Development and Testing of a Clinical Practice Framework for Pharmacists to Assess Patients’ Travel-Related Risks: The 5W Approach to Travel Risk Identification

Abstract

Objective: To assist with identifying patients who may be managed by pharmacists without additional travel medicine training, versus those who may benefit from referral, we developed and validated a clinical practice framework. This framework was then piloted in eight pharmacies in Ontario, Canada, from March to August 2019. Methods: A panel of experts, comprised of physicians and pharmacists from Ontario, Canada, holding a Certificate in Travel HealthTM from the International Society of Travel Medicine was recruited. This panel participated electronically in the development of the framework in three stages: (1) Sharing their current approach when performing information gathering and assessing risk in a traveling patient; (2) judging of items collated from all panellists on the basis of how essential they are to a risk assessment; and (3) validation of items deemed essential by the panel using the Item and Average Content Validity Index. The framework was then released to community pharmacies, where pharmacists that self-identified as beginners to travel medicine completed pre- and post-test phase surveys to determine the utility of the framework. Key Findings: A total of 64 items for consideration were deemed essential enough to proceed 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. 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. Conclusion: The 5W Approach tool allows pharmacists inexperienced in travel medicine to collect information when required to use their professional judgement when assessing traveling 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 traveling patients and increasing their involvement in travel medicine, future research will test this framework for feasibility in Canadian community pharmacy practice.

Ensuring the quality of pre-travel prescribing

“…However, further differentiation among patients based on health conditions and/or travel itineraries is necessary to determine patients who could be appropriately cared for by non-travel health qualified nurses, pharmacists and health physicians respectively. Fernandes et al ’s 9 work does suggest that there are some, albeit limited, patients whose travel risks are manageable by community pharmacists with no additional specialized travel health expertise. Clarification is also needed as to the patients with risks who could be managed by travel-health specialized pharmacists and nurses relative to patients who require care by travel-health specialized physicians.…”