Text of Research report by Jim Middleton, Pharmacist
(an MCTE project at Ferris State University, 2001)
Introduction
Prescription volumes are increasing. The estimate of 4 billion
annual prescriptions by 2004, up from the projections of 2.9 billion
prescriptions for 2001, represents nearly a 38% increase when
pharmacist numbers are expected to increase only by 6 percent during
the same period (18,19). At the same time, requirements for
cognitive services and pharmaceutical care are making further demands
on the pharmacist's daily work load (15, 21). Highly publicized
medication errors (1, 7, 9) and discussions of pharmacist liability
(8) that have accompanied the staffing shortage (10) are even
prompting Congressional inquiry (20).
Pharmacists have long made use of pharmacy technicians to help
lighten their workload (14, 16). However, until the late 1970s,
there was no real mechanism to ascertain a technician's competency
within the discipline (17). Michigan led the way by introducing
a Certified Pharmacy Technician program, sponsored by the Michigan
Pharmacists Association, with national contracting of the service in
1981. The initial 15 states participating helped in
establishing a nationally recognized certification exam by 1995
(6). As of November, 2000, nearly 71,000 technicians were
certified nationally (6).
However,
the existence of an exam did not make certification mandatory, nor
did it establish any structured educational requirements for taking
the exam. Some states, such as California, Nebraska (2), and
Utah, have required state licensure for pharmacy technicians in
addition to the exam certification; others, such as Texas and Oregon,
require certification but no licensure; and still others follow
Virginia (5), making certification of pharmacy technicians
voluntary. Michigan, the state that began the certification
program, falls under that last category. Several states have
colleges which offer certificate or associate's degree course work
for pharmacy technicians; again, there are no set guidelines for
these programs. In fact, California offers no fewer than six
different ways to become eligible for registry as a pharmacy
technician.
National discussions
on requiring certification have created friction between certified or
licensed technicians wanting more recognition for their education and
ability, and pharmacists concerned over competition for their jobs
(7), as controversy remains over the proper pharmacist-to-technician
working ratio (3, 4). While Michigan has surveyed its
pharmacists in the past regarding certification of specific pharmacy
services (13) within its discipline (ie diabetes education, cancer
chemotherapy, radiopharmacy), it has not yet examined the
pharmacists' attitudes regarding mandatory certification or licensure
of pharmacy technicians, nor of a structured program of education for
pharmacy technicians.
The purpose
of this study was to survey pharmacists’ attitudes toward
pharmacy technician duties as well as conduct a needs assessment
within the pharmacy profession regarding the development of a
college-based program for training pharmacy technicians.
The specific research questions that were explored included:
1. What is the profile of the pharmacist involved in the
study, inclusive of academic, demographic, and employment
information?
2. What is the importance that pharmacists
place on specific activities performed by pharmacy technicians?
3.
What is the importance that pharmacists place on specific educational
needs for a pharmacy technician?
4. What is the pharmacist
attitude toward the potential for licensure of pharmacy technicians?
5. What is the relationship between selected academic,
demographic and employment variables of pharmacists and their
attitude toward a formalized education program for pharmacy
technicians and their possible licensure?
Methodology and Procedures
This survey was a non-experimental, descriptive study comparing
differences in attitudes among a cross-section of Michigan
pharmacists. The descriptive study made use of a self-developed
questionnaire, first tested with three pharmacists and a researcher
from Ferris State University. A copy of the complete
survey follows as an appendix to this report.
The population surveyed were those pharmacists of residence within
the State of Michigan, with active licensure, as of 12 February
2001. The pharmacists' names were drawn from the database on
file at the Michigan Pharmacists Association. This
represented a pharmacist population of approximately 8100.
A random sampling of 1000 pharmacists was chosen from this database;
a time frame of 3 weeks was allowed for the response to the survey,
at which point 455 usable responses were obtained. 367 minimum
responses were necessary to achieve a margin of error of +/- 5% in
such a population.
The final
results were analyzed statistically, making use of means,
frequencies, percentages, charts and graphs, and chi-square.
Results of the Survey–Demographics
The average age (mean) of the respondents was 48.48 years, with a
range of 24 to 80 years. 69.2% were male, 30.8% were female.
Graduates from Ferris State University predominated, at 61.8%,
followed by graduates from Wayne State University (20.7%) and the
University of Michigan (9.2%). Non-Michigan pharmacy graduates
accounted for 8.4%, with 1.1% coming from Ohio State University.
41.5% of respondents had been practicing for over 25 years, 36.5% had
been at work from 11-25 years, and 17.2% had been pharmacists for
6-10 years. 4.8% of the respondents had been working for 5
years or less.
Bachelor’s
degrees also predominated, at 85.5%. Another 10.5% had obtained
some graduate work beyond their Bachelor’s degree, not
necessarily toward a PharmD. PharmD degrees accounted for 2.6%
of respondents, with another 1.3% having pursued education beyond the
PharmD level.
Pharmacists in the
retail setting accounted for 65.9% of the respondents, further broken
down into independent (37.8%) and community chain (28.1%, a chain
being defined as more than 3 pharmacies). Hospital pharmacists
represented 23.1%, with 3.7% serving in a consultant capacity and
0.7% focused on long-term care. 6.6% fell into the “other”
category, with hospital management, pharmaceutical representative,
and semi-retired being cited as specific occupations.
96% of the respondents worked with pharmacy technicians; 33.4% worked
with five or more. Further, of those surveyed, 54.9% indicated
that they worked in a pharmacy with at least one certified pharmacy
technician (17.1% indicated that they worked in a pharmacy with five
or more certified technicians).
Results of the Survey--Responses to the survey questions
There were a total of 40 questions
posed in the questionnaire related to pharmacists’ attitudes
regarding various aspects of technician duties, training, educational
requirements, and licensure. A general summary of
the responses follows:
Note:
Values in parentheses represent the portion of the percent that is
“strong agreement” or “strong disagreement”
Table I.
Statement: “A pharmacy technician's duties
should include...”
Duty |
Agree |
Disagree |
No Opinion |
1. Answering the telephone |
98% (85.3%) |
0.9% (0.2%) |
1.1% |
2. Taking refills from patients over the phone |
93.4% (80%) |
1.5% (0.4%) |
5.1% |
3. Taking refills from doctor’s office or nursing station over the phone |
69% (35.4%) |
25.3% (5.1%) |
5.7% |
4. Taking new prescriptions over the phone from doctor’s office or nursing floor |
35.6% (12.7%) |
60.9% (25.7%) |
3.5% |
5. Computer data entry of prescription/drug order information |
89.5% (56.9%) |
7.5% (2.4%) |
3.1% |
6. Interpreting insurance company information for computer entry |
92.7% (70.1%) |
1.7% (0.4%) |
5.5% |
7. Interpreting drug interactions |
9.2% (1.1%) |
86.8% (40.9%) |
4% |
8. Calculating doses based on age or weight |
22% (2.6%) |
68.8% (27.5%) |
9.2% |
9. Calculating IV administration rates |
37.4% (6.4%) |
44.1% (18.7%) |
24% |
10. Contacting physician or office regarding hospital or formulary requirements |
64% (23.7%) |
24% (6.2%) |
12.1% |
11. Contacting insurance companies for vacation overrides (retail setting) |
91% (58.7%) |
2.7% (0.9%) |
6.4% |
12. Contacting insurance companies for prior authorization on non-formulary drugs (retail) |
83.5% (50.3%) |
8.4% (1.8%) |
8.1% |
13. Checking other technician work prior to dispensing |
27% (6.6%) |
61.8% (25.1%) |
11.2% |
14. Advising on OTC use |
18.5% (2.2%) |
72.6% (21.3%) |
9% |
15. Advising on nutritional or dietary supplements |
19.1% (1.8%) |
67.7% (21.3%) |
13.2% |
16. Teaching use of glucometers |
56.5% (7.9%) |
31.3% (8.4%) |
12.3% |
17. Teaching use of MDIs (ie albuterol) |
44% (6.2%) |
46.1% (6.8%) |
9.9% |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table II.
Statement: “A pharmacy technician should...”
Statement |
Agree |
Disagree |
No Opinion |
1. Receive all of his or her training on-site |
23.5% (3.7%) |
60.2% (7%) |
16.3% |
2. Receive additional training in a formalized classroom setting |
69.9% (12.1%) |
14.5% (1.5%) |
15.6% |
3. Hold at least a certificate degree (2-3 semester program) from a college setting |
28.1% (7.3%) |
51% (6.4%) |
20.9% |
4. Hold at least an associate's degree (4 semesters) from a college setting |
9.9% (2.9%) |
66% (13%) |
24.2% |
5. Be certified |
59.1% (18.2%) |
29% (3.1%) |
11.9% |
6. Be licensed by the State of Michigan |
36.3% (12.7%) |
43.7% (10.5%) |
20% |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table III.
Statement: “A Certified Pharmacy Technician
should...”
Statement |
Agree |
Disagree |
No Opinion |
1. Still have on-site training before taking on additional responsibilities |
96.9% (43.7%) |
1.1% (0.2%) |
2% |
2. Be paid more than a non-certified technician |
84% (46.4%) |
7.2% (0.2%) |
8.8% |
3. Be allowed to perform routine dispensing functions under minimal supervision by a pharmacist |
52.1% (11%) |
36.5% (7%) |
11.4% |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table IV.
Statement: “A pharmacy technician's training
should include...”
Course work |
Agree |
Disagree |
No Opinion |
1. Pharmacology |
57.6% (9.5%) |
26.4% (4.2%) |
16% |
2. Organic Chemistry |
13.6% (1.8%) |
62.1% (11.6%) |
24.2% |
3. Algebra |
59.6% (16.7%) |
24.6% (2.4%) |
15.8% |
4. Drug interactions |
66.8% (12.3%) |
22.4% (2.4%) |
10.8% |
5. Biology |
53.4% (4.4%) |
25.7% (2.6%) |
20.9% |
6. Anatomy and physiology |
56.9% (5.3%) |
24.4% (2.2%) |
18.7% |
7. Herbal medicine |
57.1% (6.8%) |
20.2% (1.3%) |
22.6% |
8. Nutritional supplements and OTC products |
69.5% (8.8%) |
15.4% (1.1%) |
15.2% |
9. Preparation toward a pharmacist's degree |
17.6% (2.4%) |
45.3% (6.6%) |
37.1% |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table V.
Statement: “Regarding pharmacy technicians...”
Statement |
Agree |
Disagree |
No Opinion |
1. Certification of a pharmacy technician is unnecessary |
29% (4.6%) |
58.9% (17.4%) |
12.1% |
2. Certification of a pharmacy technician means the same whether done by a national examination or by an on-site program |
24% (3.5%) |
60.7% (11.9%) |
15.4% |
3. Certification and licensure of technicians represents a threat to pharmacist job security |
5.7% (1.5%) |
86.5% (33.8%) |
7.7% |
4. I encourage my technicians to become certified |
74.1% (30.8%) |
9.7% (1.1%) |
16.3% |
5. I encourage my technicians to obtain advanced, formalized training |
73.8% (26.2%) |
10.6% (0.9%) |
15.6% |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Results of the
Survey--Correlations
The demographics of “pharmacy
school,” “degree held,” “years of practice,”
and “type of pharmacy practice” were further examined.
Using a chi-square analysis of the results, the following
correlations emerged as being statistically significant. Unless
stated otherwise, the total agreement or disagreement percentage is
given, with the portion of that percent being “strongly agree”
or “strongly disagree” being placed in parentheses.
1. Pharmacy School Demographic
Four statements demonstrated a significant difference in responses
among the various pharmacy school graduates.
When it came to technicians teaching patients the proper use of multi-dose inhalers, 57.2% of University of Michigan graduates disagreed (14.3% strongly), while Ferris graduates were 45.9% in disagreement (10% strongly), and 38.2% of Wayne graduates took issue with the statement (19.1% strongly).
Table VI:
Technicians teaching MDI use
Pharmacy school |
Agree |
Disagree |
University of Michigan |
38.1% (8.1%) |
57.2% (14.3%) |
Ferris State University |
45.5% (6.4%) |
45.9% (10%) |
Wayne State University |
45.7% (5.3%) |
38.2% (19.1%) |
Note: Values in parentheses represent the portion of the percent
that is “strong agreement” or “strong disagreement”
When asked whether a technician should “hold at least an associate’s degree (4 semesters) from a college setting,” 71.4% of University of Michigan graduates disagreed (11.9% strongly), with Ferris graduates dissenting at 67.1% (12.1% strongly) and Wayne State graduates disagreeing at 57.5% (16% strongly).
Table VII:
Technicians holding Associate’s Degree
Pharmacy School |
Agree |
Disagree |
University of Michigan |
11.9% (2.4%) |
71.4% (11.9%) |
Ferris State University |
7.1% (1.4%) |
67.1% (12.1%) |
Wayne State University |
17.1% (4.3%) |
57.5% (16%) |
Note: Values in parentheses represent the portion of the percent
that is “strong agreement” or “strong disagreement”
When discussing possible course work for pharmacy technicians, University of Michigan graduates found disagreement with organic chemistry at 71.5% (16.7% strongly), with Wayne State disagreeing at 62.8% (12.8% strongly), and Ferris State at 59.8% (8.9% strongly).
Table VIII:
Organic Chemistry in Course work
Pharmacy School |
Agree |
Disagree |
University of Michigan |
11.9% (2.4%) |
71.5% (16.7%) |
Ferris State University |
16.3% (1.4%) |
59.8% (8.9%) |
Wayne State University |
6.4% * |
62.8% (12.8%) |
* no “strongly agree”
responses indicated
Note: Values in parentheses represent the
portion of the percent that is “strong agreement” or
“strong disagreement”
On the other hand, biology as a subject drew agreeable responses from 56.4% of Wayne graduates (2.1% strongly), 53.4% of Ferris graduates (5% strongly), and 45.2% of University of Michigan graduates.
Table IX:
Biology in Course work
Pharmacy School |
Agree |
Disagree |
University of Michigan |
45.2% * |
31% (4.8%) |
Ferris State University |
53.4% (5%) |
27.4% (1.4%) |
Wayne State University |
56.4% (2.1%) |
20.2% (5.3%) |
* no “strongly agree”
responses indicated
Note: Values in parentheses represent the
portion of the percent that is “strong agreement” or
“strong disagreement”
2. Pharmacy Degree demographic
Two possible correlations emerged when analyzing the respondent’s
degree held and his or her response.
When examining potential technician course work, respondents holding
a PharmD agreed that algebra should be included 83.3% of the time
(33.3% strongly). Bachelor’s degree pharmacists agreed at
57% (14.1% strongly), and Bachelor’s degree pharmacists who
have obtained further education agreed at a 70.5% rate (33.3%
strongly).
Table X:
Algebra in Technician Course work
Degree |
Agree |
Disagree |
Bachelor’s |
57% (14.1%) |
26.8% (2.6%) |
Pharm D |
83.3% (33.3%) |
16.7% * |
Bachelor’s with graduate work |
70.5% (33.3%) |
12.5% (2.1%) |
* no “strongly disagree” responses indicated
Note:
Values in parentheses represent the portion of the percent that is
“strong agreement” or “strong disagreement”
The statement, “I encourage
my technicians to become certified” also demonstrated a
significant variety of responses based on pharmacy degree.
91.7% of PharmD graduates agreed (41.7% strongly), while Bachelor’s
degree graduates who have gone for further education agreed 85.4%
(62.5% strongly), and 71.9% of Bachelor’s degree only agreed
(26.7% doing so strongly).
Table XI:
Encourage Technicians to Become Certified
Degree |
Agree |
Disagree |
Bachelor’s |
71.9% (26.7%) |
10.3% (1.3%) |
Pharm D 91.7% |
(41.7%) |
none |
Bachelor’s with graduate work |
85.4% (62.5%) |
6.3%* |
* no “strongly disagree”
responses indicated
Note: Values in parentheses represent the
portion of the percent that is “strong agreement” or
“strong disagreement”
3. Years of practice demographic
Six
statements showed possible correlations between response and number
of years in pharmacy practice.
A
technician giving advice on which “OTC cough or cold
preparation to take” had the least disagreement with those who
have worked over 25 years, with 61.4% (of that, 17.5% strongly
disagreeing). Respondents in practice from 6 to 10 years
disagreed the most, at 86.4% (40.9% strongly).
The tables below summarize the information for each practice
category. The number in parentheses is, again, the portion of
agreement or disagreement that is “strong.”
Table XII: Statement: A technician “advising a patient which OTC cough or cold preparation to take.”
Years of Practice |
Agree |
Disagree |
0-5 |
13.6%* |
81.8% (40.9%) |
6-10 |
11.4%* |
86.4% (40.9%) |
11-15 |
2.9%* |
82.4% (20.6%) |
16-20 |
13.8%* |
81.3% (32.5%) |
21-25 |
16.3% (1.2%) |
75.6% (25.6%) |
over 25 |
25.9% (4.2%) |
61.4% (17.5%) |
* no “strongly agree” responses were indicated
Note:
Values in parentheses represent the portion of the percent that is
“strong agreement” or “strong disagreement”
Similarly, the statement “advising a patient on which dietary or nutritional supplement to take” showed a significant variance between these groups.
Table XIII: Statement, “advising a patient on which dietary or nutritional supplement to take”
Years of Practice |
Agree |
Disagree |
0-5 |
9.1%* |
77.3% (36.4%) |
6-10 |
9.1%* |
86.4% (40.9%) |
11-15 |
8.8%* |
73.5% (14.7%) |
16-20 |
17.5%* |
77.6% (31.3%) |
21-25 |
10.5%* |
73.3% (18.6%) |
over 25 |
29.1% (4.2%) |
54.5% (13.2%) |
*no “strongly agree”
responses were indicated
Note: Values in
parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Significant variations emerged on technicians teaching glucometers, both in agreement and disagreement:
Table XIV: Statement, “instructing a patient on the proper use of a glucometer”
Years of Practice |
Agree |
Disagree |
0-5 |
40.9% (4.5%) |
45.4% (22.7%) |
6-10 |
47.7% (9.1%) |
40.9% (18.2%) |
11-15 |
64.7% (2.9%) |
26.5% (5.9%) |
16-20 |
52.6% (3.8%) |
42.6% (8.8%) |
21-25 |
52.3% (5.8%) |
31.4% (7%) |
over 25 |
62.4% (11.6%) |
23.3% (5.3%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
And with multiple dose inhaler teaching:
Table XV: Statement, “instructing a patient on the proper use
of a multi-dose inhaler”
Years of Practice |
Agree |
Disagree |
0-5 |
27.3%* |
59.2% (18.2%) |
6-10 |
31.8% (6.8%) |
69.5% (22.7%) |
11-15 |
38.2% (2.9%) |
44.1% (14.7%) |
16-20 |
37.6% (3.8%) |
58.8% (13.8%) |
21-25 |
40.7% (4.7%) |
46.5% (9.3%) |
over 25 |
54% (9%) |
34.9% (9.5%) |
* no “strongly agree”
responses were indicated
Note: Values in
parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Regarding potential technician course work, years of
practice indicated variances in the need to include algebra.
Table XVI: Technician training should include algebra
Years of Practice |
Agree |
Disagree |
0-5 |
77.3% (40.9%) |
13.6% (4.5%) |
6-10 |
75.9% (18.2%) |
25%* |
11-15 |
58.9% (11.8%) |
17.6%* |
16-20 |
67.6% (21.3%) |
18.8%* |
21-25 |
65.1% (18.6%) |
20.7% (4.7%) |
over 25 |
49.2% (11.6%) |
31.2% (3.2%) |
*no “strongly disagree”
responses were indicated
Note: Values in
parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Variances again emerged when asked whether nutritional supplement and OTC products should be part of a technician training:
Table XVII: Technician training should include nutritional supplements and OTC products
Years of Practice |
Agree |
Disagree |
0-5 |
90.9% (18.2%) |
0%** |
6-10 |
63.6%* |
22.7%* |
11-15 |
54.7% (11.8%) |
23.5%* |
16-20 |
60% (7.5%) |
23.8% (1.3%) |
21-25 |
65.1% (9.3%) |
22.1% (1.2%) |
over 25 |
75.1% (9.5%) |
7.4% (1.6%) |
* no
“strongly” agree or disagree statements were indicated
** no disagreement of any sort indicated
Note: Values in parentheses represent
the portion of the percent that is “strong agreement” or
“strong disagreement”
4. Type of pharmacy practice demographic.
The
types of pharmacy practice examined were “community chain (3 or
more pharmacies),” “community independent,”
“hospital,” “long-term care,” “consultant,”
and “other.”
Chi-square analysis revealed
several questions with responses statistically unique among the three
categories of “community chain,” “community
independent,” and “hospital.”
a. Technician Duties
Variances emerged when asked
whether a technician should take new orders over the phone from a
doctor’s office or nursing floor
Table XVIII:
Taking new orders from a doctor’s office or nursing floor
Type of Practice |
Agree |
Disagree |
Chain |
42.2% (13.3%) |
55.5% (20.3%) |
Independent |
41.8% (18%) |
54% (17.4%) |
Hospital |
20.9% (6.9%) |
76.2%% (38.1%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances emerged when asked whether a technician should
interpret drug interactions
Table XIX: Technicians
interpreting Drug Interactions
Type of Practice |
Agree |
Disagree |
Chain |
10.9% (2.3%) |
85.9% (35.9%) |
Independent |
12.2% (1.2%) |
82% (32%) |
Hospital |
6.7% * |
90.5% (50.5%) |
* no “strongly agree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Variances were noted when asked whether technicians should
calculate administration times for IV drugs
Table
XX: Technicians calculating IV administration times
Type of Practice |
Agree |
Disagree |
Chain |
21.9% (1.6%) |
47.6% (20.3%) |
Independent |
16.3% (2.3%) |
55.2% (25%) |
Hospital |
62.8% (17.1%) |
27.6% (8.6%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances emerged when asked whether technicians should check
other technicians prior to having drugs dispensed from the pharmacy.
Table XXI: Technicians checking other technicians
prior to dispensing
Type of Practice |
Agree |
Disagree |
Chain |
20.3% (4.7%) |
67.2% (25.8%) |
Independent |
28.5% (6.4%) |
59.3% (22.7%) |
Hospital |
31.5% (4.8%) |
59.1% (24.8%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances emerged when asked whether technicians should
advise on OTC cough and cold preparations.
Table XXII: Technicians advising on OTC cough and cold preparations
Type of Practice |
Agree |
Disagree |
Chain |
11% (0.8%) |
79.7% (22.7%) |
Independent |
27.3% (3.5%) |
66.3% (21.5%) |
Hospital |
18.1% (1.9%) |
69.5% (27.6%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances emerged when asked whether technicians should
advise on nutritional or dietary supplements
Table
XXIII: Technicians advising on nutritional or dietary supplements
Type of Practice |
Agree |
Disagree |
Chain |
16.4% (0.8%) |
71.8% (19.5%) |
Independent |
26.2% (2.9%) |
61.1% (16.9%) |
Hospital |
12.4% (1%) |
68.6% (22.9%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances appeared when asked whether technicians should
instruct patients on the proper use of a glucometer.
Table XXIV: Technicians instructing patients on glucometer use
Type of Practice |
Agree |
Disagree |
Chain |
57.1% (6.3%) |
30.5% (7.8%) |
Independent |
65.7% (8.7%) |
22.1% (4.1%) |
Hospital |
46.6% (5.7%) |
41% (14.3%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances also appeared when asked whether technicians
should instruct patients on proper use of multi-dose inhalers (MDI).
Table XXV: Technicians instructing patients on MDI
use
Type of Practice |
Agree |
Disagree |
Chain |
43% (5.5%) |
46.9% (10.2%) |
Independent |
53.5% (7.6%) |
38.9% (8.7%) |
Hospital |
33.3% (1.9%) |
54.2% (17.1%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
b. Technician
Education
Variances
emerged when asked whether technicians should hold at least a
certificate-level (2-3 semesters) of training
Table
XXVI: Technicians holding certificate-level training
Type of Practice |
Agree |
Disagree |
Chain |
24.2% (7%) |
54.7% (4.7%) |
Independent |
18.1% (4.1%) |
57.6% (9.3%) |
Hospital |
41.9% (10.5%) |
40% (4.8%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances appeared when asked whether technicians should be
certified
Table XXVII: Certification of technicians
Type of Practice |
Agree |
Disagree |
Chain |
56.3% (17.2%) |
28.9% (1.6%) |
Independent |
42.5% (7.6%) |
42.4% (5.2%) |
Hospital |
83.8% (34.3%) |
10.5% (1%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Variances also appeared when asked whether technicians
should be licensed by the State of Michigan.
Table
XXVIII: Licensing technicians by the State
Type of Practice |
Agree |
Disagree |
Chain |
32% (11.7%) |
42.2% (7%) |
Independent |
29.7% (7.6%) |
49.8% (12.2%) |
Hospital |
47.6% (19%) |
40% (12.4%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
c. Comments on
certified technicians
Variances emerged when pharmacists were asked whether a certified
pharmacy technician should be paid more than a non-certified
technician.
Table XXIX: Certified technicians should be
paid more than non-certified technicians
Type of Practice |
Agree |
Disagree |
Chain |
89.6% (40.6%) |
4.7% * |
Independent |
72.1% (27.3%) |
12.8% (0.6%) |
Hospital |
93.3% (49.5%) |
1.9% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
d. Technician training
Variances on technician training
revolved around the subjects of pharmacology, algebra, anatomy and
physiology, and nutritional and OTC products.
Table
XXX: Pharmacology
Type of Practice |
Agree |
Disagree |
Chain |
57.8% (8.6%) |
24.4% (2.3%) |
Independent |
47.1% (6.4%) |
34.9% (6.4%) |
Hospital |
70.4% (15.2%) |
18.1% (2.9%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table XXXI: Algebra
Type of Practice |
Agree |
Disagree |
Chain |
60.1% (11.7%) |
24.3% (1.6%) |
Independent |
44.2% (8.7%) |
34.9% (4.1%) |
Hospital |
78.1% (31.4%) |
13.3% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Table XXXII: Anatomy and Physiology
Type of Practice |
Agree |
Disagree |
Chain |
54.7% (5.5%) |
28.2% (1.6%) |
Independent |
48.9% (4.7%) |
29.7% (3.5%) |
Hospital |
63.8% (6.7%) |
17.1% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Table XXXIII: Nutritional and OTC products
Type of Practice |
Agree |
Disagree |
Chain |
63.3% (7%) |
18.8% * |
Independent |
68.6% (9.3%) |
15.7% (1.7%) |
Hospital |
76.2% (10.5%) |
9.5% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
e. General comments on
pharmacy technicians
Variances
emerged when the pharmacists were asked about whether technician
certification was necessary, whether they encouraged their
technicians to become certified and obtain further education, and
whether certification and licensure of technicians represented a
threat to pharmacist job security.
Table XXXIV: Certification of technicians is unnecessary
Type of Practice |
Agree |
Disagree |
Chain |
29.7% (3.1%) |
56.2% (14.8%) |
Independent |
42.5% (7.6%) |
44.2% (11.6%) |
Hospital |
11.5% (1%) |
81% (32.4%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Table XXXV: Encourage technicians to become certified
Type of Practice |
Agree |
Disagree |
Chain |
74.2% (25.8%) |
9.4% (0.8%) |
Independent |
59.3% (20.9%) |
15.1% (1.7%) |
Hospital |
90.5% (50.5%) |
1.9% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Table XXXVI: Encourage technicians to obtain advanced, formalized training
Type of Practice |
Agree |
Disagree |
Chain |
70.3% (21.1%) |
14.1% (0.8%) |
Independent |
65.1% (15.1%) |
14.6% (1.2%) |
Hospital |
86.7% (43.8%) |
1.9% * |
* no “strongly disagree”
statements were indicated
Note: Values
in parentheses represent the portion of the percent that is “strong
agreement” or “strong disagreement”
Table XXXVII: Certification and licensure of technicians represent a threat to pharmacist job security
Type of Practice |
Agree |
Disagree |
Chain |
4.7% (0.8%) |
92.9% (32%) |
Independent |
8.1% (2.3%) |
80.8% (26.7%) |
Hospital |
3.8% (1.9%) |
86.7% (44.8%) |
Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”
Interpretations and Conclusions
On basic clerical functions, Michigan pharmacists are willing to give
their technicians a large latitude of independence.
Particularly, answering the telephone (98%), taking refill orders
from patients (93.4%), interpreting insurance information for
computer entry (92.7%), dealing with insurance companies for vacation
requests (91%), and, to a lesser degree, contacting insurance
companies on formulary issues (83.5%) all are considered very
acceptable activities. Less enthusiasm is shown for technicians
taking new prescriptions over the phone (35.6%), interpreting drug
interactions (9.2%), calculating doses based on weight (22%),
checking other technician’s work (27%), advising OTC use
(18.5%), or nutritional supplements (19.1%). In dealing with
the public, however, educating patients on glucometers has a 56.5%
overall approval; doing the same with multiple dose inhalers
(albuterol, et al), offers ambivalence– 44% agree, while 46.1%
disagree whether this is an acceptable technician duty.
Regarding education, certification, and State licensure, most
pharmacists (60.2%) disagree that on-site experience offers adequate
training; 69.9% agree that additional training in a formalized
classroom setting is necessary, and 60.7% agree on-site certification
is not equivalent to a nationally-based examination; however, the
same pharmacists don’t seem to think this extra training or
education should lead to either a certificate (51% disagreement) or
associate’s degree (66% disagreement) at a college level.
With 74.1% of the respondents agreeing that their technicians should
be encouraged toward certification and a similar number encouraging
formalized training (73.8%), only 59.1% indicate that they should be
certified; even fewer (36.3%) agree that technicians should be
licensed by the State. However, 86.5% of the respondents
do not believe that certification or licensure of technicians would
represent a threat to a pharmacist’s job security.
Once a technician is certified, 96.9% agree that additional on-site
training is necessary, 84% feel that additional pay is warranted, and
just over half (52.1%) agree that a certified technician can perform
routine dispensing functions with minimal supervision by a
pharmacist.
Education on
nutritional supplements and OTCs heads the list of learning
objectives at 69.5%. In fact, over half agree that
pharmacology (57.6%), algebra (59.6%), drug interactions (66.8%),
biology (53.4%), anatomy and physiology (56.9%), and herbal medicine
(57.1%) are important in a technician’s training. Only
organic chemistry drew a predominantly negative response (13.6%).
Those portions of the study that
can be further broken down with statistical confidence reveal some
interesting trends. University of Michigan graduates are more
resistant (57.2%) to having their technicians train patients with
multiple dose inhalers (albuterol, et al) than graduates from Ferris
(45.9%) or Wayne State (38.2%). University of Michigan
graduates also are in greater general disagreement (71.4%, vs Ferris’
67.1% and Wayne State’s 57.5%) to having a technician obtain an
associate’s degree in his or her discipline; and, if they do,
they take the greatest issue with including organic chemistry (71.5%)
as part of the curriculum when their responses are compared with
their Ferris (59.8%) or Wayne State (62.8%) brethren.
The pharmacy degree demographic reveals two significant trends among
bachelor’s degree, bachelor’s degree with graduate work,
and PharmD respondents. Algebra as a part of a technician’s
curriculum is encouraged with greater enthusiasm as the respondent’s
own education progressed from bachelor’s (57%), to bachelor’s
with graduate work (70.5%), to PharmD (83.3%). Holders of a
PharmD were the most likely (91.7%) to encourage their technicians to
become certified as well (bachelor’s degree respondents
agreeing at 71.9% and bachelor’s with graduate work at 85.4%).
A trend also emerges that
associated itself with years of practice in pharmacy (tables XII
through XVI). Those respondents practicing more than 25 years
appear more willing to relax their restraint on technician duties
when compared to the rest of the responding population. They
show less resistance to having a technician advise on OTC cough or
cold preparations (61.4% general disagreement to the statement,
compared with 86.4% of the 6-10 year population), suggesting dietary
supplements (54.5% vs 86.4% in the 6-10 year population), instructing
on glucometer usage (23.3% vs 45.4% of the 0-5 year group), and
proper use of a multi-dose inhaler (34.9% vs 69.5% of the 6-10 year
group). This data is represented both in bar graphs and
as line graphs in the appendix to this report.
The greatest number of statistical variances comes when analyzing the
type of pharmacy practice demographic. Twenty of the survey
statements (tables XVII through XXXVII) showed significant
differences among pharmacists who work in retail chain, retail
independent, and hospital environments. Hospital pharmacists
are least likely to have a technician take new telephone prescription
orders (20.9%) than chain (42.2%) or independent (41.8%)
pharmacists. They are also least likely to have a
technician interpret drug interactions (6.7% vs 10.9% for chain and
12.2% for independent pharmacists). In a task more specific to
the hospital environment, IV administration time calculation, they
are more likely (62.8% vs 21.9% for chain and 16.3% for independent
pharmacists) to assign this as a technician task. A program of
technicians checking other technicians meets with general
disagreement with all three categories of pharmacists, with chain
pharmacists leading at 67.2%, followed by independents at 59.3%
virtually tied with hospital pharmacists at 59.1%. Independent
pharmacists show the greatest agreement with having technicians
instruct patients on multiple-dose inhaler use (53.5% vs chain’s
43% and hospital’s 33.3%) and in teaching patients about
glucometers (65.7% vs chain’s 57.1% and hospital’s
46.6%). Similarly, while all groups disagreed in general,
independent pharmacists disagreed least when it came to having
technicians advise on OTC cough and cold preparations (66.3% vs chain
pharmacists’ 79.7% and hospital pharmacists’ 69.5%) and
nutritional or dietary supplements (61.1% vs chain’s 71.8% and
hospital’s 68.6%).
The
pharmacy practice demographic varied with technician’s proposed
education levels. While all disagreed that technicians should
have certificate-level training, the least enthusiasm was shown by
independents (at 18.1%, with chain respondents 24.2% and hospital
41.9%). Independents were also least enthusiastic about the
statement “technicians should be certified,” with the
total of agreement responses 42.5%, followed by chain pharmacists at
56.3%, and hospital pharmacists at 83.8%. Licensing technicians
was also regarded with the least acclamation by independents, with a
29.7% agreement comparing to the chain pharmacists’ 32% and the
hospital pharmacists’ 47.6%.
However, once a technician has become certified, all three categories
agree that he or she should be paid more than a non-certified
technician. Nevertheless, even with this question, the
variances split among the practice sites: independent respondents
agreed at 72.1%, chain respondents at 89.6%, and hospital respondents
at 93.3%.
When exploring potential technician course work,
the type of practice again influenced the pharmacists’
response. Of the options presented, “pharmacology,”
“algebra,” “anatomy and physiology,” and
“nutritional and OTC products” all show significant
variation (tables XXX through XXXIII), with nearly two-thirds or more
of hospital pharmacists agreeing with the need for this sort of
training, and a majority of chain pharmacists in accord.
Independent pharmacists agreed less than half the time with each
these presented choices, with the one exception being “nutritional
and OTC products.”
Finally,
four of the closing survey comments (tables XXXIV through XXXVII)
indicate that hospital pharmacists are least likely to find
certification of technicians unnecessary (11.5% vs 29.7% of chain and
42.5% of independent pharmacists), are most likely to encourage their
technicians to become certified (90.5% vs 74.2% of chain and 59.3% of
independents) and to obtain advanced, formalized training (86.7% vs
70.3% of chain and 65.1% of independents). In addition,
hospital pharmacists are least likely to find certification or
licensure of pharmacy technicians to be a threat to pharmacist job
security (3.8% vs 4.7% for chain pharmacists and 8.1% of independent
pharmacists).
Conclusion
The fact that
most pharmacists encourage their technicians to pursue certification
and to obtain advanced formalized training appears incongruent with
the generally negative responses shown when they are asked whether
this training should culminate in a certificate or associate’s
level degree. This is additionally perplexing with a 69.9%
agreement that a technician’s additional training should be in
a “classroom setting.”
The particular comparative resistance registered by independent
pharmacists is also interesting. Their possible reluctance to an
expanded technician role (with certification, possible licensure, and
the generally agreed accompaniment of enhanced salary) could be based
on their intimacy with fiscal concerns not shared by hospital and
chain pharmacists, but this would have to be explored specifically in
a different study.
And while
considering new studies, some trends witnessed here beg additional
questions. For example, while it is pointedly expressed by
pharmacists that organic chemistry would not be a useful part of a
technician’s training, it would be interesting to pursue why
graduates of the University of Michigan in particular believe so,
just as why they appear more resistant to having technicians teach
patients on the use of multi-dose inhalers.
Michigan began the trend for pharmacy technician certification over
20 years ago, and many states are following, even elaborating upon,
its example. However, Michigan pharmacists seem to be
struggling with the amount of freedom to grant their technicians, as
well as defining their role as coworkers.
Postscript--2003
One of
the nicest things about the internet is that it enables me to get
this entire survey put out for all to see, instead of the somewhat
truncated version that made it into print previously. It also
allows those few who turn to these ramblings to contact me quickly
and directly--and perhaps give some insight on attitudes beyond the
borders of Michigan.
Pharmacy as a
profession keeps getting publicized as being so attractive for its
high salary. I have yet to see where anyone has explored the
consequences of the high salaries, insane volumes of prescriptions,
and the abysmal reimbursement (if any at all) for "cognitive
services" at at what point will the high salaries be regarded as
not "cost effective." Chains are certainly making
such projections in their board meetings, and there will come a time
where someone will grease the right politician's palm (or
governmental agency) and with a single stroke, the mandate for an
on-site pharmacist in a pharmacy could go "poof." Who
will be left? When the last independent pharmacy closes its
doors...watch out.
I received only one
dissenting comment about this attitude survey, and that came from an
area where PharmD degrees and hospitals predominate, where
technicians are actually held in high regard, and their training is
encouraged, quantified, and certified. I went back to the raw
data and determined that this area's collection of zip codes (one of
my survey questions) actually held these convictions. It
would be more comforting to know that the rest of the one-time
progressive State of Michigan held the same opinions.
In retrospect, there are some questions I should have included,
namely a quick check on the surveyed pharmacists' attitudes toward
clinical services by the profession in general, and whether they
thought a well-trained, licensed, or even certified technician would
afford them the opportunity to focus more on patient care. Some
other time, perhaps.....
The above
survey is now two years old. I would like to think that the
attitudes are changing, but alas, it seems there is still resistance,
at least in the casual surveys I've undertaken since this report's
publication. The disturbing trend is that pharmacists are
finding their attitudes dismissed by third-party payors and
governmental direction. Recently a call to the Medicaid HMO
First Health's "clinical line" was greeted with the
official message that "a Certified Pharmacy Technician will be
available to discuss your clinical question." The longer
the profession waits to determine its role in health care, the
quicker that determination will be made by others interested solely
in money and marketing, and not in the best interest of the patients
we all serve.
Jim Middleton, Pharmacist
January,
2003
1 comment:
Well, here we are in 2022, and the prospect of a world without independent pharmacies is more than a supposition. It's an aggressively pursued conclusion. I "retired" three years ago, from what had become a "job," not one's "work." As independent pharmacies vanish, areas will become underserved, and in that case, the apparent way to "help" this situation is to open a storefront, staff it with a licensed technician, and then have the work checked by an off-site pharmacist, who is obligated to inspect the site monthly. Technicians are less expensive than pharmacists, and pharmacies are only being reimbursed their drug cost - any clinical services, overhead, staff, are apparently being donated or volunteered. It's no longer a career for the future, or with a future, at least in the non-institutional or research settings. If you're considering pharmacy in your future, I suggest some other line of work.
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