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The U.S. Travel Health Pharmacists’ Role in a Post-COVID-19 The U.S. Travel Health Pharmacists’ Role in a Post-COVID-19
Pandemic Era Pandemic Era
Keri Hurley-Kim
University of California, Irvine
Karina Babish
Rosary Academy
Eva Chen
Canyon High School
Alexis Diaz
Chaminade College Preparatory
Nathan Hahn
Portola High School
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Hurley-Kim, K.; Babish, K.; Chen, E.; Diaz, A.; Hahn, N.; Evans, D.; Seed, S.M.; Hess, K.M. The U.S. Travel
Health Pharmacists’ Role in a Post-COVID-19 Pandemic Era.
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Citation: Hurley-Kim, K.; Babish, K.;
Chen, E.; Diaz, A.; Hahn, N.; Evans,
D.; Seed, S.M.; Hess, K.M. The U.S.
Travel Health Pharmacists’ Role in a
Post-COVID-19 Pandemic Era.
Pharmacy 2022, 10, 134. https://
doi.org/10.3390/pharmacy10050134
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pharmacy
Review
The U.S. Travel Health Pharmacists’ Role in a Post-COVID-19
Pandemic Era
Keri Hurley-Kim
1
, Karina Babish
2
, Eva Chen
3
, Alexis Diaz
4
, Nathan Hahn
5
, Derek Evans
6
, Sheila M. Seed
7
and Karl M. Hess
8,
*
1
University of California at Irvine School of Pharmacy and Pharmaceutical Sciences, Irvine, CA 92627, USA
2
Rosary Academy, Fullerton, CA 92831, USA
3
Canyon High School, Anaheim, CA 92807, USA
4
Chaminade College Preparatory, West Hills, CA 91304, USA
5
Portola High School, Irvine, CA 92618, USA
6
Evans Travel Health, Newport NP18 2NT, UK
7
Massachusetts College of Pharmacy and Health Sciences, Worcester, MA 01608, USA
8
Chapman University School of Pharmacy, Irvine, CA 92618, USA
* Correspondence: [email protected]
Abstract: Background:
Many countries have enforced strict regulations on travel since the emergence
of the SARS-CoV-2 (COVID-19) pandemic in December 2019. However, with the development of
several vaccines and tests to help identify it, international travel has mostly resumed in the United
States (US). Community pharmacists have long been highly accessible to the public and are capable
of providing travel health services and are in an optimal position to provide COVID-19 patient
care services to those who are now starting to travel again.
Objectives:
(1) To discuss how the
COVID-19 pandemic has changed the practice of travel health and pharmacist provided travel health
services in the US and (2) to discuss the incorporation COVID-19 prevention measures, as well as
telehealth and other technologies, into travel health care services.
Methods:
A literature review was
undertaken utilizing the following search engines and internet websites: PubMed, Google Scholar,
Centers for Disease Control Prevention (CDC), World Health Organization (WHO), and the United
States Department of Health and Human Services to identify published articles on pharmacist and
pharmacy-based travel health services and patient care in the US during the COVID-19 pandemic.
Results:
The COVID-19 pandemic has changed many country’s entry requirements which may now
include COVID-19 vaccination, testing, and/or masking requirements in country. Telehealth and other
technological advancements may further aid the practice of travel health by increasing patient access
to care.
Conclusions:
Community pharmacists should consider incorporating COVID-19 vaccination
and testing services in their travel health practices in order to meet country-specific COVID-19 entry
requirements. Further, pharmacists should consider utilizing telehealth and other technologies to
increase access to care while further limiting the potential spread and impact of COVID-19.
Keywords:
COVID-19; community pharmacy; travel clinic; vaccines; point-of-care testing; telehealth
1. Background
The practice of travel health includes providing preventive and self-treatment mea-
sures to patients traveling internationally including travel-related immunizations (e.g., yel-
low fever, Japanese encephalitis, typhoid fever); medications for malaria, traveler’s diarrhea,
motion sickness, jet lag, and other diseases; as well as ordering and interpreting labora-
tory tests for confirmation of vaccine-associated antibodies [
1
,
2
]. This is done through
a comprehensive review of one’s travel plans such as their destination(s), arrival dates,
planned activities, length of stay, and personal health and medical information in order to
identify specific travel-related disease risks. Additionally, travel health providers adminis-
ter appropriate travel-related vaccines and furnish appropriate travel-related prescription
Pharmacy 2022, 10, 134. https://doi.org/10.3390/pharmacy10050134 https://www.mdpi.com/journal/pharmacy
Pharmacy 2022, 10, 134 2 of 11
and nonprescription medications based off of their patient risk assessment [
1
]. Organiza-
tions such as the CDC and WHO recommend that individuals traveling internationally
receive a pre-travel health consultation and any necessary vaccines and medications from a
healthcare provider four to eight weeks in advance of their departure [
3
,
4
]. It is therefore
important that individuals are able to access and receive care in a timely manner so that
they can receive all necessary vaccinations and medications prior to their departure.
While pharmacists have traditionally provided travel health services under protocol or
through a collaborative practice agreement with a physician, various states and territories
in the US now allow for more independent practice [
2
]. In a review of state laws and
regulations, pharmacists in 15 jurisdictions (i.e., a US state or territory) were able to
administer all routine vaccines independently and in eight jurisdictions, pharmacists were
able to administer all travel-related vaccines independently. Furthermore, in 27 jurisdictions,
pharmacists were authorized to furnish travel-related medications to patients and in at
least 23 jurisdictions, pharmacists were authorized to order travel health related laboratory
tests [
1
]. Pharmacists intending to practice in travel health should ensure that they have
the proper education and training as well as ensure that their clinic area is set up properly
with all necessary supplies and is conducive to providing patient care in a separate and
private environment but is still adjacent to the rest of workflow [5,6].
The American Pharmacists Association (APhA) has developed the Advanced Compe-
tency Pharmacy-Based Travel Health Services Training Program to prepare pharmacists to
offer travel health services (https://www.pharmacist.com/Education/Certificate-Traini
ng-Programs/Travel-Health (accessed on 13 October 2022)). The successful completion
of the APhA Pharmacy-Based Immunization Delivery Certificate Training Program and
being an authorized provider of immunizations in one’s state of practice are prerequisites
for enrollment in this course which offers 10 h of continuing education through self-study
and live seminar components. The certificate program helps prepare pharmacists to eval-
uate travel itineraries, assess health and safety risks based on destinations, and create
and communicate a plan for patients for the necessary prescription and nonprescription
medications, immunizations, supplies, and counseling for their trip. This program is based
off of the gold standard in travel health knowledge, the Body of Knowledge, which was
developed by the International Society of Travel Medicine (ISTM). Furthermore, this Body
of Knowledge serves as the basis for ISTM’s Certificate of Knowledge examination for
all travel health professionals. Those who successfully complete the exam are awarded
the Certificate in Travel Health (CTH
®
) by the ISTM. The CTH
®
is one of few credentials
offered across health disciplines and recognized internationally by health care providers
(https://www.istm.org/bodyofknowledge2 (accessed on 13 October 2022)) [5].
Prior to the COVID-19 pandemic, rates of international travel increased annually from
28.5 million outbound international departures (excluding North American destinations) in
2010 to 44.8 million international departures in 2019. In 2020, as COVID-19 began rapidly
spreading throughout the world, public health protocols such as limiting international
travel began to be enacted to help contain the spread of infection in numerous countries.
As a result, international travel dropped to 9.8 million outbound departures in 2020 [
4
,
7
].
However, as rates of COVID-19 began to decline and as the pandemic began to evolve into
endemicity, international travel has begun to pick back up once again with 26.9 million
outbound departures from 2021 to April 2022 [8].
Identifying health risks associated with travel prior to departure has grown in im-
portance as a result of increasing international travel, the dynamic COVID-19 situation,
and presence of other infectious diseases more traditionally associated with international
travel (e.g., yellow fever, malaria, rabies, etc.). Pharmacists are in an optimal position to
provide travel health services given their ability to successfully implement such public
health services in community and ambulatory care settings [
9
,
10
]. Furthermore, it has
been estimated that approximately 90% of the US population lives within five miles of a
community pharmacy, thus making community pharmacists arguably the most accessible
healthcare provider in the US, allowing more individuals access to care [
11
]. The extended
Pharmacy 2022, 10, 134 3 of 11
hours that community pharmacies are open, particularly when other healthcare settings
are closed, further improves the public’s access to important public health services such as
immunizations and travel health care [
12
]. During the height of the COVID-19 pandemic,
many states also implemented waivers or legislation that allowed pharmacy technicians
to administer COVID-19 vaccines to further increase patient access to care. As COVID-19
now transitions to an endemic phase in its epidemiology and many individuals resume
pre-pandemic travel schedules, considerations related to COVID-19 will remain a pertinent
and dynamic aspect of US travel health care services into the future.
2. Objectives and Methods
The aim of this paper is to discuss how the COVID-19 pandemic has changed the practice
of travel health, specifically pharmacist provided travel health services in the US, and to
discuss the incorporation of COVID-19 prevention practices, telehealth, and use of other
technologies into the ongoing practice of travel health care. A literature review from 2018
to the present was undertaken utilizing PubMed and Google Scholar using the following
search terms: COVID-19, community pharmacy, community pharmacist, travel health, travel
medicine, travel clinic, vaccines, point-of-care testing, and telehealth. In addition, internet
websites including, but not limited to, the CDC, WHO, and the US Department of Health and
Human Services were identified as other sources of information on pharmacist-managed and
pharmacy-based travel health services during the COVID-19 pandemic.
3. Results
Thirty-one original research peer-reviewed articles were identified along with informa-
tion from agency websites listed above that illustrate the impact of the COVID-19 pandemic
on travel and healthcare in general. In summary, our literature review shows changes to
travel health practices in response to the COVID-19 pandemic including changes in desti-
nation country’s entry requirements and regulations, inclusion of COVID-19 counseling
and vaccination as part of a travel health services, and the incorporation of telehealth and
other technological advancements to the practice of travel health in order to safely (and
efficiently) access care. Detailed findings from our literature review are discussed below in
the discussion section and grouped according to theme.
4. Discussion
4.1. Practices and Regulations
As discussed above, individuals who are traveling internationally should contact a
travel healthcare provider four to eight weeks before departure to ensure that all necessary
vaccines and medications can be provided and administered prior to their trip and that
their response to these measures can be monitored [
3
,
4
]. This is important since it is
also now essential to ensure that travelers are aware of any COVID-19 entry restrictions
at their destination while the pharmacist also confirms that they meet that country’s
COVID-19 vaccine requirements and perform any necessary COVID-19 testing within the
required timeframe. Masking guidelines for public transportation and elsewhere may
be specific to destination countries and are also pertinent to patient counseling during
travel health visits [
13
]. Pharmacists that practice in travel health should inform the
patient of any restrictions and communicate the required steps for the given destination(s).
These procedures are crucial given the ever-evolving and variable nature of COVID-19
waves and public health responses. Various countries often have significantly different
requirements and recommendations even where level of risk may be considered similar.
Table 1 is included as an example of variation in entry requirements related to COVID-19
in developing countries. It is up to date as of September 2022 but is not intended to serve
as a reference for specific travelers or itineraries. Pharmacists who wish to view updated
COVID-19 entry information can access this database at the U.S. Department of State’s
Bureau of Consular Affairs website at https://travel.state.gov/content/travel/en/travela
dvisories/COVID-19-Country-Specific-Information.html [14].
Pharmacy 2022, 10, 134 4 of 11
Table 1. Entry requirements for selected popular destinations [14].
Country COVID-19 Level Entry Requirements
Tanzania Level 1: Low Risk
Negative COVID-19 laboratory test 24–72 h before
departure, completed Traveler’s Health Surveillance Form,
and airport health screening which may include on-site
rapid antigen testing are all required. COVID-19
vaccination not required. Fully vaccinated travelers are
exempt from testing requirements.
Kenya
Level 2:
Moderate Risk
Negative COVID-19 laboratory test 24–72 h before
departure, on-site rapid antigen test on arrival, and
completed Traveler’s Health Surveillance Form are all
required. COVID-19, vaccination is not required. Fully
vaccinated travelers and those under age 5 years are exempt
from testing requirements. Masks are required indoors.
Thailand Level 3: High Risk
Full vaccination or negative COVID-19 laboratory test
within 72 h before departure is required.
Brazil Level 3: High Risk
COVID-19 vaccination required with limited exception.
Negative COVID-19 laboratory test within 24 h before
departure is required for unvaccinated travelers. Masks
required in certain jurisdictions.
Argentina Level 3: High Risk
Negative COVID-19 test not required, electronic sworn
statement required confirming absence of COVID-19
symptoms and vaccination status within 48 h before
departure. Medical travel insurance with coverage for
COVID-19 related events is required.
Vietnam
Level unknown:
Risk unknown
Negative COVID-19 test not required, but health screening
procedures upon arrival are required.
Note: database last accessed September 2022. Country specific information is subject to change.
4.2. Vaccinations, Testing, and Counseling for COVID-19
4.2.1. Administering COVID-19 Vaccines and Tests as Part of Travel Services
Pharmacists’ administration of COVID-19 vaccines and tests as part of travel clinic
services are crucial in protecting the health and welfare of travelers as well as the local
communities they visit. The CDC recommends that travelers receive routine vaccinations,
including COVID-19 vaccines, to lessen the chance of contracting and spreading infectious
diseases [
15
]. Table 2 provides COVID-19 vaccine resources, as the recommendations
and schedules for each vaccine differs depending on age, immunocompetent status, and
booster recommendations. Vaccination requirements and recommendations differ based
on itinerary, medical history and risk tolerance. Pharmacists providing travel health care
services can ensure that vaccines specific to certain countries, including the COVID-19
vaccine, are received in advance [
16
]. For travel, the CDC has yet to specifically recommend
the use of mix-and-match COVID-19 vaccination strategies wherein the formulation of
booster dose(s) is different from the primary series. However, this form of vaccination is
becoming more common in countries including the U.S. Emerging research has shown that
mixed inoculation is beneficial in boosting the effectiveness of vaccinations [
17
,
18
]. CDC
currently continues to recognize any combinations of accepted COVID-19 vaccines [19].
As of 12 June 2022, COVID-19 tests are no longer required for return entry into the US,
but some destination countries may still require testing depending on vaccination status for
entry [
14
]. Providing COVID-19 testing can be a vital service for patients at both pre- and
post-travel health appointments. Each country has their own specific testing requirements
regarding which test is acceptable and the timing of the test prior to entry. It is best to
review the entry requirements of each country during the pre-travel health visit.
Pharmacy 2022, 10, 134 5 of 11
Table 2. Recommended COVID-19 vaccine information resources for travel health clinicians.
COVID-19 Vaccine Resources Description
World Health Organization
(WHO)—Status of COVID-19
Vaccine within WHO EUL
https://extranet.who.int/pqweb/sites
/default/files/documents/Status_COVI
D_VAX_07July2022.pdf
Guidance document summarizing status of WHO
Emergency Use Listing for COVID-19 vaccines,
comprehensive of recognized and candidate
vaccines worldwide
Centers for Disease Control and
Prevention (CDC)—COVID-19
Vaccines
https://www.cdc.gov/coronavirus/20
19-ncov/vaccines/stay-up-to-date.htm
l#about-vaccines.
https://www.cdc.gov/vaccines/covid-1
9/index.html
Information for the general public regarding
COVID-19 vaccine recommendations in the U.S.
COVID-19 vaccine resources for clinicians and
public health professionals
Immunization Action Coalition
(IAC)—Vaccines COVID-19
https://www.immunize.org/covid-19/
Comprehensive information and numerous
communication tools for professionals and
patients/general public for U.S. FDA approved
COVID-19 vaccines.
Johns Hopkins University
Coronavirus Resource
Center
https://coronavirus.jhu.edu/vaccines
COVID-19 vaccine information and public health
data visualization tools. Includes worldwide
country-level data.
American Pharmacists
Association
(APhA)—COVID-19
Vaccine schedules
https:
//s3.amazonaws.com/filehost.pharmaci
st.com/CDN/PDFS/APhA%20Guide
%20to%20Vaccination%20Schedules%20
Resource%207_27_22_web%20rev.pdf?A
WSAccessKeyId=AKIAYICBVAN2V7IW
VG4T&Expires=1661624398&Signature=
DrhUSbz4t8wTJ2CNGXv3of4inzs%3D.
https://www.pharmacist.com/Practice/
COVID-19/COVID-19-Vaccines
COVID-19 vaccine resources curated for
pharmacists and other clinicians in the U.S.
Includes visual COVID-19 vaccination schedules
for all ages.
American Health Systems
Pharmacist (ASHP)—COVID-19
Vaccines
https://www.ashp.org/covid-19/vaccin
es?loginreturnUrl=SSOCheckOnly
Clinical, policy, and logistical COVID-19 vaccine
information for U.S. health systems providers
Government of
Canada—Vaccines for
COVID-19
https://www.canada.ca/en/public-heal
th/services/diseases/coronavirus-disea
se-covid-19/vaccines.html
Information and resources for the general public
and professionals regarding COVID-19 vaccines
in Canada
National Health System
(NHS)—UK
Coronavirus (COVID-19)
Vaccines
https://www.nhs.uk/conditions/coro
navirus-covid-19/coronavirus-vaccinati
on/coronavirus-vaccine/#:~:text=Every
one%20aged%205%20and%20over,dose
%20before%20any%20booster%20doses
Information and resources for the general public
and professionals regarding COVID-19 vaccines in
the U.K., including for international travel.
European
Commission—COVID-19
Vaccines
https://ec.europa.eu/info/live-work-tr
avel-eu/coronavirus-response/safe-covi
d-19-vaccines-europeans_en
Public health, policy, and vaccination strategy
information for the European Union.
Real-Time Polymerase Chain Reaction (RT-PCR) or Nucleic Acid Amplification Tests
(NAAT) have a high degree of sensitivity (i.e., correctly identifies disease, produces fewer
false negative results) and specificity (i.e., correctly identifies those without disease, pro-
duces fewer false positives), detect the RNA of the virus, and are considered the gold
standard for COVID-19 identification. Most PCR/NAAT tests are processed in a laboratory
setting but some NAAT tests can be performed as a point of care test (POCT) [
20
]. It is
important to note that a false negative result may occur if someone tests too early after an
exposure to COVID-19 or if the sample is mishandled or improperly collected.
Antigen-based tests have similar specificity to PCR tests but have less sensitivity,
particularly if asymptomatic, they detect a specific viral protein of the virus. Antigen-
based tests can be processed in a variety of settings; laboratory, POCT or home self-
testing. Antigen tests may need to be performed several times for a definitive diagnosis,
Pharmacy 2022, 10, 134 6 of 11
a single negative test result is considered a preliminary result and does not rule out
illness [
20
]. Rapid antigen tests were found by other countries to be more inaccurate and
less sensitive to detecting COVID-19 than PCR tests [
21
]. One study concluded that antigen
tests misidentified asymptomatic individuals as COVID-19 negative when, in fact, they
were carrying the virus [22]. Another study found that the accuracy of rapid antigen tests
significantly higher in symptomatic patients rather than in asymptomatic patients, which is
most likely due to the higher viral load that could be more easily detected when at the early
phases of the disease [
23
]. However, frequent testing has shown to be useful in detecting the
Omicron variant, especially when identifying those with a high enough viral load [
24
,
25
].
Rapid antigen tests for this purpose have also been improving in accuracy and sensitivity,
but may still produce inaccurate results if the sample is mishandled or improperly collected.
In a 2021 study, the Abbott ID NOW test demonstrated a high degree of accuracy and a
strong agreement with RT-PCR results, which is similar to the high sensitivity of other tests,
such as AQ-TOP and GeneChecker [
26
]. The current Omicron variant mutations, though,
have a portion of the Spike protein (S protein) that cannot be detected by antibodies or
targeted by COVID-19 vaccines [
27
]. These mutations have led to reduced sensitivity in
an N-gene or S-gene genetic target with tests, suggesting that a higher viral load would
be necessary for rapid tests, which are able to detect multiple genetic targets, to detect the
sub-variants [
28
]. Table 3 includes the similarities and differences between the common
types of COVID-19 tests currently available, antibody testing is not used to diagnose a
current infection [29,30].
Table 3.
NAAT and Antigen Test Differences to Consider When Planning for Diagnostic or Screening
Use [20,30].
Nucleic Acid Amplification Test (NAATs) Antigen Tests
Analyte Detected Diagnose current infection Diagnose current infection
Specimen Type(s)
Nasal, Nasopharyngeal, Oropharyngeal,
Sputum, Saliva
Nasal, Nasopharyngeal, Breath
Sensitivity (for accuracy)
Laboratory tests: generally high
Point-of-Care tests: moderate-to-high
Generally moderate-to-high at peak viral load.
More accurate if symptomatic
Specificity High High
Authorized for Use at the Point-of-Care Most are not Most are
Turnaround Time
Most are 1–3 days
Some rapid tests in 15 min
Most are 15–30 min
Cost per Test Moderate (~$75–$100/test) Low (~$5–$50/test)
Advantages
Most sensitive test available
Short turnaround time for NAAT
Point-of-Care tests (rare)
Usually does not need to be repeated to
confirm results
Short turnaround time (~15 min)
Allows for rapid identification of infected
people, thus preventing further virus
transmission in the community, workplace, etc.
Comparable performance to NAATs for
diagnosis in symptomatic persons and
whether a culturable virus is present or not
Disadvantages
Longer turnaround time for lab-based tests
(1–3 days)
Higher cost per test
A positive NAAT diagnostic test should not be
repeated within 90 days in case detectable
RNA is still present after risk of transmission
has passed
Less sensitive (more false negative results)
compared to NAATs, especially among
asymptomatic people and with some variants
May need to be repeated to confirm results
(any negative test on a symptomatic person
should be confirmed with a PCR or NAAT test
(CDC, 2022)
Most community pharmacies in the U.S. administer COVID-19 PCR tests; however,
this may pose a significant barrier for travel patients due to the time required for results
to be reported since samples are mailed to an outside laboratory for processing. POCT
tests such a NAAT test or the Abbott ID NOW test could be utilized in a travel clinic or
community pharmacy setting to provide accurate and more timely results for patients.
Pharmacy 2022, 10, 134 7 of 11
4.2.2. Incorporating Counseling Regarding COVID-19 into Practice
Providing patient education on COVID-19 rates of transmissibility and preventative
measures required by the destination country (masking, quarantine, etc.) is important for
pharmacists to consider and implement. Many studies report a lack of general knowledge
and/or acceptance regarding the information surrounding the virus and its related vaccina-
tions. A survey carried out among international travelers to non-European destinations
in 2021 revealed that approximately 52.4% sourced their information from the internet,
while 42.4% sought a doctor or health professional [
31
]. Another survey of COVID-19
testing offered at US airports led to the conclusion that some travelers might not be able to
grasp the meaning of testing “positive” at the airport before taking off, largely because the
testing sites are private companies who may be less familiar with advising the public of
testing results [
32
]. In another study, where questionnaires were administered to evaluate
participant knowledge on COVID-19 and their perceptions of the COVID-19 vaccine, it
was apparent that those without sufficient knowledge about vaccines are more likely to
be doubtful towards immunizations for viruses such as COVID-19 [
33
]. As proven in the
data collected from questionnaires and surveys, pharmacist involvement would be vital in
preserving post-COVID-19 travel health in a variety of ways, such as through providing
advice on safety measures and prevention protocols for travelers [34,35].
Carmosino et al. observed that patient education in promoting increased knowledge
and trust in vaccine approval allowed travelers to gain more awareness and have more
positive attitudes towards immunizations [
36
]. Another study found that people with
adequate knowledge of COVID-19 were more willing to receive immunizations for vaccine-
preventable diseases. Furthermore, 76% of the respondents were willing to receive COVID-
19 immunization later on, suggesting that with further guidance and counseling on the
pandemic, more people would be open to vaccination [27].
In general, a more informative service regarding infectious disease outbreaks, such as
COVID-19, would be helpful to offer at travel clinics. Current trends show that patients are
more willing to receive this service from pharmacists. In part with counseling, pharmacists
must also work with health care team members to reject misinformation related to COVID-
19, vaccinations, and other similar concerns [36].
4.3. Telehealth and Other Technologies
4.3.1. Movement towards and Rationale for Distance Consultations
Trends during the COVID-19 pandemic forecast the heavy reliance of pharmacists
and patients on technology in the future [
37
]. Telehealth, or telemedicine, is defined by the
US Department of Health and Human Services as “online care provided by a healthcare
provider without an in-person office visit” [
38
]. Prior to the COVID-19 pandemic, telehealth
was already being used for patients with inflexible schedules who were unable to attend
in-person appointments with their healthcare provider. However, there has been a surge in
telehealth implementation during the past two years during the pandemic [37,39–42].
Healthcare providers offered telehealth as an alternative to in-person scheduled ap-
pointments, which allowed continual access to healthcare services which increased as
COVID-19 lockdowns prevented individuals from visiting their providers [
43
]. Some
participants in a pharmacy practice workforce survey noted that they faced challenges in
adjusting to remote practices at first; also mentioning that in-person contact was still much
more valuable [
37
]. There may also be technical and logistical challenges in implementing
telehealth; however, pharmacists should continue working towards expanding telehealth
services since information has become highly digitalized in the 21st century and since
telehealth can provide added flexibility and is expected to see an increase in its utility in the
near future [
37
]. Table 4 lists various resources and references for pharmacists to consider
for implementing telehealth into their practices.
Pharmacy 2022, 10, 134 8 of 11
Table 4. Telehealth/telemedicine resources and guidance.
Reference Web Link Summary
World Health Organization
WHO—Digital Health
https://www.who.int/health-topics/digita
l-health#tab=tab_1
Discusses the strategy and resources for
use in Digital Health
Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
https://www.cdc.gov/phlp/publications/
topic/hipaa.html
Federal law creation of standards to
protect sensitive healthcare information
being disclosed without the patient’s
consent or knowledge
ITIT Travel Health https://www.itit-travelhealth.org App for illness tracking in travelers
Best Telemedicine Companies in 2022
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There are various benefits of telehealth to both the patients and providers such as
increased access to care, flexible scheduling, decreased transportation costs, and lower
cancellation rates [
39
]. Education and training programs that incorporate resources on
telemedicine and remote patient care would be helpful in improving confidence for phar-
macists during their assessments [
37
,
43
]. Despite these benefits, one of the main concerns
with telehealth is that it may limit pharmacists to provide consult-only based services [
44
].
Overall, telehealth should become a useful addition to a pharmacist’s practice as it allows
for ongoing interactions between pharmacists and patients, regardless of hesitancy, for
in-person consultations in a post-COVID-19 pandemic world.
4.3.2. Other Technologies/Technological Innovations
Due to telehealth becoming more prominent during the COVID-19 pandemic, other
technological advancements need to be made in order to adapt to a changing world.
The recent development of smartphone applications has aided in these services with
their capability to monitor travel health behavior and warn patients of possible risks
at destinations; however, there are some ethical issues such as maintaining up to date
information [
40
]. One such smartphone application is called the Illness Tracking in Travelers
(ITIT). ITIT has also been collaborating with the WHO to provide people with prompt public
health responses [
40
,
45
]. Travel medicine apps can benefit both providers and patients
as they can access different types of relevant travel-related data including geolocations,
contract tracing, and travel advisories, which would be beneficial in overseeing diseases
such as COVID-19.
5. Best Practices and Conclusions
The COVID-19 pandemic has increased the strain on existing healthcare systems
around the world, necessitating an increased scope of practice for pharmacists. Therefore,
in an effort to contain and prevent the further spread of COVID-19 while balancing the
increased demand for international travel, various COVID-19 preventative practices should
be incorporated into pharmacist provided travel health services. These include COVID-19
patient education and counseling (including methods to reduce one’s risk for COVID-19
and dispelling inaccurate information and myths surrounding COVID-19) as well as incor-
porating COVID-19 vaccines and testing into practice to help aid the traveler in meeting
country entry requirements. Routine immunizations such as influenza and pneumococcal
should also be administered for patients regardless of their travel plans in order to ensure
Pharmacy 2022, 10, 134 9 of 11
that patients are up-to-date with all of their routine vaccines. The advancement of tech-
nology and increasing use of remote communications, particularly the use of telehealth
during the pandemic, appears to be a lasting trend and its use may continue well beyond
the current pandemic. Pharmacists should therefore look to incorporate telehealth practices
in their travel health services to increase patient access to care while also minimizing the
amount of time that patients would need to be in a health care setting. Limitations to this
paper include that it was not undertaken as a systematic review and therefore relevant
work may have been excluded which could have strengthened our findings. Furthermore,
the COVID-19 situation is rapidly changing, thus potentially rendering certain research or
findings out of date. This illustrates the importance that pharmacists need to stay up to
date in order to provide the most effective and relevant care to their patients. However,
by incorporating COVID-19 prevention measures and adopting telehealth practices, phar-
macist provided travel health services can help meet the once again growing demand for
international travel while providing their patients with evidence-based recommendations
and counseling from the comfort of their own homes.
Author Contributions:
K.H.-K. served as primary author and helped revise and edit sections of the
manuscript; K.B., E.C., A.D. and N.H. initially developed the manuscript as part of a summer research
program for high school students at Chapman University School of Pharmacy and contributed to
final edits; D.E. and S.M.S. helped revise and edit sections of the manuscript; K.M.H. served as senior
author and finalized all edits and also served as research mentor to K.B., E.C., A.D. and N.H. All
authors have read and agreed to the published version of the manuscript.
Funding:
The authors report that no funding was requested or utilized to prepare this manuscript or
honorarium received.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors have no conflicts of interest to report.
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