Travel Health

Pharmacist Expanded Scope of Practice

Today the health care system is undergoing a transformation. Pharmacists play a key role in this transformation by providing services to expand their scope of practice and fill the gaps that currently face patients in regards to access to care.

Pharmacists can provide medications based upon legally written prescriptions they receive from a prescriber, standing orders issued by the state, under collaborative practice agreements with designated prescribers, or in some states, by prescriptions initiated by the pharmacist themselves.

Each state is responsible for determining the scope of practice through laws and rules for licensed professionals, including pharmacists. These regulations are made to meet specific needs of the states and their populations.

On January 17, 2017, CMS’s Center for Medicaid and CHIP Services (CMCS) issued an Informational Bulletin that encouraged states to expand the scope of pharmacy practice. Expanding pharmacists’ roles, including the power to dispense drugs under certain arrangements, such as pharmacists’ prescriptions, can be an important tool for addressing national public health challenges and gaps in medical care.

The Informational Bulletin does stress that this is a state decision. However, by expanding the scope of practice, it can “facilitate easier access to medically necessary and time-sensitive drugs for Medicaid beneficiaries.”

Specific national public health examples cited include: tobacco cessation, influenza immunizations, emergency contraceptives and pharmacist provision of naloxone to combat the opioid epidemic.

The Informational Bulletin in its entirety is available at Medicaid.gov.¹

Pharmacist’s Role in Travel Health

Pharmacists are in a key position to become involved in travel health medication provision due to their accessibility to the community and their knowledge and drug expertise. Travel health services are a way for the pharmacy to expand their scope of practice and presence in the community. Even if a pharmacy does not have a dedicated travel clinic process or program they can still be involved in travel health by providing travel vaccination recommendations to prescribers, ensuring patients have received appropriate standard vaccinations, administering vaccinations, and offering consultation and provision of pre-traveler medications and products such as Imodium, sunscreen or insect repellant. Pharmacists can also offer services and products to patients upon their return from their travels.

By understanding the opportunities involved in travel health and providing them to patients, the pharmacy can differentiate itself from the competition, grow their immunization program, increase patient loyalty and increase opportunities for revenue.

Vaccine Protocol

All 50 states allow pharmacists to provide vaccinations. Of those, 46 states, can administer ALL types of vaccines, including herpes zoster, pneumococcal and travel health vaccines. Pharmacists can administer a vaccine when they receive a prescription from a provider or when it is approved by a state protocol or standing order, or in some states when it is initiated by the pharmacists themselves. As of July 2015, eight states allow pharmacists to prescribe and administer all vaccines without a prescription. Another 9 states allow for influenza vaccine to be prescribed by the pharmacist.²By allowing pharmacists to screen, recommend, prescribe and administer vaccines, access is increased, and patients are more likely to receive the vaccine that is recommended for them.

Travel Vaccines and Travel Consultation

Traditionally, patients seeking vaccines for travel come to the pharmacy with a prescription from a physician or health care provider. The pharmacist would then administer the prescribed vaccine to the patient.

However, many pharmacists are expanding their scope of practice and are completing additional training and certification to provide comprehensive travel consultations within the pharmacy. Pharmacies are also instituting programs and processes to provide complete travel health clinics.

Pharmacists can perform a pretravel consultation with the patient. The consultation would include discussion about the patient’s overall health, travel itinerary, duration and season of travel. Pharmacist obtain a medical history and immunization history. Based on the discussion, pharmacists can provide/recommend any standard immunization that the patient does not have (influenza, pneumococcal etc.) as well as assessing what travel vaccination is needed. Depending on the specific laws and regulations, collaborative practice acts etc., this may be initiated by the pharmacists themselves or may require consultation with a prescriber. Pharmacists must be aware of the regulations in the state in which they practice.³

Based on this consultation, pharmacists may also recommend over the counter or prophylactic products that might be needed for the patient’s specific travel. For example, a pharmacist may want to discuss ways to prevent and options to treat traveler’s diarrhea.³

If a pharmacist recommends a travel vaccine, there are many resources that can assist in adequately determining the correct vaccination. First, pharmacists should access the CDC Yellow Book also knows as CDC Health information for International Travel. The Yellow Book is a guide to the practice of travel medicine as well as the authoritative source of the US government recommendations for immunizations for foreign travel.³ The Yellow Book can be purchased or accessed for free online. Specifically, Chapter 4 of the Yellow Book provides important information on destinations as well as immunizations required. Additionally, the CDC Pink Book, WHO Website and other drug information resources can be used to develop recommendations. There are also vendor supplied travel software that can be purchased and utilized to create personalized travel reports and education documents for patients.⁴ Once the correct travel vaccination has been determined the pharmacist would recommend the vaccination to a prescriber or initiate the prescription for the vaccination themselves, if authorized by state laws, standing order, or collaborative practice agreement. The pharmacist must know the laws in their state.

A Travel Vaccine Summary Table can be found on the Centers for Disease Control (CDC) website.

Pharmacist Training

Providing travel health services is an excellent way to expand a pharmacy’s business. However, to be comfortable performing pretravel and post travel consultations and become comfortable and proficient with making travel vaccine recommendations, pharmacists should seek additional training or certification in travel health. Listed below are additional trainings and certification programs to expand a pharmacist’s knowledge around regarding vaccines. These trainings can also assist if the pharmacy’s goal is to expand their business by offering travel health clinics.

Resources

There are many resources available for the pharmacists regarding travel health and immunizations. If a pharmacy wants to implement a travel health vaccine clinic or program, below is an implementation guide for reference.

Pharmacy Travel Health Clinic Operations Guide

Additional resources for travel vaccine information:

The information provided here is for reference use only and does not constitute the rendering of clinical, legal or other professional advice by Health Mart. Health Mart is not responsible for, nor will it bear any liability for, the accuracy, efficacy or reliability of the content provided herein and is not advocating any particular program or approach herein. Readers should consult appropriate professionals for advice and assistance prior to making important decisions regarding their business.