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Adams AJ. Extending COVID-19 Pharmacy Technician Duties: Impact on Safety and Pharmacist Jobs. J Pharm Technol 2023; 39:134-138. [PMID: 37323767 PMCID: PMC10209718 DOI: 10.1177/87551225231172343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The 2019 coronavirus pandemic (COVID-19) led to an expanded scope of practice for pharmacy technicians. As the pandemic wanes, state governments are faced with the decision of whether or not to make permanent the authority of pharmacy technicians to perform extended duties. Objective: Determine the impacts on patient safety and job market demands preadoption and postadoption of Idaho's expanded technician duties in 2017 as a natural experiment for expanded technician duties. Methods: Data from the National Practitioner Data Bank (NPDB) is used to explore patient safety outcomes in Idaho preadoption and postadoption and as compared with its border states. Data from Pharmacy Demand Reports is used to compare job postings in Idaho and its border state, and National Association of Boards of Pharmacy census data are used to compare growth in the number of pharmacists and technicians in Idaho and its border states over time. Results: For Idaho pharmacists, the average number of disciplinary actions reported against both pharmacists and technicians dropped after implementation of expanded technician duties. Idaho also had a lower rate of discipline for pharmacists and technicians than its border states. Idaho had the third highest job postings for pharmacists and the second highest for technicians among its border states. Idaho also had the largest growth in the number of licensed pharmacists and technicians of the observed states in the study period. Conclusion: Available statewide data from Idaho as compared with its border states suggests that expanded technician duties did not adversely impact patient safety outcomes or the pharmacist job market. Additional states may wish to expand pharmacy technician duties in the years ahead.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Eagle, ID, USA
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Hohmeier KC, Baker P, Storey C, Martin N, Gatwood JD. Exploring the Membership Pharmacy Model: Initial impact and feasibility. J Am Pharm Assoc (2003) 2022; 63:672-680.e1. [PMID: 36564328 DOI: 10.1016/j.japh.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/12/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a need to shift pharmacy payment models, given the expanding role of the community pharmacist in improving patient outcomes, misaligned incentives of the existing reimbursement model, and deleterious effects of a lack of transparency on prescription costs. OBJECTIVES The primary objective of this paper was to develop a payment strategy for a Membership Pharmacy Model within an independent community pharmacy setting. A secondary objective of this paper is to explore the early impact of a novel value-based pharmacy payment model on patients, pharmacies, and self-insured employers. PRACTICE DESCRIPTION Good Shepherd Pharmacy, a nonprofit Membership Pharmacy founded in Memphis, TN, in 2015. PRACTICE INNOVATION We discuss a novel, value-based payment model for community pharmacy, which involves a partnership between pharmacy and employer, without the use of a pharmacy benefit manager, using a recurring (i.e., membership pharmacy) business revenue model. EVALUATION METHODS The pilot program was assessed using the RE-AIM framework. RESULTS The pilot enrolled 34 patients for whom 1399 prescriptions were filled spanning 13 quarterly refill cycles from January 2019-March 2022. After the intervention, proportion of days covered for diabetes and cholesterol medications both increased: 96.7% and 100% (P < 0.05); 90.3% and 98.1% (P > 0.05). Financial savings for the employer group were realized across both fee charges and prescription medication costs. The net savings provided to the employer was $67,843, a 35% reduction in topline pharmacy spending. Revenue for the pharmacy was realized exclusively through synchronization fees of $30 per fill. Synchronization fees for the entire study totaled $41,970, and the average revenue per quarterly batch refill was $3228. CONCLUSION The Membership Pharmacy Model represents a potentially viable alternative to traditional fee-for-service, buy-and-bill pharmacy payment models through its use of medication pricing based on actual acquisition costs, lean pharmacy operations, and value-based reimbursement methods.
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Corelli RL, Merchant KR, Hilts KE, Kroon LA, Vatanka P, Hille BT, Hudmon KS. Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial. Res Social Adm Pharm 2022; 18:3158-3163. [PMID: 34544660 PMCID: PMC8898316 DOI: 10.1016/j.sapharm.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described. OBJECTIVE To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation. METHODS Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training. RESULTS Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10). CONCLUSION In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.
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Affiliation(s)
- Robin L Corelli
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA.
| | - Kyle R Merchant
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA
| | - Katy Ellis Hilts
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Lisa A Kroon
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA
| | - Parisa Vatanka
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA; American Pharmacists Association, Washington DC, 20037, USA
| | | | - Karen Suchanek Hudmon
- University of California, San Francisco School of Pharmacy, San Francisco, CA 94143, USA; Purdue University College of Pharmacy, Indianapolis, IN 46202, USA
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Koehler T, Velthuis F, Helmich E, Westerman M, Jaarsma D. Implementing the pharmacy technician role in existing pharmacy settings: Stakeholders views of barriers and facilitators. Res Social Adm Pharm 2022; 18:3814-3820. [DOI: 10.1016/j.sapharm.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
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Barenie RE, Wheeler JS. The Academy Is Well Positioned to Offer Pharmacy Technician Training Programs. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8554. [PMID: 35228199 PMCID: PMC8887064 DOI: 10.5688/ajpe8554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/05/2021] [Indexed: 06/14/2023]
Abstract
Schools and colleges of pharmacy are optimally positioned to train the entire pharmacy team, including pharmacists and pharmacy support personnel, because they can provide comprehensive workforce development, utilize established faculty expertise, harness existing infrastructure, afford opportunities for intraprofessional education, and support institutional growth and reputability. As the emphasis of training shifts towards team-based approaches and expanded responsibilities, ensuring the existing and future pharmacy workforce is equipped to serve their communities becomes increasingly important. Thus, schools and colleges of pharmacy should consider offering a pharmacy technician training program to meet the needs of their community and the profession.
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Affiliation(s)
- Rachel E Barenie
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tenneesee
| | - James S Wheeler
- The University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tenneesee
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Hohmeier KC, Sain A, Garst A, Shell L, Desselle S, Gatwood J, Cost M. The Optimizing Care Model: Final findings of a novel community pharmacy practice model to enhance patient care delivery using technician product verification. J Am Pharm Assoc (2003) 2021; 62:112-119. [PMID: 34711522 DOI: 10.1016/j.japh.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The community pharmacy represents a convenient health care access point for patients and is increasingly used to deliver direct patient care services; however, several barriers exist that hinder widespread patient service implementation and scalability. Such barriers include scope of practice restrictions, a dearth of sustainable payment models, lack of pharmacist capacity given other responsibilities, and workflow models developed for dispensing medications rather than clinical care. In an effort to overcome the lack of pharmacist time and capacity, further task delegation to pharmacy technicians has been suggested. OBJECTIVES The primary objective of this study was to present the final outcomes of the Optimizing Care Model's impact. The model's impact on pharmacist patient care, workday composition, and rates of product selection errors not identified during final product verification are reported. METHODS The Optimizing Care Model is an innovative approach to community pharmacy practice aiming to foster a new patient-centered care delivery model that expands clinical service delivery and fosters collaboration across health care settings through task delegation, primarily through technician product verification (TPV). To investigate the impact of its sustained implementation, a quasi-experimental, 1-group pretest-posttest design was used. Outcomes assessed included medication errors, clinical activities, and workday composition. RESULTS Six chain and 3 independent pharmacies completed the final, continuation phase of the study. Overall pharmacist time spent delivering patient care services increased significantly upon implementation of the Optimizing Care Model (21% vs. 43%; P < 0.05), whereas pharmacist time spent performing dispensing-related activities decreased significantly (67% vs. 37%; P < 0.05). Total undetected error rates were significantly less in the Optimizing Care Model phase compared with the traditional model (0.05% vs. 0.01%; P < 0.001). CONCLUSION This study presented the final results of a 2-year assessment of the Optimizing Care Model. Results reaffirmed initial published findings that the model and its use of TPV increase the array and frequency of direct patient care services rendered while resulting in lower undetected error rates. Final project results of the Optimizing Care Model demonstrate increased clinical service delivery versus the traditional model, while also improving patient safety with lower rates of undetected dispensing errors within the Optimizing Care Model. The Optimizing Care Model continues to show promise as a future practice model for community pharmacies.
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Pope S, Hill H, Cardosi L, Henson L, Wasson M, Stallworth S, Ward K, Desselle SP, Hohmeier KC. Enhancing point-of-care testing through standardized training and redeployment of pharmacy technicians in the community setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100034. [PMID: 35481116 PMCID: PMC9029904 DOI: 10.1016/j.rcsop.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 10/26/2022] Open
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Saling JC, Atchley DR, Frederick KD, Kiles TM, Rein LJ, Lam HR, Hohmeier KC. Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain. J Am Pharm Assoc (2003) 2021; 61:632-639. [PMID: 34099422 DOI: 10.1016/j.japh.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain. METHODS A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers. RESULTS During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases. CONCLUSION TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.
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Community pharmacist perceptions of increased technician responsibility. J Am Pharm Assoc (2003) 2021; 61:382-389.e4. [PMID: 33853751 DOI: 10.1016/j.japh.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pharmacists have struggled to find time to spend on clinical tasks. As such, regulatory steps have been taken by some states to expand the scope of practice for community pharmacy technicians. OBJECTIVE The objective of this study was to determine what settings and characteristics predict pharmacists' comfort levels with technicians giving or receiving verbal prescriptions, performing nonclinical medication therapy management tasks, administering vaccinations, and verifying prescriptions. METHODS This study employed a national Internet-based survey of community pharmacists using a health care marketing research panel. The Consolidated Framework for Implementation Research (CFIR) was used as a theoretical basis for inquiry, particularly the CFIR domains of "outer setting," "inner setting," and "individual characteristics." As the outcome variable of this study, the respondents were asked to report their comfort levels with technicians performing the 4 advanced tasks. Four multivariable linear regression models identified statistically significant predictors of pharmacists' comfort with each task. Repeated measures analysis of variance (ANOVA) was used to compare the pharmacists' comfort levels among tasks. RESULTS For all 4 tasks, pharmacists who believed that technicians had the ability to complete each task were more comfortable with technicians completing those tasks. In addition, pharmacists with perceptions of stronger technician interest in advanced tasks were found to be more comfortable with technicians taking on more responsibility for all tasks except vaccine administration. Repeated measures ANOVA found that pharmacists' comfort levels differed on all 4 tasks. CONCLUSION This study found that the CFIR domains of inner setting (pharmacy location) and individual characteristics (perceptions of technicians and pharmacist education) affect pharmacists' level of comfort with technicians taking on additional responsibilities, but outer setting variables such as regulations do not. This suggests that pharmacist characteristics may affect the expansion of technician task responsibilities, no matter what state regulations allow.
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Frederick KD, Desselle SP, Gatwood JD, Hohmeier KC. The intersection of pharmacy leadership and management with clinical skills: Education plays a key role. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:198-202. [PMID: 33641727 DOI: 10.1016/j.cptl.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/18/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Clinical pharmacy service expansion is a challenge of scalability, and education can play a big part in the profession's transition to patient care. Underdeveloped staff management and leadership skills may prohibit scalability of innovative patient care service models observed in research and academic pharmacy environments. COMMENTARY In today's rapidly evolving healthcare industry, formal education in leadership and management may provide the prerequisite skills for frontline pharmacists to innovate and scale clinical care services thereby improving quality patient outcomes. One important component of this is the use of pharmacist-extenders and team-based task delegation to eliminate technical tasks from the pharmacist's workload and maximize time spent in functions requiring professional judgment. IMPLICATIONS The Academy should develop leadership and management skills in tandem with patient care-related skills to optimize care delivery. Specifically, pharmacy educators should lean into concepts of organizational behavior and evidence-based management. The future of pharmacy is highly dependent on future pharmacist leaders; development of successful leaders is imperative to the profession of pharmacy.
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Affiliation(s)
- Kelsey D Frederick
- University of Tennessee Health Science Center College of Pharmacy, 301 S. Perimeter Park Drive, Suite 220, Nashville, TN 37211, United States.
| | - Shane P Desselle
- Touro University California College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Justin D Gatwood
- University of Tennessee Health Science Center College of Pharmacy, 301 S. Perimeter Park Drive, Suite 220, Nashville, TN 37211, United States.
| | - Kenneth C Hohmeier
- University of Tennessee Health Science Center College of Pharmacy, 301 S. Perimeter Park Drive, Suite 220, Nashville, TN 37211, United States.
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Hohmeier KC, Wheeler J, Heintz K, Gatwood J. Community pharmacist workflow and medication therapy management delegation: An assessment of preferences and barriers. J Am Pharm Assoc (2003) 2020; 60:e215-e223. [DOI: 10.1016/j.japh.2020.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/18/2023]
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Burke R. Embracing the Evolution of Pharmacy Practice by Empowering Pharmacy Technicians. PHARMACY 2020; 8:pharmacy8020066. [PMID: 32326659 PMCID: PMC7356159 DOI: 10.3390/pharmacy8020066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/31/2022] Open
Abstract
While pharmacy technician roles in some practice settings are expanding beyond the traditional dispensing activities to include advanced or specialized tasks such as immunization administration, medication history collection, and final product verification, these practices are not yet widespread. There are apparent barriers to expanding the role of pharmacy technicians, including inconsistency in the education, training, and certification requirements across the United States, and regulations that have not kept pace with the evolving role of pharmacy technicians. Every corner of the profession has an opportunity, and responsibility, to elevate pharmacy technicians in an effort to advance safety and better serve patients. Regulators can expand the responsibilities that may be delegated to technicians, professional organizations can bring pharmacy technicians into the fold, employers can build career ladders to allow for advancement, and individual pharmacists and pharmacy technicians can advocate and engage.
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Affiliation(s)
- Ryan Burke
- Pharmacy Technician Certification Board, Washington, DC 20037, USA
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Renfro C, Coulter D, Ly L, Fisher C, Cardosi L, Wasson M, Hohmeier KC. Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program. PHARMACY 2020; 8:E28. [PMID: 32138328 PMCID: PMC7151672 DOI: 10.3390/pharmacy8010028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.
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Affiliation(s)
- Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Davis Coulter
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Lan Ly
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Cindy Fisher
- Kroger Pharmacy, Memphis, TN 38103, USA; (C.F.); (M.W.)
| | - Lindsay Cardosi
- Methodist South Bedside Delivery Program, Memphis, TN 38116, USA;
| | - Mike Wasson
- Kroger Pharmacy, Memphis, TN 38103, USA; (C.F.); (M.W.)
| | - Kenneth C. Hohmeier
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Nashville, TN 37211, USA
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