Australian Pharmacists' Perceptions and Practices in Travel Health

Worldwide, pharmacists are playing an increasing role in travel health, although legislation and funding can dictate the nature of this role, which varies from country to country. The aim of this study was to explore the current and potential future practices in travel health for pharmacists in Australia, as well as the perceived barriers, including training needs, for the provision of services. A survey was developed and participation was sought from a representative sample of Australian pharmacists, with descriptive statistics calculated to summarise the frequency of responses. A total of 255 participants, predominantly female (69%), below 50 years (75%) and registered less than 30 years completed the survey. Although over two-thirds (68%) provided travel-related advice in their current practice, the frequency of advice provision was low (less than 2 travellers per week) and limited to responding to travellers questions. Although Australian pharmacists are currently unable to administer travel vaccines and prescription only medications without prescription, they still consider travel health to be an appropriate role and that their clients would seek travel health advice from pharmacies if offered. Currently, key roles for Australian pharmacists are advising travellers who do not seek advice from other practitioners, reinforcing the advice of other health practitioners and referring travellers needing vaccinations and antimalarials. In order to expand these services, the barriers of workload, time, staffing and the need for training in travel health need to be addressed. In summary, the travel health services provided by pharmacies in Australia still have a way to go before they match the services offered by pharmacies in some other countries, however Australian pharmacist are keen to further develop their role in this area.

Correction to: Risk factors associated with academic difficulty in an Australian regionally located medical school

Following publication of the original article [1], one of the authors reported that prior to publication her surname had changed from 'Kerlen' to 'van der Kruk', but that this change had not been incorporated in the final version.

Correction to: Strengthening medical training programmes by focusing on professional transitions: a national bridging programme to prepare medical school graduates for their role as medical interns in Botswana

Following publication of the original article [1], one of the authors reported that prior to publication her surname had changed from 'Kerlen' to 'van der Kruk', but that this change had not been incorporated in the final version.

Risk factors associated with academic difficulty in an Australian regionally located medical school

BACKGROUND

Despite the highly selective admission processes utilised by medical schools, a significant cohort of medical students still face academic difficulties and are at a higher risk of delayed graduation or outright dismissal.

METHODS

This study used survival analysis to identify the non-academic and academic risk factors (and their relative risks) associated with academic difficulty at a regionally located medical school. Retrospective non-academic and academic entry data for all medical students who were enrolled at the time of the study (2009-2014) were collated and analysed. Non-academic variables included age at commencement of studies, gender, Indigenous status, origin, first in family to go to University (FIF), non-English speaking background (NESB), socio-economic status (SES) and rurality expressed as Australian Standard Geographical Classification-Remoteness Area (ASGC-RA). Academic variables included tertiary entrance exam score expressed as overall position (OP) and interview score. In addition, post-entry mid- and end-of-year summative assessment data in the first and second years of study were collated.

RESULTS

The results of the survival analysis indicated that FIF, Indigenous and very remote backgrounds, as well as low post-entry Year 1 (final) and Year 2 (mid-year and final) examination scores were strong risk factors associated with academic difficulty. A high proportion of the FIF students who experienced academic difficulty eventually failed and exited the medical program. Further exploratory research will be required to identify the specific needs of this group of students in order to develop appropriate and targeted academic support programs for them.

CONCLUSIONS

This study has highlighted the need for medical schools to be proactive in establishing support interventions/strategies earlier rather than later, for students experiencing academic difficulty because, the earlier such students can be flagged, the more likely they are able to obtain positive academic outcomes.

Pharmaceutical care model to assess the medication-related risks of travel

BACKGROUND

People are at greater risk of health problems when travelling and a significant number of travel-related health problems are associated with the effects of travel on pre-existing chronic diseases. Medications play a key role in the management of these conditions. However, there is a notable lack of research evaluating the potential medication-related risks associated with travel.

OBJECTIVE

To apply a systematic pharmaceutical care model developed to evaluate potential pharmaceutical risks (PPRs) and pharmaceutical care issues (PCIs) in travellers.

SETTING

Adult travellers leaving Cairns International Airport, Australia, for an international destination.

METHOD

A cross-sectional survey using semi-structured interviews, including a systematic medication history, followed by the application of a pharmaceutical care model to evaluate each participant for PPRs and PCIs.

MAIN OUTCOME MEASURE

Evaluation of standard clinical and travel-related PPRs and PCIs.

RESULTS

Medications for chronic diseases were being taken by 47.7% of the 218 travellers interviewed. Although 75.2% of participants presented with no PPRs, a total of 274 PCIs were identified across 61.5% of the participants, with an average of 2.04 PCIs per participant. The most prevalent PCIs related to the inadequate precautions taken by some travellers visiting malaria-endemic regions. Although 91 participants recognised that they were travelling to malaria-endemic regions, 65.9% of these participants were not using malarial chemoprophylaxis, and only 16.5% were using chemoprophylaxis that fully complied with standard recommendations. The second most prevalent PCI was the need for 18.8% of participants to be educated about their medications. Other PCIs identified have the potential to increase the risk of acute, travel-related conditions, and complicate the care of travellers, if they inadvertently became unwell while overseas.

CONCLUSION

PPRs and PCIs were not identified in all participants. However, the impact of many of the identified medication-related issues could be substantial to the traveller. This study represents the novel application of a pharmaceutical care model to identify potential PPRs and PCIs in travellers that may not be identified by other pre-travel risk assessment methods.

Pharmacist intervention in an elderly care facility

The effectiveness of a pharmacist-initiated drug regimen review (DRR) in reducing the incidence of drug-related problems (DRPs), such as drug interactions, additive adverse effects and duplicate therapy, in the elderly was investigated. The medication profiles of 85 patients aged over 65 years, in an elderly care facility in South Africa, were evaluated for potential DRPs. It was found that 77 per cent of the patients were receiving one or more drugs at a dose exceeding the recommended geriatric dose. Some 68 per cent were receiving six or more drugs. Potential drug interactions and duplicate therapy were identified in 64 per cent and 34 per cent, respectively. A total of 85 pharmacist-initiated recommendations was presented to seven medical practitioners over a period of 16 weeks. Of these, 66 (77.7 per cent) met with the approval of the prescribers. Statistical interpretation of results showed that the incidence of all DRPs declined significantly post-recommendation. The cost benefit of the study was clearly illustrated by a 41 per cent reduction in the incidence of polypharmacy (P<0.01).

The Women's Health Initiative Study: individualisation of hormone replacement therapy in a defined South African population

Objective

The aim of this study was to investigate the impact of the Women's Health Initiative (WHI) study on the prescribing of hormone replacement therapy (HRT) in a defined South African population and to establish whether patient therapy was appropriately individualised as a result of the WHI study.

Setting

Claims data from a South African managed healthcare organisation.

Method

A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined study groups. This analysis included determining discontinuation and initiation rates for HRT during selected 6-month periods. An investigation into patient demographics and prescribing patterns followed, whereby trends observed among patients either initiating or discontinuing HRT in the 6-month period post-WHI publication were contrasted with patients using HRT prior to publication of the WHI study. The prevalence of concomitant disease states among these subgroups was also assessed.

Key findings

The discontinuation rate for HRT following publication of the WHI study increased from 3.47% to 7.54%, while the initiation rate decreased from 15.34% to 9.10%. Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study), and were at a higher risk for disease states for which HRT use is considered harmful, such as diseases affecting the cardiovascular system.

Conclusion

It can be concluded that HRT was appropriately individualised according to recommendations based on the results of the WHI study in the defined populations of this study.