SEATTLE —In the 2008 movie “Sex in the City,” there’s a scene in which the character Carrie Bradshaw laughs her way out of a deep emotional slump when, during a trip to Mexico, her friend Charlotte has an accident after drinking some of the local tap water. But as anyone who has had it can attest, a bout with traveler’s diarrhea is anything but funny.
Traveler’s diarrhea results from a wide variety of bacteria, viruses and protozoa, and affects anywhere between 30% and 70% of visitors to other countries. Hot spots for the trots include most countries in Asia, the Middle East, Africa and Latin America.
Over-the-counter medications that relieve some symptoms are a must-have for any international traveler, and are universally available at retail pharmacies. But at least one chain has sought to make a business out of catering to international travelers. Bartell Drugs, a Seattle-based chain with stores throughout Washington’s Puget Sound region, started operating travel clinics eight years ago, and since has expanded the clinics to 10 stores.
“Basically, people would not find enough travel providers,” Bartell’s pharmacist Sharon Woodward told Drug Store News. Woodward, who works at the chain’s store in Issaquah, Wash., was a co-founder of Bartell’s first travel clinic, with fellow Bartell pharmacist Jolene Kalmbach, and is a member of the International Society of Travel Medicine. “There seemed to be a real need for providers of travel medicine.”
More than 15 million Americans flew out of the country between January and May, according to the Department of Commerce, with trips to Africa, the Middle East and Asia posting respective increases of 15.6%, 31.1% and 9.2% compared with the same period last year. Many of those traveling abroad will try to get vaccinations and prescriptions from their general practice physicians or go to commercial travel clinics, but Woodward and Kalmbach saw that existing services weren’t enough, with the physicians often lacking expertise in travel medicine and the clinics frequently overbooked.
That led the two to become experts on travel medicine, reading up on vaccines, medicines and the needs of travelers going to different areas so that they could help fill demand. “We’re not trying to push out any physicians,” Woodward said. “We’re trying to supplement travel clinics that already exist.”
Woodward and Kalmbach benefited from two circumstances. First, Bartell gives its pharmacists great leeway in deciding what services they want to provide, not requiring them to provide vaccinations if they don’t want to and allowing them to provide such things as travel clinics, Woodward said. Second, Washington state has been a pioneer in pharmacy services, particularly in giving pharmacists limited power to prescribe medicines. “We started a lot of things, so even though we’re way up here in the corner, we’ve done a lot,” Woodward said.
Washington pharmacists can make protocols known as collaborative practice agreements with physicians, each of which is signed and dated by the pharmacist and the doctor, and is valid for two years, allowing the pharmacist to prescribe the specified medication—such as a malaria prophylaxis or EpiPen—to a patient. The two- to five-page protocols specify when pharmacists can prescribe drugs and vaccines and to whom—barring, for example, children younger than 14 years of age and pregnant women, both of whom the pharmacist would have to refer to a physician.
In the case of Bartell’s travel clinics, customers can pay $50 for a consult in which they fill out a questionnaire and meet with the pharmacist, who reviews their medical history, destinations and drugs they take. Patients then can get immunizations for $10 plus the cost of the vaccine. Including consultations and booster shots, Woodward said she sees six to eight patients every week and will be able to see patients every day once the store has more staff.
Overall, Woodward sees the program as taking a step further from medication therapy management, with the pharmacist acting as a patient’s healthcare provider. “It’s kind of surprising that pharmacists are prescribing all these things, but it’s actually worked pretty well for these last eight years,” she said.