Development and Testing of a Framework for the Assessment of Health-Related Risks Among Travellers by Pharmacists in Ontario
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As pharmacists move away from traditional dispensary roles and towards more clinical services, a therapeutic realm that pharmacists are exploring is travel medicine. However, travel medicine can be challenging to beginners in the field. Despite an expansion in scope in December 2016 allowing pharmacists in Ontario, Canada, to administer a broader range of vaccines including many indicated for travel, the uptake of these services by pharmacists has been slow. Key reasons include a lack of confidence in travel medicine knowledge and challenges integrating the service into existing workload. To assist with identifying patients who may be manageable by pharmacists without additional travel medicine training, versus those who may benefit from referral, we developed and validated a clinical practice framework. A panel of experts, comprised of physicians and pharmacists holding a Certificate in Travel HealthTM from the International Society of Travel Medicine, generated the initial content on information gathering and assessing risk in a travelling patient. The initial list of 114 items was then judged by the panel to remove non-essential items, resulting in 64 items proceeding to content validation, organized into 5 ‘W’ domains: Who, What, Where, When, and Why. Each item was ranked by the experts according to its relevancy, resulting in an Average Content Validity Index of 0.91. The resulting framework was titled “The 5W Approach to Travel Risk Identification.” This clinical practice framework is the first published assessment tool for travel medicine tailored for pharmacy’s scope of practice that has been content validated. The tool allows pharmacists inexperienced in travel medicine to collect information required to use their professional judgement when assessing travelling patients as either high-risk (requiring a referral to a travel medicine specialist) or low-risk. With the aim of supporting pharmacists to be more confident in caring for travelling patients and increasing their involvement in travel medicine, this framework was then piloted in 8 pharmacies in Ontario, Canada, from March to August 2019. Pharmacists completed pre- and post-test phase surveys to determine the utility of the framework. Pharmacists reported that the framework is simple to use and provides structure for interactions with travelling patients. However, it may not be as beneficial for those with a higher level of travel medicine expertise than the average pharmacist, and improvements to its design were suggested. This feasibility study is the first to trial the use of a validated risk assessment framework for pharmacists to use when providing care to travelling patients. To further understand its potential in community pharmacies, this work will be further expanded to pharmacists across Canada.
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Heidi Fernandes (2019). Development and Testing of a Framework for the Assessment of Health-Related Risks Among Travellers by Pharmacists in Ontario. UWSpace. http://hdl.handle.net/10012/15341