Travel health services provided through UK community pharmacies

In 2016, there were 70.8 million visits abroad by UK residents^[1]
and the World Tourism Organization expects worldwide tourist arrivals to increase to 1.8 billion by 2030^[2]
. Travellers are put at increased risk of preventable diseases causing considerable medical and economic burden^[3]
. Pre-travel advice can help to identify means of reducing the risks of travelling to health. However, approximately 50% of people travel without any vaccinations and therefore are at risk of infection^[4]
.

UK community pharmacists have become increasingly involved in the delivery of vaccinations, through both private and NHS services (e.g. influenza vaccination), and, more recently, in travel health services. Last-minute holiday deals and lack of awareness of lead times for vaccination mean a growing number of travellers seek advice at short notice. As part of a diploma in travel health undertaken in 2015, an audit was conducted to explore the uptake of a travel vaccination and health advice service in community pharmacy. The service was available at a selection of pharmacies representing a variety of locations, socioeconomic groups and types of pharmacy.

Data were analysed from electronic records from July to November 2014 and showed that a large number of travellers (11,322 across 143 Boots UK pharmacies) chose to access their pre-travel health advice from community pharmacy. Most of these travellers (68.2%) were aged 18–49 years. Weekends (including Sunday) were chosen for 18.4% of all appointments and 7.3% were outside traditional working hours. A high proportion of patients accessed the service within two weeks of travelling (42.3%) and chose to pay for vaccines which they could have received free on the NHS (41.6%). The uptake of hepatitis A, diphtheria, tetanus and polio (DTP) and typhoid vaccinations, which are available free on the NHS, was significantly higher in last minute travellers compared with those with ≥28 days to departure (36.4% vs 20.0%; 17.3% vs 10.2%; and 59.1% vs 36.7%, respectively).

In an evaluation of patients accessing flu vaccination in community pharmacy, patients chose pharmacy over the general practice setting due to accessibility, convenience and preference for the environment^[5]
. Our audit did not capture reasons for travellers choosing to access the service and we are therefore unable to determine why patients chose community pharmacy. However, it seems possible that similar reasoning may also apply to this service. In a US study, 96% of travellers using a travel health clinic in community pharmacies were satisfied with the overall service and, in Scotland, 98% of travellers would use a similar service again, with most rating it as excellent^[6]
,[7]
. These evaluations demonstrate that patient satisfaction and acceptance of community pharmacy may also be reasons why travellers might choose this setting for their travel health.

There are clear benefits of providing the additional option of travel health advice and vaccinations through community pharmacy to both the public and the health service. Travellers benefit from being able to obtain associated travel products and advice about over-the-counter medicines all in the community pharmacy where they already collect their prescriptions. This alternative option may contribute to increased uptake of protective advice and medicines.

NHS England is expected to consult on the appropriateness of expenditures on prescribing medicines, such as travel vaccines^[8]
which may lead to them no longer being routinely available on the NHS. If this is the case, the provision of travel vaccination via community pharmacy as convenient and accessible locations acceptable to patients will become even more crucial for protecting traveller health.

Although the results presented relate to 2014 data (analysed as part of a clinical diploma) there have been no significant changes to the way the service is undertaken or to commissioning arrangements of travel vaccinations and therefore the results are still applicable.

This retrospective analysis shows that patients are willing to use community pharmacy to receive their travel advice and vaccinations; that they are willing to pay for vaccinations they could access for free; and that a high proportion accessed the service last minute. We speculate that it could be convenience and accessibility that make community pharmacy well placed to meet the travel health needs of the general public. However, further study into the reasons why patients chose pharmacy for their travel vaccinations is required.

Janet M Jones

jan.jones@boots.co.uk

Charlotte L. Kirkdale

Boots UK, Nottingham

Tracey Thornley

Boots UK, Nottingham

School of Pharmacy, University of Nottingham

Financial disclosure: this work was part of the Diploma in Travel Medicine through the Royal College of Physicians and Surgeons of Glasgow, which was funded by Boots UK.

Tracey Thornley is a member of the English Pharmacy Board, Royal Pharmaceutical Society. The views expressed here are her own and do not necessarily reflect those of the board or the Society. — Editor.

Acknowledgement: The team at knowmalaria for assistance in providing the data extract. We would also like to thank the patients and pharmacists who provided the service.