As patients prepare for their holidays, are you ready to help them, asks Rod Tucker
The summer represents a season where pharmacists can increase over-the-counter (OTC) sales by ensuring they are sufficiently stocked with all the necessary holiday merchandise required by their patients before embarking on holiday. This article provides an overview of the areas in which pharmacists can help those travelling abroad.
Travel health insurance
As the UK is currently still part of the European Economic Area (EEA), a European Health insurance card (EHIC) will allow travellers access to state-provided healthcare in member countries. This will be either free of charge or at a reduced cost although the UK has reciprocal arrangements with many countries outside of the EEA that permits similar benefits to those within EEA states.
The EHIC is not an alternative to travel insurance and does not cover private medical care or the costs incurred if an illness on holiday delays returning home. Health insurers require patients to declare any existing medical conditions and planned activities such as skiing, scuba-diving etc. Since health insurance provides cover in the event of the need to cancel a holiday due to illness, it should be arranged several weeks before travel.
Travelling overseas with medicines
Patients needing regular medication should be advised to take enough supplies for the duration of their holiday, including extra for any delays, damage or losses. Medicines should be kept in their original pack with the dispensed labels and carried in hand luggage with extra supplies in suitcases are lost in transit.
Certain medicines such as insulins require careful storage during travel and may freeze in the aircraft hold or overheat during a long hot car/bus journey. Travel accessories bags designed specifically to carry insulin are available and pharmacies should stock such bags for their diabetic patients.
The UK government permits individuals to carry essential medicines and equipment (including needles, syringes, insulins, inhalers, etc) through airport security and in hand luggage. This also applies to liquids greater than the normal 100 ml restriction, provided that the patient has the necessary documentation (usually a letter) from their doctor or specialist. It is also necessary to contact the airport and the airline in advance informing them of the need to carry insulins, other injectables or even oxygen cylinders.
Patients travelling with controlled drugs in schedule 2, 3 and 4 will require a personal license if travelling for more than 3 months although a letter from the prescriber is required for shorter periods documenting that the treatment is legitimately held by the patient. It is also worth checking with the relevant embassy prior to travel if there are any restrictions imposed on bringing controlled drugs to the holidaying country.
What should your pharmacy be offering to travelling patients?
Many pharmacies now offer a holiday vaccination service for their customers. Most vaccinations are administered four to six weeks before travel and it is worth discussing these with patients planning a trip abroad. The vaccinations required will vary depending on the destination and websites such as Travel Health Pro provide current advice on the vaccinations required.
2. Malaria tablets
Though uncommon in the UK, patients develop malaria because they have not taken chemoprevention. It is vital that pharmacists emphasise the important of prophylactic treatment to those travelling to a country in which there is a risk of developing the disease. The recent POM to P switch of Maloff®, containing atovaquone and proguanil, allows pharmacists to provide effective chemoprophylaxis treatment for patients.
3. Insect repellents
In addition to malaria, mosquitos are known to transmit dengue fever, chikungunya, the Zika virus and yellow fever. Thus, minimising the risk of being bitten by using insect repellents will help to reduce the transmission of these diseases.
The most effective repellents contain N,N,-Diethyl-m-tolumide (DEET) and the drug is available in different concentrations ranging from 20 to 50%, with higher concentrations providing longer protection. DEET can be used from two months of age and for pregnant women and while it has the best evidence to support its use, alternative repellents include Picaridin and lemon eucalyptus extract which contains PDM (p-Menthane-3,8-diol) are available for purchase.
In addition, various commercial sprays that contain permethrin can be used to provide a long-lasting insect repellent effect on clothing. Pharmacies should also consider stocking mosquito nets.
4. Treatments for bites and stings
Bites and stings are often an unavoidable consequence of travelling and there are several pharmacy products for the relief of bites and stings, including topical and oral antihistamines, crotamiton and hydrocortisone cream.
Ultraviolet B (UVB) is responsible for burning and the sun protection factor (SPF) provides a measure of the level of protection against UVB offered by a product. The normal range is from 15 to 50, with higher SPF values providing a greater protection. Protection against ultraviolet A (UVA) is also required as this leads to skin ageing and the level of protection is measured using a star-rating scale that ranges from one to five with higher numbers indicating greater protection.
Patients should use a broad-spectrum agent, since this provides protection against both UVA and UVB. It is important to note that sunscreens labelled as ‘water resistant’ are not water or sweat proof and should be reapplied at least every two hours, as towel drying usually removes the product from the skin.
Lip balms containing a sun protection should also be used because lips lack melanin and are thus not protected against sunlight.
Pharmacists should warn travellers that the ultraviolet (UV) index, which measures the intensity of sunlight, is often much higher overseas so that the time taken to burn is much shorter. Travellers should also consider taking an aftersun cooling product if, despite their best efforts, they get sunburnt.
6. Flight socks
The risk of a deep vein thrombosis (DVT) increases for long haul flights (ie over eight hours), though the risks to patients can be further increased if they have potential risk factors including a previous DVTs, cancer, stroke and recent surgery. Compression socks apply low level pressure to the ankles to help blood flow can be purchased through pharmacies, although it is important that the correct sizes are used.
7. Travel sickness products
Motion sickness occurs due to repeated movement when travelling in cars, boats and planes. Though general advice such as sitting in the front of the care or middle of boat can help, drug treatment in the form of antihistamines and travel bands are available OTC for use in both children and adults.
8. Other medicines
Finally, no holiday travel kit should be without a small supply of medicines for everyday problems that can blight a holiday. Supplies of analgesics, which can help with aches and pains as well as sunburn, are advisable. It is useful to have anti-diarrhoeal tablets, which are of value when patients need to travel, as well as oral rehydration sachets for use while on holiday in case of stomach upsets.
Rod Tucker is a community pharmacist