Table 1.

Travel health clinic considerations and logistics [15,16].

Components	Comments
Patient education material	Printed or electronic (must be current). Patient-and itinerary-specific. U.S. Centers for Disease Control and Prevention (CDC) and commercial sources have patient handouts.
Immunization	With the exception of yellow fever vaccine, most immunizations are available to order through pharmacy wholesalers or other vaccine distributors. Yellow fever vaccine is supplied directly by the manufacturer, and may only be ordered by facilities associated with an official yellow fever vaccine provider. As with basic immunization services, it is important that all necessary supplies and equipment for administration are available and easily accessible. Close attention should be paid to the storage requirements of all vaccines. See the CDC’s recommendation for proper storage and handling of all vaccines. (http://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html).
Provision of prescription medications	Furnishing, prescribing, initiating, and ordering medications (term varies by state) Medications recommended for international travel that the pharmacists may furnish or provide generally fall into two categories: ⚬ self-treatment ⚬ chemoprophylaxis. The CDC Yellow Book details all drugs and conditions that fall into these categories. Many travel health practices opt to use pre-populated checklist-type prescription forms, as the regimens for common travel related medications are standard. This may help to increase efficiency, consistency, and potentially reduce furnishing errors. All furnishing pharmacists in need to obtain an individual National Provider Identification (NPI).
Laboratory tests	State law dictates how or if pharmacists can order tests. Antibody titers: ⚬ Hepatitis A and B ⚬ Varicella Zoster Virus (VZV) ⚬ Measles, Mumps, and Rubella (MMR) ⚬ Rabies Glucose-6 Phosphate Dehydrogenase (G6PD) deficiency for primaquine and tafenoquine.
Supplies	Best to stock an adequate supply for sale, but can create patient handouts of supplies to obtain elsewhere. Over-the-counter supplies. Non-medication supplies.
Workflow	Perform the risk assessment based on the patient’s travel health history. Prepare patient specific education documents and recommendations. Provide the travel consultation. Provide appropriate immunizations and documentation.
Staffing	Marketing, patient scheduling and reminders, and vaccine/prescription input and billing can be delegated to a pharmacy technician, clerk, or intern pharmacist (i.e., a student pharmacist in training). In an ambulatory care setting, nurses may also be used to perform clerical responsibilities and administer vaccinations. A student pharmacist may also assist in the preparation of the consultation documents and recommendations, and preparation and administration of vaccinations if appropriately trained and supervised.
Space	The space used for existing services, such as routine immunizations, is usually appropriate for providing travel health services. A private clinic room is ideal, but not required, as patients may feel more comfortable discussing medical history and receiving immunizations in an enclosed area.
Scheduling of Patients	Appointment (preferred), but can do walk-in. Schedule for a minimum of 30 minutes, depending upon the complexity of the visit. Ask patients to make appointments four to six weeks before departure. Focused travel clinic visits rather than integrating with other services. Consider group consults for families traveling together or groups with the same itinerary.
Documentation	Documentation can be print or electronic—states that require immunization registry documentation will need electronic transmission. A patient progress note that fully documents the clinical assessment and travel medication plan. A patient medication record for each medication provided to the patient by the pharmacist. Documentation of the administration of vaccines (vaccine name, lot number, expiration date, anatomical site vaccine administered, initials of pharmacist, date vaccine given, date of Vaccine Information Statement (VIS) Documentation of yellow fever vaccination on the International Certificate of Vaccination or Prophylaxis (ICV-P) form with associated official stamp from the state health department when yellow fever vaccine is administered. Documenting refrigerator and freezer temperatures at least twice a day following CDC recommendations. This is also a requirement of being a yellow fever vaccine provider.