Relationship between regulatory barriers to entry and pharmacy technician wages.

BACKGROUND: Pharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While these requirements may improve patient safety, there is a risk that laws and regulations which impose substantial education and training requirements on technicians could create barriers to entry which restrict the workforce and increase wages. OBJECTIVE: This study has two objectives: 1) Describe changes in barriers to entry and wages over time; and 2) Evaluate the correlation between changing barriers to entry and pharmacy technician wages. METHODS: Data come from Bureau of Labor Statistics Occupational Employment Statistics from 1997 to 2017 and National Association of Boards of Pharmacy Surveys of Pharmacy Law from 1997 to 2014. A barrier to entry was defined as adoption of registration, licensure, or certification. Wage data was adjusted to 2017 dollars using the Consumer Price Index. Ordinary least squares regression evaluated the correlation between the proportion of states which had at least one barrier to entry and wages. An interrupted time series model estimated the impact of adopting a barrier to entry on the trend in technician wages over time. RESULTS: Technician wages increased between 1997 and 2007 but remained flat between 2008 and 2017. A strong correlation was observed between the proportion of states which had at least one barrier to entry and technician wages (R2 = 0.93, p < 0.0001). However, the interrupted time series models did not identify any relationship between adoption of a barrier to entry and the trend in technician wages (p = 0.363). CONCLUSIONS: This research suggests adoption of legal/regulatory barriers to entry did not have a significant influence on the trend in technician wages over time. More research is needed to evaluate the impact of barriers to entry on non-wage practice variables, such as privileges and satisfaction.

Pharmacy Technicians Are People, Too! Let's Consider Their Personal Outcomes Along With Other Pharmacy Outcomes.

Studies have found that expanded pharmacy technician roles can help "free up" pharmacist time, leading to role optimization. However, these studies and the positions taken by many are quite pharmacist-centric. We seem to have underestimated the importance of support staff in pharmacy operations. If research demonstrates that technicians can perform a function safely and effectively, that alone should compel the function's allowance in practice. Freeing up pharmacist time for higher-order care is a positive corollary to technician advancement, but it need not be a precondition for it.

Advancing technician practice: Deliberations of a regulatory board.

In 2016, the Idaho State Board of Pharmacy (U.S.) undertook a major rulemaking initiative to advance pharmacy practice by broadening the ability of pharmacists to delegate tasks to pharmacy technicians. The new rules of the Board thus moved the locus of control in technician scope of practice from law to pharmacist delegation. Pharmacist delegation is individualistic and takes into account the individual technician's capabilities, the pharmacist's comfort level, facility policies, and the risk mitigation strategies present at the facility, among other factors. State law limits, by contrast, are rigid and can mean that pharmacists are unable to delegate tasks that are or could otherwise be within the abilities of their technicians. The expanded technician duties are in two domains: 1) medication dispensing support (e.g., tech-check-tech, accepting verbal prescriptions, transferring prescriptions, and performing remote data entry); and 2) technical support for pharmacist clinical services (e.g., administering immunizations). This commentary reviews the evidence behind these expanded duties, as well as the key regulatory decision points for each task. The Board's rules and approach may prove useful to other states and even other governing bodies outside the U.S. as they consider similar issues.

State programs assisting pharmacy professionals with substance use disorders.

OBJECTIVES: To identify which states currently have substance use disorder (SUD) programs to facilitate the return of pharmacy professionals (including technicians, interns, and student pharmacists) to active practice, to identify the operational structures used by the states in providing these services and compare them with those reported previously, and to compile the most current and accurate contact information for each state SUD program. METHODS: Information specific to each state program was identified from Internet resources including state pharmacy associations, licensing boards, and professional associations. Each state's site was evaluated for currency within 2016-2017. Direct contact by e-mail or telephone using the program information, or association, or licensing board contacts was pursued to identify the current program status. RESULTS: Five states with no program in 1990 have since developed programs, and 2 states with programs in 1990 have closed their programs. Overall, 4 states do not currently have a program, 2 of which have never had one. One of the 2 states has recent authorization from their legislature to develop a program. Three other programs are currently in transition from 1 model to another, resulting in website inaccuracies. The operational models have undergone significant shifts with a decrease in the association (± [with or without] Foundation) model toward a group health care association or organization model including other health- or all state-licensed professionals. CONCLUSION: Currently, 46 states have programs for assisting pharmacy professionals. Information presented in this article provides the most current contact information and model structure used by states with programs. Frequent updating of program information is critical for those who might decide to seek assistance. Expansion to include a central database that enables rigorous evaluation of outcomes and specific features is viewed as desirable.

A global picture of pharmacy technician and other pharmacy support workforce cadres.

INTRODUCTION: Understanding how pharmacy technicians and other pharmacy support workforce cadres assist pharmacists in the healthcare system will facilitate developing health systems with the ability to achieve universal health coverage as it is defined in different country contexts. The aim of this paper is to provide an overview of the present global variety in the technician and other pharmacy support workforce cadres considering; their scope, roles, supervision, education and legal framework. MATERIAL AND METHODS: A structured online survey instrument was administered globally using the Survey Monkey platform, designed to address the following topic areas: roles, responsibilities, supervision, education and legislation. The survey was circulated to International Pharmaceutical Federation (FIP) member organisations and a variety of global list serves where pharmaceutical services are discussed. RESULTS: 193 entries from 67 countries and territories were included in the final analysis revealing a vast global variety with respect to the pharmacy support workforce. ROLES AND COMPETENCY: From no pharmacy technicians or other pharmacy support workforce cadres in Japan, through a variety of cadre interactions with pharmacists, to the autonomous practice of pharmacy support workforce cadres in Malawi. RESPONSIBILITIES: From strictly supervised practice with a focus on supply, through autonomous practice for a variety of responsibilities, to independent practice. SUPERVISION: From complete supervision for all tasks, through geographical varied supervision, to independent practice. EDUCATION: From on the job training, through certificate level vocational courses, to 3-4 year diploma programs. LEGISLATION, REGULATION AND LIABILITY: From well-regulated and registered, through part regulation with weak implementation, to completely non-regulated contexts. CONCLUSION: This paper documents wide differences in supervision requirements, education systems and supportive legislation for pharmacy support workforce cadres globally. A more detailed understanding of specific country practice settings is required if the use of pharmacy support workforce cadres is to be optimized.

Enactment of mandatory pharmacy technician certification in Kansas.

PURPOSE: The successful enactment of mandatory pharmacy technician certification in Kansas is described. METHODS: In 2004, Kansas began requiring registration of all pharmacy technicians with the state board of pharmacy. Registration identified individuals working as pharmacy technicians but did not require any specific education or certification. In September 2012, the Kansas Board of Pharmacy created a task force of key stakeholders including pharmacists from multiple areas of practice, the University of Kansas School of Pharmacy, organizational leaders from the Kansas Council of Health-System Pharmacists (KCHP) and Kansas Pharmacists Association, and professional lobbyists. The goals of this task force were to research practices of technician certification in other states and to make recommendations to the state board of pharmacy on how Kansas could accomplish mandatory technician certification. RESULTS: The task force outlined the steps needed to achieve legislation that could be supported by the members. These topics included the creation of a technician trainee category, grandfathering certain technicians who had been practicing for a designated period of time, state board-approved exemptions, training requirements, age and education requirements, continuing-education requirements, and pharmacist:technician ratio. The recommendations were finalized at the August 2013 Kansas Pharmacy Summit, and the proposed legislation was introduced and passed during the 2014 legislative session. KCHP members learned many valuable lessons about advocacy and the legislative process with this initiative, including building relationships, working with legislators, and working with other professional organizations. CONCLUSION: The formation of a task force led to the successful passage of a bill granting the Kansas Board of Pharmacy the authority to issue regulations regarding mandatory pharmacy technician certification.

Pharmacy technician-to-pharmacist ratios: a state-driven safety and quality decision.

OBJECTIVE: To discuss the policy of pharmacy technician-to-pharmacist ratios by comparing Florida as an example of legislative-led authority versus Tennessee as an example of board of pharmacy-led ruling. SUMMARY: Over the past 2 years, the Florida legislature has debated the issue of pharmacy staffing ratios, initially leaving the Florida Board of Pharmacy with little authority to advocate for and enact safe technician staffing ratios. Anticipating this situation, the Tennessee Board of Pharmacy created rules to meet pharmacy staffing needs while protecting the authority of the pharmacist-in-charge and promoting patient safety. Before enacting rules, members of the board toured the state and talked about proposed rule changes with pharmacists. The final rule sets the pharmacy technician-to-pharmacist ratio at 2:1 but permits a 4:1 ratio based on public safety considerations and availability of at least two Certified Pharmacy Technicians. CONCLUSION: Pharmacists and leaders within the profession should conduct further research on appropriate and safe ratios of pharmacy technicians to pharmacists, with a focus on safety and quality of care.

Ensuring continuing fitness to practice in the pharmacy workforce: Understanding the challenges of revalidation.

BACKGROUND: Revalidation is about assuring that health practitioners remain up to date and fit to practice, and demonstrating that they continue to meet the requirements of their professional regulator. OBJECTIVES: To critically discuss issues that need to be considered when designing a system of revalidation for pharmacy professionals. Although providing international context, the article focuses in particular on Great Britain (GB), where both pharmacists (Phs) and pharmacy technicians (PTs) are regulated. METHODS: Following a brief historical overview, the article draws on emerging evidence in context. RESULTS: Revalidation may involve discrete periodic assessment or a continuous process of assessment against clearly identified standards. The evolving scope of pharmacy practice involves increasingly clinical roles and also practitioners in nonpatient-facing roles. The potential risk to patients and the public may require consideration. Although revalidation, or systems for recertification/relicensure, exist in numerous jurisdictions, most center on the collection of continuing education credits; continuous professional development and reflective practice are increasingly found. Revalidation may involve assessment of other sources, such as appraisals or monitoring visits. Existing revalidation systems are coordinated centrally, but particularly in larger jurisdictions, like GB, where approximately 67,000 pharmacy professionals are regulated, some responsibility may need to be devolved. This would require engagement with employers and contracting organizations to ensure suitability and consistency. Existing systems, such as company appraisals, are unfit for the assessment of fitness to practice owing to a focus on organizational/business targets. Certain groups of pharmacy professionals may pose particular challenges, such as self-employed locums, pharmacy owners, those working in different sectors, or returning after a break. CONCLUSIONS: To ensure proportionality, it must be considered whether the same standards and/or sources of evidence should apply to all pharmacy professionals, either dependent on whether they are patient facing, their scope of practice, or whether Phs and PTs should be treated differently.

"Tech-check-tech": a review of the evidence on its safety and benefits.

OBJECTIVE: The published evidence on state-authorized programs permitting final verification of medication orders by pharmacy technicians, including the programs' impact on pharmacist work hours and clinical activities, is reviewed. SUMMARY: Some form of "tech-check-tech" (TCT)--the checking of a technician's order-filling accuracy by another technician rather than a pharmacist--is authorized for use by pharmacies in at least nine states. The results of 11 studies published since 1978 indicate that technicians' accuracy in performing final dispensing checks is very comparable to pharmacists' accuracy (mean ± S.D., 99.6% ± 0.55% versus 99.3% ± 0.68%, respectively). In 6 of those studies, significant differences in accuracy or error detection rates favoring TCT were reported (p < 0.05), although published TCT studies to date have had important limitations. In states with active or pilot TCT programs, pharmacists surveyed have reported that the practice has yielded time savings (estimates range from 10 hours per month to 1 hour per day), enabling them to spend more time providing clinical services. States permitting TCT programs require technicians to complete special training before assuming TCT duties, which are generally limited to restocking automated dispensing machines and filling unit dose batches of refills in hospitals and other institutional settings. CONCLUSION: The published evidence demonstrates that pharmacy technicians can perform as accurately as pharmacists, perhaps more accurately, in the final verification of unit dose orders in institutional settings. Current TCT programs have fairly consistent elements, including the limitation of TCT to institutional settings, advanced education and training requirements for pharmacy technicians, and ongoing quality assurance.

Satisfacción percibida por los pacientes y por el personal auxiliar de farmacia del área de atención a pacientes externos como método de mejora de la calidad / Satisfaction perceived by outpatients and pharmacy auxiliaries in a Hospital Pharmacy Department, as a method of improving quality

Objetivo. Evaluar el grado de satisfacción de pacientes atendidos y auxiliares de farmacia del área de pacientes externos del servicio de farmacia tras una reestructuración del espacio y del procedimiento de dispensación. Métodos. Tres meses después de la reestructuración del área (enero de 2009), se entregaron encuestas de satisfacción (anónimas y voluntarias) durante 2 semanas a una muestra de los 3.300 pacientes/mes atendidos y a los auxiliares que trabajaron en ella. Ambas constaban de ocho preguntas cerradas con formato tipo Likert referentes al espacio físico, la organización, la dispensación y la satisfacción global (variable principal) más una pregunta abierta para recoger sugerencias. Resultados. Recibieron la encuesta 265 pacientes (tasa de respuesta, 94%). El aspecto mejor valorado fue la confidencialidad (4,2±0,7) y el peor, la zona de espera (3,2±1). Se entregaron y se contestaron 26 encuestas por parte de los auxiliares. La mayor puntuación se obtuvo en la instalación del lector del código de barras (3,9±0,6) y la menor, en la organización del almacén (3,1±1,2). En la pregunta abierta se recogieron comentarios sobre falta de personal, dificultad del sistema informático, organización y poca claridad de las prescripciones. El grado de satisfacción global de los pacientes fue de 4,2±0,6 y el de los auxiliares, 3,7±0,7. Conclusiones. Los resultados nos han proporcionado una información útil para evaluar cambios y detectar puntos de mejora. En la mayoría de las cuestiones se ha detectado un mayor grado de satisfacción en los pacientes que en los trabajadores. Son necesarias nuevas acciones de mejora en el espacio físico y en la organización(AU)

Objectives. To evaluate the satisfaction of pharmacy auxiliaries, and patients attending the Outpatient Pharmacy, after the restructuring of the physical space and the process of dispensing drugs. Methods. Three months after the restructuring of the Area (January 2009), we gave satisfaction surveys (anonymously and voluntarily) over 2weeks, to a sample of the 3,300 patients who came per month and another to pharmacy auxiliaries who had worked in the area. The surveys consisted of eight closed questions with a Likert-type format about the physical space and organization, dispensing process and overall satisfaction (primary endpoint). In addition, there was an open question to gather suggestions. Results. A total of 265 patients received the questionnaire (response rate 94%). The most valued aspect was the confidentiality (4.2±0.7) and the worst was the waiting area (3.2±1). There was a 100% response rate from the 26 pharmacy auxiliaries who received the questionnaire. The highest score was obtained by the installation of the bar-code reader (3.9±0.6) and the lowest for organization of the stores (3.1±1.2). They added comments about the lack of personnel, computer systems, organization of space and the lack of clarity of the prescription. The overall patient satisfaction was 4.2±0.6 and that of the auxiliaries was 3.7±0.7. Conclusions. The results of patients and employees satisfaction surveys have been useful information to assess changes in the area and identify points for improvement. In most of the issues the satisfaction was greater in patients than employees. We believe it is necessary to carry out actions for improving physical space and organization(AU)

Identifying characteristics that allow pharmacy technicians to assume unconventional roles in the pharmacy.

OBJECTIVE: To identify aspects of pharmacy technicians' experience, training, practice setting, and location that influence whether technicians undertook roles traditionally performed by pharmacists. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: North Dakota in 2005. PATIENTS: All 456 pharmacy technicians registered in North Dakota (response rate 42.1% [n = 192]) actively working in a pharmacy-related practice setting. INTERVENTION: A survey was developed based on workforce studies of pharmacists and pharmacy technicians. The survey asked technicians to report demographic characteristics, education, experience, pharmacy setting, and community practice size. Respondents also were asked to identify whether they routinely performed specific tasks in the pharmacy, some of which are not typically performed by technicians. MAIN OUTCOME MEASURES: Eight "unconventional" tasks performed by technicians were selected as the focus of the analysis: compounding oral medications under the supervision of a pharmacist, compounding topical medications under pharmacist supervision, preparing third-party billing, requesting a refill authorization from a prescriber, taking patient medication history information, ordering stock from a wholesaler, taking new prescriptions over the telephone, and counseling patients on nonprescription medications. RESULTS: For each task, a binary logit model was used to identify the characteristics that significantly affected whether technicians performed a task. The practice setting was the most pervasive determinant of whether technicians performed specific tasks. Educational background and certification played a secondary role in influencing whether technicians performed each of these tasks. CONCLUSION: Pharmacy technicians are able to take on a larger role in pharmacy practice. However, technicians' abilities to fill these expanded roles may be limited and depend on various factors, including practice setting, acceptance by pharmacists, and technician experience.