Best practices: Incorporating pharmacy technicians and other support personnel into the clinical pharmacist's process of care

Using pharmacy technicians and electronic health record capabilities to improve outcomes for patients with cardiovascular disease

OBJECTIVE

This study aimed to compare lipid and blood pressure (BP) control before and after implementing a certified pharmacy technician (CPhT) protocol that optimized electronic health record (EHR) capabilities and shifted work from clinical pharmacy specialists (CPSs) to CPhT.

SETTING

Kaiser Permanente Colorado's pharmacist-managed cardiac risk reduction service (which manages dyslipidemia, hypertension, and diabetes for all patients with atherosclerotic cardiovascular disease).

PRACTICE DESCRIPTION

In 2019, a protocol that optimized EHR capabilities and allowed work to be offloaded from CPS to CPhT was implemented. Filtered views within the EHR were created that bucketed patients with specific lipid results criteria. The CPhT protocol provided guidance to CPhT on determining whether patients were at low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein (non-HDL) goals, on appropriate statin intensity, adherent to medications, and whether the most recent BP was controlled. The CPhT notified CPS of uncontrolled patients who would assess and manage these patients, as necessary. The CPhT notified controlled patients of their results.

PRACTICE INNOVATION

Data on the outcomes of incorporating pharmacy technicians to support CPS clinical activities in ambulatory clinical pharmacy are limited.

EVALUATION METHODS

This retrospective study compared a "Pharmacist-Driven" (index date: January 1, 2016) with a "Tech-Enhanced" (index date: January 1, 2019) group. The primary outcome was the proportion of patients at all goals defined as LDL-C < 70 mg/dL, non-HDL < 100 mg/dL, and BP < 140/90 mm Hg at 1 year after the index dates.

RESULTS

There were 6813 patients included (mean age: 70.2 ± 11.1 years, 71.4% male): 3130 and 3683 in the "Pharmacist-Driven" and "Tech-Enhanced" groups, respectively. The proportion of patients who attained LDL-C, non-HDL, and BP goals was higher in the "Tech-Enhanced" group (51.1% vs. 39.7%, P < 0.001) than the "Pharmacist-Driven" group.

CONCLUSION

A protocol integrating EHR decision support and CPhTs enabled work to shift to from CPS to CPhT and improved clinical outcomes.

Identifying key roles of the pharmacy technician in primary care settings

DISCLAIMER

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PURPOSE

As the pharmacist's role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist's professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature.

METHODS

The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians.

RESULTS

Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects.

CONCLUSION

Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Introducing clinical pharmacy specialists into interprofessional primary care teams: Assessing pharmacists' team integration and access to care for rural patients

Clinical pharmacy specialists (CPS) were deployed nationally to improve care access and relieve provider burden in primary care.The aim of this study was to assess CPS integration in primary care and the Clinical Pharmacy Specialist Rural Veteran Access (CRVA) initiative's effectiveness in improving access.Concurrent embedded mixed-methods evaluation of participating CRVA CPS and their clinical team members (primary care providers, others).Health care providers on primary care teams in Veterans Health Administration (VHA).Perceived CPS integration in comprehensive medication management assessed using the MUPM and semi-structured interviews, and access measured with patient encounter data.There were 496,323 medical encounters with CPS in primary care over a 3-year period. One hundred twenty-four CPS and 1177 other clinical team members responded to a self-administered web-based questionnaire, with semi-structured interviews completed by 22 CPS and clinicians. Survey results indicated that all clinical provider groups rank CPS as making major contributions to CMM. CPS ranked themselves as contributing more to CMM than did their physician team members. CPS reported higher job satisfaction, less burn out, and better role fit; but CPS gave lower scores for communication and decision making as clinic organizational attributes. Themes in provider interviews focused on value of CPS in teams, relieving provider burden, facilitators to integration, and team communication issues.This evaluation indicates good integration of CPS on primary care teams as perceived by other team members despite some communication and role clarification challenges. CPS may play an important role in improving access to primary care.

Evaluation of a pharmacy technician-based medication prior authorization program

BACKGROUND

The roles of pharmacy technicians in clinical practice are being explored. Medication prior authorizations (PAs) from insurers can lead to delays in pharmacotherapy.

OBJECTIVE

To assess the efficiency of our clinical pharmacy technicians in processing PAs for medications.

PRACTICE DESCRIPTION

Outpatient clinics in a comprehensive health care provider group.

PRACTICE INNOVATION

PA requests are routed to technicians for initial data collection. Clinical pharmacists can review their work before submission.

EVALUATION METHODS

Clinical pharmacy staff in 4 clinics recorded information about PA requests from January 21, 2020, to April 21, 2020. In 3 of the clinics, PA requests were primarily processed by clinical pharmacy technicians. In another clinic, requests were processed by a clinical pharmacist. Information collected included the date the request was received, outcomes (e.g., approval, therapy change, or nonapproval), and the date of final outcome. Descriptive statistics were prepared, including number of requests that were approved, number of business days between request and decision, and final outcome.

RESULTS

Overall, 720 PA requests were received. Of these, 88.6% were approved with first response, and 673 (93.5%) were eventually approved. Median time to first response was 0 business days, regardless of clinic. In 75% of cases, first response was within 1 business day. PA characteristics varied across clinics; however, PA approval percentages were comparable (91.2%-94.3%).

CONCLUSION

In an assessment of clinical pharmacy technicians' efficiency in responding to pharmacy plan PA requests, more than 90% were approved, often within one business day. Our results must be interpreted in light of local factors and a virus pandemic during the study. However, results of requests handled by technicians were similar to results when the requests were handled by a clinical pharmacist. Clinical pharmacy technicians can be efficient and cost-effective in this role.

Defining the Role of the Advanced Pharmacy Technician: Perspective Dissonance

Background: Pharmacy technicians serve as pharmacist extenders. Attempts at advancing their practice have not been as rapid as the profession would prefer. We postulated that a barrier to this advancement is lack of agreement between pharmacists and technicians on how advancement should occur and on what it means. Objective: The objectives were to evaluate the differences in definitions and expectations of “technician advancement” between pharmacists and pharmacy technicians as potential impediments to advancement. Methods: Multimodal: An initial questionnaire for pharmacy technicians was collected during the American Association of Pharmacy Technicians Annual Convention to identify major topics for further survey. From those data, a survey was developed to ask pharmacists and pharmacy technicians about “technician advancement.” Surveys were provided to technicians in seminar settings; to members of the Nebraska Pharmacists Association; and via online platforms such as Facebook. Additionally, face-to-face targeted interviews were conducted with pharmacy technicians attending American Association of Pharmacy Technicians conventions and with the pharmacy technician and pharmacist leaders at the Nebraska Pharmacists Association. Results: Responses show that pharmacists’ expectations for advancing the practice of pharmacy technicians and the expectations of the technicians themselves vary widely. A notable finding is that 96% of all technicians responding see technician payment as a significant issue in advancement, while less than 4% of pharmacists commented on rate of pay. Conclusion: While both pharmacists and pharmacy technicians are hopeful for pharmacy technician role advancement, there is substantial disagreement about the definition of advancement that may be a barrier to the process.

Pharmacist-Pharmacy Technician Intraprofessional Collaboration and Workplace Integration: Implications for Educators

Globally, concerns have been expressed regarding the impact of regulation of pharmacy technicians. After more than a decade of experience with technician regulation in Ontario, Canada, uptake of the full scope of practice for technicians has been sporadic at best. The objective of this study was to examine barriers and facilitators to intraprofessional collaboration between pharmacists and pharmacy technicians for the purpose of identifying possible curricular or educational interventions to enhance workplace integration. A qualitative, interview-based study of 24 pharmacists, technicians, educators, pharmacy managers, and owners was undertaken using a semi-structured interview guide. Key findings of this research include: i) Confirmation of suboptimal utilization of regulated technicians in practice; ii) identification of crucial knowledge and skills gaps for both pharmacists and technicians; and iii) proposals for undergraduate education and training, and continuing professional development learning opportunities to address these gaps. In order to achieve the promise and potential of regulation of pharmacy technicians, system-wide change management-beginning with education-will be required and will benefit from multiple stakeholder engagement and involvement.

T.E.A.M.S.Work: Leveraging Technicians to Enhance ABM Med Sync in Community Pharmacies

The expansion of pharmacy technicians' roles in community pharmacies allows pharmacists the opportunity to focus on providing clinical services to patients. This study explores the tasks pharmacy technicians' perform to support Med Sync programs in community pharmacies. Pharmacy staff members at North Carolina pharmacies with more than fifty percent of their prescription volume being dispensed as part of a Med Sync program were recruited to participate in semi-structured interviews. Inductive coding and summary analysis were used to analyze the interview data. Study participants described pharmacy technicians' roles in identifying patients for marketing and enrollment, reviewing patients' medications list, choosing alignment dates based on patient preference, contacting patients in preparation for dispensing and, lastly, engaging in pickup or delivery of medications. This study highlights technicians' vital role in completing tasks that support Med Sync programs in community pharmacies.

Wage Premiums as a Means to Evaluate the Labor Market for Pharmacy Technicians in the United States: 1997-2018

Pharmacy technicians are integral members of the health care team, assisting pharmacists and other health professionals in assuring safe and effective medication use. To date, evaluation of the labor market for pharmacy technicians has been limited, and relatively little has been evaluated regarding trends in wages. The objective of this research is to use US Bureau of Labor Statistics (US BLS) data to evaluate changes in pharmacy technician wages in the United States from 1997 to 2018 relative to changes in the US consumer price index (CPI). Median hourly wages for pharmacy technicians were collected from US BLS data from 1997 to 2018. Median hourly wages were compared to expected hourly wages, with the difference, a wage premium, indicative of imbalances in the supply and demand of labor. Both positive and negative wage premiums were observed, with most positive wage premiums occurring prior to 2007 and most negative wage premiums observed after 2008. Differences in wage premiums were also observed between technicians working in various practice settings. Given the median length of employment of pharmacy technicians, it is likely that the majority of technicians working in US pharmacies have not experienced increases in their wages relative to what would be expected by changes in the CPI. This has occurred at a time when pharmacies and pharmacists are asking more of their pharmacy technicians. Researchers and pharmacy managers must continue to evaluate the pharmacy technician labor market to assure that technician wage and compensation levels attract an adequate supply of sufficiently skilled workers.

Perceived Roles of Independent Community Pharmacists and Pharmacy Technicians in Patient Referrals to Community Resources: A Study from the Medication Safety Research Network of Indiana (Rx-SafeNet)

INTRODUCTION

Referrals to community resources represent one element of the Chronic Care Model, however, little is known about the perceived role of community pharmacy staff in referring patients to community resources.

OBJECTIVES

The objective of this study was to describe community pharmacists', community pharmacy technicians', and patients' perceptions of pharmacist referrals to community resources.

METHODS

Semi-structured interviews were conducted with community pharmacists, pharmacy technicians, and patients from community pharmacies that are members of the Medication Safety Research Network of Indiana (Rx-SafeNet). Qualitative analysis was conducted to identify emergent themes.

RESULTS

A total of 37 participants, including six community pharmacists, one pharmacy student completing an advanced pharmacy practice experience, 15 community pharmacy technicians, and 15 patients across four independently-owned community pharmacies were interviewed. Themes included: 1) Need to build on a foundation of strong patient-community pharmacist relationships to clearly define the pharmacist's role in referrals, 2) Need to improve familiarity with community resources, 3) Need to clearly delineate and support the role for pharmacy technicians in making referrals, and 4) Need to follow-up on referrals.

CONCLUSION

To enhance community pharmacy staff provision of referrals to community resources, interventions are needed to improve patient and pharmacist familiarity with available resources, patients' perception of the pharmacist's role outside of prescription fulfillment, and follow-up on referrals. Moreover, pharmacy technician education and training could be expanded to optimize their role in supporting community pharmacists in making referrals.

Advancing pharmacy technician training and practice models in the United States: Historical perspectives, workforce development needs, and future opportunities

The United States healthcare system faces immense challenges related to cost, quality, and access. As the pharmacy profession addresses these challenges by shifting toward a practice model centered around direct patient care clinical services, a competent and capable technician workforce is needed to support the roles of pharmacists. Until recently, little focus has been paid to pharmacy technicians or their role as they relate to practice model change. With ongoing pharmacist practice transformation, an approach that ensures uniform technician education, training, registration, and certification is vital to support a practice model designed to transform medication management across the continuum of care. The purpose of this commentary is three-fold: to review the history of pharmacy technician training and practice, discuss current and future technician practice models, and examine workforce development implications.