The use of insulin, considered a high-risk medication with APINCHs classification,5 Ms Barwick notes, provides justification for a Home Medicines Review (HMR). ‘There’s an advantage to going into the home to observe the patient’s diet, consider potential interactions, and educate patients on the best effects and outcomes,’ she says.
Advice around cleaning blood glucose level (BGL) monitors to ensure accuracy can also be provided. ‘Pharmacists can explain how to put test drops through and clean blood spills on the monitor, common in pregnancy due to higher blood volume,’ says Ms Barwick.
With only 50% of women diagnosed with GDM receiving tests for heart disease and type 2 diabetes post-pregnancy,6 HMRs can be beneficial at this stage of the journey, too.
‘Along with conversations around diet choices, exercise regimes and sleep, I also explain how often testing is required over the next 5–10 years, and how to monitor for signs of the development of diabetes,’ Ms Barwick advises.
Nausea and vomiting in pregnancy
The presence of iron in pregnancy multivitamins may exacerbate symptoms of nausea and vomiting in some pregnancies, according to Ms Barwick.
‘Pharmacists can recommend a trial cessation of the iron component of pregnancy vitamins, often unnecessary in pregnancy,’ she says.
In 2020, photographer Bobbi Lockyer created a Birthing on Country project to highlight and create awareness around birthing issues and outcomes in Aboriginal women. For more, see 
Suzanne Nielsen MPS[/caption]
As we approach the holiday season, now is the time to help patients factor health into their travel plans.
Australians have a renewed interest in travel this year, following years of border closures due to COVID-19. From July 2022 to July 2023, there was a 39% increase in short-term travel.
Australians are also becoming more adventurous travellers. Data indicates most (76%) are interested in visiting new places, with nature-centric (64%), coastal (59%) and secluded (54%) locations being the destinations of choice.
But a recent study by Sanofi revealed one in three Australians either don’t see a GP to discuss travel health and vaccination, or leave the consultation to the last minute.
As we approach a busy end-of-year travel season, the Immunisation Coalition is urging healthcare professionals to emphasise the importance of getting vaccinated prior to jetting off overseas.
‘GPs and pharmacists have a wealth of knowledge and can provide really useful information,’ said University of Queensland Associate Professor Paul Griffin, Director of Infectious Diseases at Mater Health Services.
‘Healthcare professionals should discuss not only the importance of travel vaccinations, but the benefits preventing travel-related infections have to the individual and the population as well as other ways to stay healthy while travelling.’
Pharmacist-administered vaccinations
Pharmacists’ have new opportunities to support travel health, said PSA Professional Practice Pharmacist Clara Fittler MPS.
‘A quickly evolving area at the moment is vaccinations, with a recent increase in scope for some states in what appropriately trained pharmacists can administer,’ she said.
Though which vaccinations pharmacists can provide varies between different states and territories, many of those relevant to travel health can also include vaccinations routinely recommended to non-travellers.
In some cases, a booster or re-vaccination of previously administered vaccines may be required prior to travel, depending on:
- time since previous vaccination
- level of risk
- whether a full course was completed
- brand and type of vaccine used.
Other factors that determine the required, recommended and routine vaccinations that travellers need include:
- age
- medical history
- itinerary
- nature of travel
- what’s currently endemic at the destination(s)
- legal requirements of visited areas
- time before departure.
‘As a general rule, given the timeframe for vaccinations to reach full effect, a pre-travel consultation is recommended at least 6–8 weeks prior to travel,’ said Ms Fittler.
Along with administering vaccines within scope, pharmacists can offer general travel advice.
‘Should pharmacists identify something that needs further discussion or action with a GP or travel medicine specialist, they can also facilitate a referral,’ she said.
Getting travel conversations going
Pharmacists have plenty of opportunities to engage patients in conversations about travel, said Ms Fittler.
‘People often chat with us about exciting plans that are happening in the future, including upcoming holidays or trips,’ she said. ‘Asking if they have any trips planned may also spark that conversation nice and early.’
Others may have specific questions as they start planning for a trip, including:
- organising medicines in advance, including dose administration aids
- over-the-counter items to take with them
- vaccine information.
To determine the appropriate vaccination and health advice, pharmacists should refer to the ‘this traveller, this trip, this time’ mnemonic.
It’s important to engage patients travelling to destinations they believe are ‘safe’ or ‘low-risk’ – such as domestic travel, or returning to the country they grew up in.
All travel has some inherent risk, and pharmacists can help to raise awareness among patients.
‘Someone travelling to their native country may perceive overall risk to be lower, travel at short notice, stay for longer periods of time or stay with family/friends where they may be more exposed to local risks, for example, to consuming high-risk food or drink,’ said Ms Fittler.
For example, if a patient’s home country is endemic to malaria and they return for a visit, they may have a heightened risk of contracting the disease if adequate precautions are not taken.
Other diseases and illnesses
There are a plethora of different diseases and illnesses patients need to consider when travelling. This includes travellers’ diarrhoea (TD), the most common travel-related illness.
When patients are travelling to malaria-endemic areas, pharmacists should refer them to a GP for a prophylactic medicine prescription, and provide dosing advice.
Sexually transmitted infections are other overlooked risks patients should prepare for, relevant for any destination.
‘Providing advice on safer sex, what to do if they develop symptoms, supplying condoms, and encouraging testing once they return are ways pharmacists can help mitigate risk in this area,’ she said.
Other safe sex considerations include mpox vaccination, doxycycline (doxyPEP) and Pre-exposure prophylaxis (PrEP).
Those with medical conditions need to be further prepared. ‘It may be illegal to bring in types or quantities of medicines or medical equipment that are considered legal in Australia,’ said Ms Fittler. ‘Airlines also have medical requirements, including contraindications to fly (or the requirement to fill in a medical form) in some cases.’
Upskill to become a travel health provider of choice by:
- Attending the travel health session at Queensland’s Annual Therapeutic Update this weekend (23 September 2023), or the West Australian ATU on 14 October
- Completing PSA’s Travel Health Essential CPE.
