.
Speaker 1 (26:24):
So what I'm hearing is there aren't too many
barriers to offering travel help, vaccines and services.
So I hope that our listenersare motivated by this and really
realizing that this is a viableopportunity to kind of increase
services that are offered topatients and, potentially,
(26:45):
revenue streams for the pharmacy.
So quickly, we only have acouple minutes left, but do you
have any barriers toreimbursement?
Are there any specialconsiderations?
Is there a lot of times wherethe patient's having to pay cash
for things and that's a problem, if you can just kind of speak
to that component of it too.
Speaker 2 (27:03):
Yes, a lot of travel vaccines are vaccines that are
specifically for travel, soyellow fever and typhoid are
usually not covered by thepatient's insurance.
So that's an out-of-pocket costwhich certainly can be a
barrier for the patient.
We do sometimes run into issueswith some travel vaccines where
(27:25):
our reimbursement is not asmuch as the cost.
So where the pharmacy is notbeing appropriately reimbursed
for the vaccine.
But the most common issue ishonestly for the patient because
insurance does not see them asessential.
Speaker 1 (27:45):
So they don't cover them?
Sure, yeah, and if they'replanning ahead early enough,
then hopefully there's timeenough to kind of make
arrangements and whatnot.
So, yeah, well, that's superhelpful.
I always say I don't understandhow I run out of time so
quickly, but lots of greatinformation, but we are already
out of time for this episode.
So, regina, before we go today,a question I always like to
(28:07):
kind of double back to and askis what's the game changer here?
It's our topic of our podcast.
Is game changers, um, our title?
And so I always like to kind ofask the, the speaker for the
day, to just summarize what youfeel like is the game changer
here?
What have we talked about?
Speaker 2 (28:23):
that is like the key point I think that, as
pharmacists role pharmacistsroles are expanding this is a
really great place for apharmacist to fill a need that
might not otherwise be filled.
So it's a great way to haveyour patients see you in a
different light.
Speaker 1 (28:42):
Absolutely.
And you know one thing I'lltouch on too.
You know you all did your duediligence to determine that in
your state you needed to get acollaborative practice agreement
and to work under a doctor withprotocol and whatever, and so I
would encourage our listenersif this is something you're
considering, be sure that you'rechecking your state guidelines
and your state board of pharmacyas to what you can and can't do
(29:03):
under scope of practice there.
But, like you said, this is anopportunity for pharmacists to
fill that void and I love howyou put it to have your patients
see you in a different light.
That's great, because I thinkit's really important that we're
continuously sharing with ourpatients all the different great
things that we can do aspharmacists.
(29:25):
One thing I will mention as wellis Regina is working with us to
create a travel health advancedtraining course.
She has a component in that aswell and is going to really talk
about it.
Correct me if I'm wrong, but Ithink you're part of that
content is about implementingand setting up an actual travel
clinic.
So there'll be other componentsof that advanced training that
(29:48):
will talk more about themedications that Regina's
mentioned, go into greaterdetail on some of those nuances,
dosaging as well as sideeffects, to be aware of
counseling tips, that kind ofthing.
But she's going to be joiningthat advanced training on kind
of how to implement an actualtravel clinic.
So thank you so much for thisinformation.
This is, I feel, like, just agreat quick overview that kind
(30:11):
of reminds us all that there isa need for this.
You know, depending on whereyou are, you could have a lot of
patients that are in need ofthis, these types of services,
and I think that these arethings that, from what I'm
hearing I'm not trying todownplay the difficulties that
you might encounter, but itsounds like services that are
fairly easy to implement into astore and to kind of offer for
(30:33):
your patients are fairly easy toimplement into a store and to
kind of offer for your patients.
So, yeah, so thank you, regina,again for taking time out of
your schedule and to share someof this insights with us.
I really appreciate it.
Speaker 2 (30:40):
Sure.
Thank you for having me.
Speaker 1 (30:42):
Of course, if you're a CE Plan subscriber, be sure to
claim your CE credit for thisepisode of Game Changers by
logging in at ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
Hey, CE Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, Josh Kinsey, and, as always, I'm excited about
our conversation today.
Traveling opens the door to newexperiences, but it also comes
with health risks thatpharmacists are uniquely
positioned to help prevent.
In this episode, we'll discussessential vaccines, medications
(00:32):
and counseling strategies toensure travelers stay healthy
before, during and after theirjourney.
It's so great to have ReginaRichardson with us for today's
guest for this episode.
Regina, thanks for joining us.
Speaker 2 (00:45):
Thank you for having me.
Speaker 1 (00:46):
Yeah.
So for our learners out there,Regina, go ahead and take a
couple of minutes and introduceyourself.
Tell us a little bit about yourpractice site and maybe why
you're passionate about today'stopic.
Speaker 2 (00:57):
Sure.
So I am originally from Ohioand I attended Ohio Northern
University.
Since graduating I have livedin Richmond, virginia, and I've
worked for a retail pharmacy andnow I work at Brimo Pharmacy,
which is a local independenthere in Richmond.
Our practice site is unique.
(01:20):
We like to think of ourselvesas cutting edge, so we try to do
all the new and great thingsthat are coming in pharmacy, and
one of those is we have atravel clinic.
So one of my colleagues,probably almost 10 years ago,
had the idea to start a travelclinic.
It started very small and nowit has grown to where we get
(01:44):
referrals almost every day ofpatients who are traveling and
looking for our services.
So I love to travel myself andI have had challenges in the
past, you know, finding what Ineeded for travel, and so I
think it's great to have theservice and offer education and
(02:04):
medication that patients need.
Speaker 1 (02:06):
Yeah, that's awesome and I would assume that there
probably aren't that manypharmacies or travel clinics
nearby.
You said that you get a lot ofreferrals, so I would imagine
you probably get probably 60, 90mile radius of referrals, if
not more sometimes with things.
Speaker 2 (02:24):
So yeah, there definitely are people who come
from fairly far away.
There is a large travel health.
That's all they do.
It's not a pharmacy.
They, I think, have somerestrictions on insurance that
you know, kind of pushes peopleto use us.
Speaker 1 (02:41):
Yeah, well, that's great.
Well, that's great, well,thanks again, regina, for taking
time out of your schedule.
I can see that you are at work,I know you're at work, so I
appreciate you, and also yourstaff, for allowing you the time
to step away and join us forthis episode so we're grateful.
Well, without further ado, let'sjump into some of our topic for
(03:02):
today.
So one thing I want to talkabout it's been a long time
since I've traveled abroad I'vebeen on a few trips here and
there but probably a couple ofdecades since I've been like
overseas per se.
So I feel like I'm not evenreally in the know anymore.
So I'm looking forward tolearning more about things.
But just remind us what aresome of the common risks and
(03:24):
preventable illnesses that areassociated with international
travel?
What are the ones that you allsee the most of that you're
treating patients for?
Speaker 2 (03:33):
I think the risks fall into two categories.
The one is things that peoplecontract from contaminated food
and water.
And the other is mostly mosquitoborne but insect borne
infections.
So you know, in your bucket offood and water borne illnesses
(03:55):
there's I mean there's tons ofthings obviously that you can
run into Viruses, viruses,bacteria, parasites.
The things that we really lookat preventing are hepatitis A
and typhoid.
Those are, you know, whatvaccines exist to prevent.
And then we also really try toset people up with an antibiotic
(04:20):
to treat an infection shouldthey get one for their trip?
Antibiotic to treat aninfection, should they get one
for their trip.
And then the other bucket ofthings are insect-borne or
mosquito-borne illnesses.
So yellow fever and malaria aredefinitely the most common.
Speaker 1 (04:34):
The most common and what I guess regions or areas
are we looking at to where thoseare of concern, Like if
someone's going to London,England, over the summer, like,
is that a concern?
Or are we looking at, you know,certain regions and areas of
things where we have problems?
Speaker 2 (04:52):
Yeah, so the biggest, so most of Europe, especially
Western Europe, doesn't reallythere's not a lot of concern
there Beyond what you would beconcerned about here in the
United States, sure.
Sure concern there, beyond whatyou would be concerned about
here in the United States.
So our most common patient isgoing to Asia, especially
Southeast Asia, Africa and Southand Central America.
(05:15):
Those are the places where theyhave these infections and
things where we want to providethem some prevention before they
go.
Speaker 1 (05:23):
Sure.
So if that's the region whereyour patients are traveling,
then those are the moments whereyou can jump in as a pharmacist
with some counseling, somerecommendations, some reminders
Great.
So what?
Obviously, our listeners arepharmacists, so we always like
to make sure that we'rehighlighting the role that they
(05:44):
have in this.
So what are some of the thingsthat pharmacists can do in this
space?
Obviously, dispense medicationis one of the things, but like
specifically talk about whatexactly can they dispense?
What are some of the thingsthat go along with the
prevention and the treatment,and then some of the counseling
(06:05):
you know, I think is probablykey.
Speaker 2 (06:06):
So so yeah, as pharmacists, um we have a
protocol in place to um toprescribe and administer travel
vaccines with the doctor.
Our um state we, you know wecan prescribe and administer
routine vaccines, but travel iskind of exempt from that.
(06:29):
So we have a protocol thatincludes travel vaccines, so
that you know anytime a patientyou know was asking about them
or maybe they request onevaccine they say they're
traveling we can kind of assessand make those recommendations
in the moment.
Speaker 1 (06:45):
Sure.
Speaker 2 (06:45):
So basically like oh, you're going here and you
thought you only needed this,but you actually need this too,
so yeah, yes, If you're seeingrequests for things that are
typically for travel, that couldbe an opportunity for
pharmacists to kind of step in.
Or even if you receive aprescription for an
anti-malarial medication.
I mean, that is pretty muchonly used for travel.
(07:07):
So yeah you might be prompted toask do you have all your
vaccines?
Is this, you know, somethingthat we can help you with?
And then also, yeah, justcounseling on the medication.
So making sure patientsunderstand that you know if they
have an anti-malarialmedication, making sure they
understand how to take it, thatit's for prevention.
(07:29):
It doesn't guarantee that theywon't get malaria, unfortunately
, so they still have to useother precautions.
You know, like traveler'sdiarrhea antibiotics, those are
not going to prevent them fromgetting sick.
It's for them to take if theyare getting sick or if they do
get sick.
So you know being the person toprovide that additional
education when they pick uptheir medication.
Speaker 1 (07:51):
Yeah, the clarity over you know this antibiotic
prescription is only if you needit, like don't just start
taking this when you, when youget to your destination or
whatever.
So yeah, so we talked a littlebit about destination specific
risks.
So some of the regions and someof the areas where we're
looking at those things and Ilove the fact that you kind of
(08:12):
divided it into two buckets.
I think that's super helpful toremember what are some of the
patient specific factors that weshould consider as well?
Speaker 2 (08:22):
I think that when it comes to foodborne know,
foodborne illness andcontaminated water, that kind of
thing, you just want to be alittle bit more cautious.
Perhaps provide additionaldoses of antibiotics if someone
is immunocompromised or you knowan older patient who might have
more complications from sometype of infectious diarrhea, or
(08:47):
you know GI infection?
You also might counsel that theyshould seek medical attention a
little bit sooner than maybe ayounger, healthier person who
might recover on their own or beless susceptible to dehydration
.
The same kind of thoughtprocess goes along with
(09:07):
something we haven't talkedabout yet, which is altitude
sickness.
That's something that we don'tdo all the time, but sometimes
we have patients who areclimbing Mount Everest or Mount.
Kilimanjaro or just going toplaces like Peru is an example
where people are typically goingto high altitudes.
People who are older are goingto be more susceptible to some
(09:30):
of those things.
So just making sure theyunderstand the risks and that
their preventative medication isreally important.
Speaker 1 (09:38):
Yeah, you made me think of something that I'll ask
here when we were talking aboutdosing and if they're an older
patient and if they'reimmunocompromised and whatnot.
Are we also do dosage, and youdon't have to get into specifics
, obviously, but I assumedosages differ based on the age
of the patient as well.
(09:58):
You know, like, if we have ateenager going on a mission trip
or something with that, do youhave to consider okay, they only
get three days of ofantibiotics, whereas somebody
else would get five or whatever?
Are there?
Are there specifications there,or is it pretty much across the
board?
Speaker 2 (10:13):
The guideline for traveler's diarrhea is pretty
uniform.
It's really only weight-based.
Um the only time we reallydeviate is if someone we
typically recommend azithromycin, so if someone has an allergy,
is usually the only time wedeviate and pick a different
agent For anti-malarialmedication.
(10:35):
That is also usually onlyweight-based, so for children
the dose is different, butadults typically get the same
dose.
I think there is acontraindication for people with
very severe renal impairment,but I mean for the most part I
(10:57):
forget the actual number, butfor the most part the patients
that we're seeing are not inthat category.
But if they were, then thatjust isn't an agent that they
could take.
Speaker 1 (11:08):
Gotcha.
So there are specifics to lookat, like you said just with in
general, for dispensingmedications.
You're going to be looking atallergies and weight-based and
things like that.
Okay, that's good, that'shelpful.
What about timelines?
So I know that some people arenot as organized as I would call
myself and so they may not beplanning their trip ahead, you
(11:30):
know, six months in advance orwhatever.
Like when should people, ifthey were to ask you about it,
if you don't have a full fledgedtravel clinic in your pharmacy,
and they're just asking you foradvice, like when should they
be getting certain vaccines?
I assume there are schedulesbased for all of them.
And when should they, you know,any sort of preventative
treatment?
Is there certain timelines thatthey should be following?
Speaker 2 (11:54):
I usually tell people that earlier is always better
because I mean I think theshortest you know the shortest
efficacy for the vaccines thatwe typically recommend is the
typhoid vaccine, but it's goodfor two years.
So I mean you can't get themtoo early.
I guess is my point in sayingthat it's usually recommended to
(12:16):
get vaccines 10 to 14 daysbefore entering wherever you're
going, so that gives your bodytime to have an immune response.
Speaker 1 (12:26):
Yeah, that's really what I was asking.
I guess I didn't set you upvery great with that one, but
that's what I meant was likeyou've got it, though, thank you
for reading my mind, but that'swhat I meant was like is there
a period of it needs to takethis long to work?
You know that kind of thing?
So the lane superior?
Yeah, so that's perfect, that'sso.
(12:47):
Two to 10 to 14 days is typical.
Are there any that are longerthan that or specific?
Speaker 2 (12:54):
Not to my knowledge.
The malaria medication that wetypically recommend is Malarone
and that only needs to be takentwo days before you start, at
two days before you start, attwo days before you enter where
you're going, so that you know,gives people some time, you know
.
I think that if patients aretraveling, you know starting the
(13:16):
process before the 14 days tomake sure you know the pharmacy
has everything you need and thedoctor needs to be involved and
things like that.
But yeah, getting the vaccines14 days before will ensure that
an immune response has happenedby the time you're traveling.
Speaker 1 (13:31):
Yeah.
So it doesn't have to be youknow, it doesn't need to be
someone who would pre-plan likeI would, you know, five to six
months in advance.
We're not talking about thosekind of pre-planners, but we
need at least two to three weeksnotice.
So okay, that's helpful.
So on that note, you'vementioned some already but some
(13:52):
additional opportunities forpharmacists to kind of be
involved in this space.
So you mentioned that yourstore has a full-fledged clinic.
So in my mind when I heartravel clinic, I immediately
think of, like this extra littlespace over in the corner.
That's just about travel.
Is that how it works?
Or is it literally just thefact that you have the knowledge
and the protocol and all thatkind of stuff?
Like, give us a little bit ofinsight as to how kind of you're
set up at your practice site, Iguess.
Speaker 2 (14:14):
Yeah, we have.
We have a clinic room at ourpharmacy.
That's, you know, out in thestore.
It is its own room, its ownspace, it's private, so we do
all kinds of things in there.
That's where we do all of ourappointments.
Travel is just one part of that.
So patients submit a formonline and, you know, give us
(14:37):
all their information wherethey're going.
We ask, you know, certainhealth-related questions and
then we determine what they need.
We reach out to their doctorfor the malaria, traveler's
diarrhea or altitude sicknessmedication, if those are needed,
and then when they come in, wegive them the education and then
(14:58):
give them any vaccines thatthey need.
Speaker 1 (15:00):
Okay, so I guess my point there was it doesn't have
to be a dedicated space.
So if someone else, if anotherstore is offering immunization
services in general, thatpatient specific space could
also serve for a travel clinicas well, correct?
Speaker 2 (15:18):
Yeah, I think any space that is set aside for you
to give immunizations or counsela patient could be utilized for
yes for travel.
Speaker 1 (15:27):
Perfect.
Yep, you've touched a littlebit on some of the education
points and how counseling issuper important and whatnot.
What are some of those nuancesLike?
What are some of the thingsthat we absolutely want to be
sure that we are counseling on?
Are there specific side effectsfrom some of the medications
that we need to alert people toso that they aren't alarmed?
(15:50):
Or if it's something thatthey're taking by mouth that
they don't stop taking becauseadherence is key?
You know, like, what are someof those high key counseling
points, pain point medicationsthat need counseling?
Speaker 2 (16:01):
I think the malaria medication is really important.
Sometimes it does cause anupset stomach for patients, so
we usually tell them to take itwith food.
We also frequently will havepediatric patients who need
malaria medication.
It's only available in a tablet, so we counsel on crushing it,
(16:21):
mixing it with food, but thenpatients should receive the
medication right after that.
It shouldn't be like mixed andset aside for later.
That's something that we counselon For malaria medication, it's
important that they take onetablet a day for the entire trip
and then they also have tocontinue for seven days after
(16:42):
they come back.
Yes, because there are certaintypes of malaria that can be
latent and present later on.
So taking it after they comeback is really important For the
traveler's diarrhea antibiotics.
We make sure they know.
You know this is for treatment,this is not for maybe.
Like I just ate something thatdidn't really agree with me and
(17:05):
my stomach's a little bit queasy.
This is you have maybe somecramping, fever, diarrhea,
vomiting.
That's not getting better.
We also make sure theyunderstand that an antibiotic is
obviously for a bacterialinfection, but there's parasites
and other things that might bepresent.
Parasites and other things thatmight be present, and if this
(17:29):
antibiotic does nothing for yourinfection, you will need to you
know, seek treatment at yourdestination because, they will
have what's best for treatingthose types of things.
Speaker 1 (17:37):
Right, and unfortunately some of that is, I
imagine.
But it's almost like catch 22,where it's like you got sick
from the water and now you aredehydrated and you need to
hydrate, but like you know.
So I would imagine that thatcould become problematic.
Do you all offer any sort ofguidance there, or is that kind
of the situation where you'relike you need to seek medical
(17:57):
care because it needs toprobably be?
Speaker 2 (18:00):
replenished.
Do we offer education ondehydration?
Speaker 1 (18:03):
Yeah, like how would you hydrate in an area that you
got sick from the water to beginwith?
Yes, that's true.
Speaker 2 (18:11):
So part of our education is just about drinking
the water generally.
So I think it can bechallenging because there's no
way to know the water qualityeverywhere and it kind of also
depends on where they're stayingand what's provided for people
who are traveling.
But we normally counseleveryone that when there's a
(18:35):
doubt, make sure you're drinkingbottled water, avoiding ice
because it can be made withcontaminated water, also
understanding that you might bevisiting your family or your
friends who are drinking thewater with no issues.
However, they are accustomed todrinking that water, so you
know when the water that you aredrinking has just different
(18:58):
microbes in it in differentplaces and if you've grown up
there that's something thatyou're, you know, you're used to
, so someone coming fromsomewhere else might have, you
might have a reaction or getsick from the same water.
So we do go over just generalwater and food safety as part of
our education.
Speaker 1 (19:16):
Yeah, no, I think that's probably what I mean.
You've given some great pointsand they're all resonating, but
that one to me really resonatesbecause it's almost like oh well
, so-and-so is drinking it, soyou know I'm in their house, so
it must be fine.
So that's really key to alsorealize.
Yeah, that's great, greatadvice.
One thing that you mentionedand I meant to talk about this
(19:39):
earlier and I didn't because youmentioned like it depends on
where you're going and whatever.
So what if you're going into anarea that is usually of high
concern with water quality?
You know, like we have a, youhave a lot of issues in this
area, but you're, you're goingon and it's an all-inclusive
resort or you know somethinglike that.
(19:59):
Is there still a concern?
Or are we assuming that thosequote unquote elevated places,
you know resort style things orwhatever that they're filtering
properly?
Or should there still be greatconcern there?
Speaker 2 (20:17):
I think with food and water, you have to trust the
information that's available toyou as a traveler.
So you should probably ask Alot of times.
People are traveling withgroups or you know they have
travel agents or tour guides,things like that.
So asking those questions toyou, know the people that are
the most knowledgeable aboutwhere you're going?
Speaker 1 (20:38):
Yeah.
Speaker 2 (20:38):
And then.
But you also have to be okay,like with trusting their answer.
So I usually say when in doubt,bottled water.
However, you know, if there'sinformation that says we use a
special filtration system orsomething like that in our
resort, then I think you, youknow you can trust it.
It varies so much, I thinkwater is something that's really
(21:01):
difficult because you don'talways have all the information
as the person giving them advice.
Speaker 1 (21:07):
Yeah, no, that's great, that's great advice.
I just wondered if there was adifferent approach in your
protocol based on that, and itsounds as though I mean what
you've given me is exactly thatLike you need to ask the
questions, listen to the answersand then that allows you to
make informed decisions as towhether or not you want to trust
it or if you just want to besuper cautious, and yeah so on
(21:29):
on our form that we havepatients fill out.
Speaker 2 (21:32):
One of the questions is about where are you staying A
?
Hotel Are you camping Are youstaying with friends, because
there are certain things thatyou are more likely to get if
you're staying, you know,somewhere that doesn't have air
conditioning, like there's moremosquitoes that are going to be
there.
So you have to take all ofthose things into consideration.
Speaker 1 (21:54):
Yeah, If you're sleeping in a tree house under
the stars, you're going to bemore susceptible to yes you want
to make sure you have mosquitonets and stuff like that, as
opposed to an air conditionedhotel.
Speaker 2 (22:05):
You know the risk.
Speaker 1 (22:11):
Exactly that makes sense.
So those are again.
So it's important for forpharmacists to ask the right
questions too, and it soundslike your.
Your intake form is verythorough, and I think that that
is a recurring theme that we'reseeing with you is that?
You know, we asked them thisalready and that's how we know
to to guide our consultations,which is great.
Okay, yeah, so let's talk aboutsome of the challenges.
(22:33):
Let's do that in our last fewminutes here.
So some of the challenges thatyou might encounter are any of
the vaccine schedules complex,like is it difficult to get in
all the doses, especially if youhave a late comer?
Or is it you know that theyhave to come back for a second
dose?
And if they don't come backwithin a certain period, then
you know, like some of thosekind of issues where it's like,
(22:54):
oh, you got to start over againor whatever.
So are there any concerns likethat with any of the travel
vaccines?
Speaker 2 (23:00):
For the most part, it's fairly straightforward.
So, our most common vaccinesare hepatitis A, which is two
doses one and then one in sixmonths.
However, the first dose doesgive really good coverage for
the short term.
So, that first dose is going tousually cover that person for
their trip, and then we dorecommend that they come back
(23:24):
after six months to get theirsecond dose for lifetime
immunity.
Speaker 1 (23:28):
But that one is not they wouldn't need to plan ahead
six months to come get thefirst-.
No, right, okay, yeah.
Speaker 2 (23:33):
Yeah, because their first dose does give them Is one
Right, okay, yeah, yeah,because their first dose is what
covers them.
Speaker 1 (23:36):
Okay, yeah.
Speaker 2 (23:38):
The second one is typhoid, so that's just one dose
.
It lasts for two years, so thatone's very straightforward.
The other one that is reallycommon is yellow fever.
They recently, within the lastcouple of years, have changed
the guidelines on yellow fever,so one vaccine provides lifetime
coverage.
(23:59):
That one yellow fever is thetrickiest vaccine because
there's a card that you have togive patients and certain
countries require the card, sowe have to make sure we're
filling it out correctly, thatthey meet all the requirements.
There's also a medical waiverthat some patients can get.
So it's a live vaccine.
(24:19):
So there's, you know, patientswho have immuno, who are
immunocompromised, might not beeligible to get it.
Also, patients over the age of60 are more likely to have some
adverse effects, likely to havesome adverse effects which can
actually be very serious.
So there's like a viscerotropicis what it's called adverse
(24:40):
event.
It's like can cause multipleorgan failure.
Speaker 1 (24:44):
Wow.
Speaker 2 (24:44):
And there's also a neurologic, I guess, side effect
you could say that can bereally severe.
So making sure we identifywhich patients should and should
not get.
Speaker 1 (24:54):
The vaccine is important, yeah, very important.
So another concern orpotentially with vaccines is
sometimes the quantity in whichthey come.
So is this something that youcan just offer on a whim, or do
you really have to double downbecause you're going to have to
buy 10 yellow fevers or you knowwhat I mean 10 doses of that?
(25:15):
So if you can speak to a littlebit of kind of how that's
packaged and whatnot, that wouldbe helpful.
Speaker 2 (25:20):
Yeah, that's actually a challenge that we had in the
early days of our travel clinicwhen we had not as many patients
.
So typhoid luckily comes as asingle dose, so that one's easy.
Hepatitis A and B are routineenough that you would probably
or you could use the doses.
Yellow fever does come as apack of five.
(25:42):
You also have to get special, Iguess, registration as a site,
because you have to get a stampto give the cards.
And then I'm trying to think ofother ones.
The one that we've had we usedto have a challenge with was the
polio vaccine, because it's amulti-dose vial and we always
operated under the assumptionthat after 28 days you had to
(26:04):
discard it.
However, that's actually notthe case.
We were able to findinformation that that vaccine is
good for the life until theexpiration date on the bottle.
Speaker 1 (26:16):
So that is helpful.
Speaker 2 (26:17):
Yeah, that's really helpful, okay, so that's been
really helpful in us being ableto offer that, you know, for
more patients.
Speaker 1 (26:24):
So what I'm hearing is there aren't too many
barriers to offering travel help, vaccines and services.
So I hope that our listenersare motivated by this and really
realizing that this is a viableopportunity to kind of increase
services that are offered topatients and, potentially,
(26:45):
revenue streams for the pharmacy.
So quickly, we only have acouple minutes left, but do you
have any barriers toreimbursement?
Are there any specialconsiderations?
Is there a lot of times wherethe patient's having to pay cash
for things and that's a problem, if you can just kind of speak
to that component of it too.
Speaker 2 (27:03):
Yes, a lot of travel vaccines are vaccines that are
specifically for travel, soyellow fever and typhoid are
usually not covered by thepatient's insurance.
So that's an out-of-pocket costwhich certainly can be a
barrier for the patient.
We do sometimes run into issueswith some travel vaccines where
(27:25):
our reimbursement is not asmuch as the cost.
So where the pharmacy is notbeing appropriately reimbursed
for the vaccine.
But the most common issue ishonestly for the patient because
insurance does not see them asessential.
Speaker 1 (27:45):
So they don't cover them?
Sure, yeah, and if they'replanning ahead early enough,
then hopefully there's timeenough to kind of make
arrangements and whatnot.
So, yeah, well, that's superhelpful.
I always say I don't understandhow I run out of time so
quickly, but lots of greatinformation, but we are already
out of time for this episode.
So, regina, before we go today,a question I always like to
(28:07):
kind of double back to and askis what's the game changer here?
It's our topic of our podcast.
Is game changers, um, our title?
And so I always like to kind ofask the, the speaker for the
day, to just summarize what youfeel like is the game changer
here?
What have we talked about?
Speaker 2 (28:23):
that is like the key point I think that, as
pharmacists role pharmacistsroles are expanding this is a
really great place for apharmacist to fill a need that
might not otherwise be filled.
So it's a great way to haveyour patients see you in a
different light.
Speaker 1 (28:42):
Absolutely.
And you know one thing I'lltouch on too.
You know you all did your duediligence to determine that in
your state you needed to get acollaborative practice agreement
and to work under a doctor withprotocol and whatever, and so I
would encourage our listenersif this is something you're
considering, be sure that you'rechecking your state guidelines
and your state board of pharmacyas to what you can and can't do
(29:03):
under scope of practice there.
But, like you said, this is anopportunity for pharmacists to
fill that void and I love howyou put it to have your patients
see you in a different light.
That's great, because I thinkit's really important that we're
continuously sharing with ourpatients all the different great
things that we can do aspharmacists.
(29:25):
One thing I will mention as wellis Regina is working with us to
create a travel health advancedtraining course.
She has a component in that aswell and is going to really talk
about it.
Correct me if I'm wrong, but Ithink you're part of that
content is about implementingand setting up an actual travel
clinic.
So there'll be other componentsof that advanced training that
(29:48):
will talk more about themedications that Regina's
mentioned, go into greaterdetail on some of those nuances,
dosaging as well as sideeffects, to be aware of
counseling tips, that kind ofthing.
But she's going to be joiningthat advanced training on kind
of how to implement an actualtravel clinic.
So thank you so much for thisinformation.
This is, I feel, like, just agreat quick overview that kind
(30:11):
of reminds us all that there isa need for this.
You know, depending on whereyou are, you could have a lot of
patients that are in need ofthis, these types of services,
and I think that these arethings that, from what I'm
hearing I'm not trying todownplay the difficulties that
you might encounter, but itsounds like services that are
fairly easy to implement into astore and to kind of offer for
(30:33):
your patients are fairly easy toimplement into a store and to
kind of offer for your patients.
So, yeah, so thank you, regina,again for taking time out of
your schedule and to share someof this insights with us.
I really appreciate it.
Speaker 2 (30:40):
Sure.
Thank you for having me.
Speaker 1 (30:42):
Of course, if you're a CE Plan subscriber, be sure to
claim your CE credit for thisepisode of Game Changers by
logging in at ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
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