Work Preferences and General Abilities Among US Pharmacy Technicians and Danish Pharmaconomists

Abstract

Introduction:

The importance of pharmacy support personnel is increasingly recognized. Studies have evaluated workplace issues and evolving roles; however, needed information from technicians themselves is scarce. The purpose of this study was to examine preferences for work activities and the general abilities of US pharmacy technicians and Danish pharmaconomists.

Methods:

Surveys were administered to random samples of US technicians in 8 states and the general population of Danish pharmaconomists. Respondents indicated their preference for involvement in a set of work activities in community or hospital pharmacy on numeric scales. They also self-assessed their level of ability on facets associated with professional practice, in general. Descriptive results were tabulated, and bivariate tests were conducted on total general abilities ratings.

Results:

The 494 technicians and 313 pharmaconomists provided similar ratings on many activities. In community pharmacy, US technician ratings for performance of activities were generally higher than those of pharmaconomists; however, pharmaconomists rated certain “higher order” communication activities quite highly, such as discussing lifestyle changes with the patient. In hospital practice, Danish pharmaconomists provided low preferences for medication handling but high preferences for communication activities. General ability ratings were given high self-evaluations, but lower on some components, such as keeping up with the profession. Employer commitment was a strong correlate for both.

Conclusions:

Evaluation of preferred work activities and general abilities were likely reflected in different scopes of practice between the two and could be insightful for education and work redesign in both countries, particularly the United States, as leaders evaluate shifts in technician professionalization.

Keywords

pharmacy administration pharmacy technicians pharmaconomists quality of work life

Introduction: Pharmacy Practice Environment

The landscape of practice and education for pharmacy workforce cadres is evolving at a rapid pace. Pharmacy support personnel are increasingly recognized for the vital role they have played in the medication use process even historically, and now for emerging roles around the world that range from assistance with medication therapy management to being the principal suppliers of medication for persons in rural areas of underdeveloped nations.^1
-3 Recognizing their value, there are growing attempts to codify more explicitly and expand the role of pharmacy technicians, with evidence suggesting that pharmacy technicians can perform final verification of medication orders as accurately as pharmacists⁴ and can assist pharmacists with expanding their own roles, increasing their autonomy, and practicing at the top of their license.^5,6 A more systematic approach to workflow design to incorporate technicians into practice models can improve the flow of information to patients.⁷ Pharmacy is now exploring engineering processes to redesign tasks, tools/technology, people, and environment to begin delivering more cognitive pharmaceutical services, and many stakeholders share the belief that integration of technicians is key to success in these endeavors.⁸ Advancing technician professionalization is also said to improve the care and efficiency in hospital pharmacy practice.^9,10

Regulatory agencies in pharmacy are challenged to keep pace with what is happening in the practice sector,¹¹ and scope of practice regulations often lags behind clinical practice.¹² In the United States, for example, there has been a wave of new states recently allowing technicians to begin accepting and transferring verbal prescription orders.¹³ To that end, guidance has been offered on how one US state (Idaho) proceeded with an expeditious and aggressive agenda for change that included new scopes of activities for technicians, including immunization administration.¹¹

Pharmacy Workforce Support Education and Training

Although these advances in technician practice are taking shape, many remain critical of the lack of standards for education, training, and entry-level requirements of technicians to practice throughout the world and especially in the United States.¹⁴ For at least several years, there have been calls for unifying standards that would reflect a baseline level of entry from which more advanced designations could then be actuated.¹⁵ This was echoed at a recent technician stakeholder consensus conference.¹⁶ Among the many consensus statements produced was the delineation of advanced practice designations for new technicians with the understanding that many technicians through their experience will have gained similar competence in areas such as self-reflection, communication with patients and other providers, appreciation for safety, and public health issues.

The US National Association of Boards of Pharmacy commissioned a task on pharmacy technician education and training programs. Their recommendations included encouragement of State Boards to adopt some sort of certification requirement, that certified technicians have completed an accredited education program, that more information about practicing technicians be maintained by State Boards, and that a separate committee define specific roles of technicians.¹⁷ The task force added that this committee acquires input from technicians, themselves. The California Society of Health Systems Pharmacists published a position paper on education, training, practice, and career laddering. Among its recommendations was to gather additional information regarding practice preferences from technicians in practice.¹⁸

Although much has been written regarding technician practice in the United States, there remain many unresolved issues within and outside the United States. In other countries, though, technician education and training is often more well defined and provided by fewer institutions, making registration/licensing and administration of such educational standards much easier.¹⁹ In Denmark, for example, technicians are referred to as pharmaconomists; their roles are expansive and bear some resemblance to those of pharmacists in some countries.²⁰ Pharmaconomists are all educated at the Danish College of Pharmacy Practice, a program of 3 full-year equivalents, or 180 European Credit Transfer System points.

Recent Research on US Pharmacy Technicians and Danish Pharmaconomists

Pharmaconomists make for a compelling group to study workplace issues, as their scope of practice would appear to be aligned with where practices in other countries are heading. They also make an interesting comparison to technicians in other countries such as the United States. The caring behaviors of Danish pharmaconomists were recently examined. It was shown that although pharmaconomists report high levels of empathy, they could use improvement in other types of caring, such as assisting patients to cope with and manage their disease.²¹ US technicians were recently examined for their self-efficacies to engage in new roles.²² The aforementioned calls to gather more information on preferred roles from technicians, themselves, is especially important in consideration of high rates of turnover among these professionals.²³ It is also important to consider not only their preferences for involvement but also their general abilities (eg, communication) that transcend any particular practice setting. As such, the purpose of this research was to examine preferences for practice and general abilities of US pharmacy technicians and Danish pharmaconomists and discern patterns between them that could possibly result from their differences in setting, scope of practice, and difference in education/training levels. The research also compared levels of employer and profession commitment between US pharmacy technicians and Danish pharmaconomists.

Methods

Design and Sample

Institutional review board exemption for study procedures was granted by the investigators’ universities. The study design was cross-sectional, featuring use of a self-administered survey to populations of technicians/pharmaconomists in the United States and in Denmark. For the United States, a stratified randomized procedure was undertaken. Sample respondents were acquired from 8 states, with 2 states each from 4 geographic regions recognized by the US Census Bureau: Northeast, Southeast, Midwest, and West. State Boards of Pharmacy were contacted for the first 2 states selected from each region. If that Board of Pharmacy did not have a registry of technicians that included available e-mail addresses or if the cost of acquiring the list exceeded US$300, then the next state in that region was sampled. This method of sampling was undertaken so as to provide geographic diversity from such a large nation as is the United States where there could be geographic differences in practice, with a preference toward selection of 2 states rather than 1 to further strengthen those geographical considerations. Using a sample size calculation recommended by Dillman et al,²⁴ an estimated 384 responses were deemed required, from the US cohort, alone. Assuming a low response rate inherent in e-mail surveys of this type,²⁵ researchers conservatively estimated the need for dissemination of 5000 surveys. Once the registries of technicians were acquired from all 8 states, the total number of registrants (eligible respondents) was determined by summing them and that sum served as a denominator to calculate an equal proportion of the sample from each state. The states sampled were Florida, Louisiana, Maine, Nebraska, New Jersey, North Dakota, Oregon, and Utah.

In Denmark, an officer with the Danish Association of Pharmaconomists (henceforth, “Association”) agreed to disseminate the survey. The Association placed a cap of 600 surveys to be disseminated. This number was not derived from a sample calculation or similar such basis; rather, it was the maximum number the Association was able to handle logistically and administratively in assisting the researchers. The Association maintains a registry of all pharmaconomists. The 600 study subjects were selected from this group utilizing a simple randomization procedure.

The surveys were designed and implemented using Qualtrics technology.²⁶ The procedures for survey conduct were in accordance with the Total Design Method²⁴ to maximize rate of return. Sampled subjects received a prenotification e-mail approximately 9 to 10 days prior to launch of the survey, then an e-mail with a cover letter and link to the survey, followed by 2 reminder e-mails spread approximately 7 days apart. The surveys were conducted in October to December 2016 in the United States and January to February 2017 in Denmark. The Danish pharmaconomist survey was written and administered in the English language and involved only minor changes in a few terms recommended upon review by personnel at the Association. In both surveys, respondents were not forced to make choices/selections on the questions and allowed to skip questions if they so chose.

Study Variables

Preference for involvement was determined by asking respondents the extent to which they would like to be involved in specific activities, depending upon whether they were employed in the community or hospital setting. Responses were measured using a 4-point scale of frequency from “not at all” to “very often” like to be involved in this activity. The lists of activities (35 for community and 36 for hospital) were derived from the literature, borrowing much from a previous study of pharmacist workforce, which itself derived from a Pharmacy Technician Certification Board task analysis²⁷ and supplemented with additional activities from a global study of technician practice.²⁸ A few more activities were acquired from a progressive US state (Idaho) in technician scope of practice and from a White Paper on the scope of responsibilities for pharmacists and pharmacy technicians by the Council on Credentialing in Pharmacy.²⁹ Using skip logic, technicians who during the initial demographic questions stated they practiced in the community setting were directed to the community pharmacy activities and likewise the hospital activities for respondents from that setting. For the US survey, this included those who were in mass merchandising, outpatient clinic, and other ambulatory settings. The Danish survey, upon advice of the Office, included only the terms ambulatory/retail and did not differentiate between various subcategories of community settings. Those not practicing in either setting skipped this section and were directed to other components of the survey. There was no known task analysis available specifically for Danish pharmaconomists from which to draw for any additional items to add to the list of activities.

Technicians’/pharmaconomists’ general abilities were ascertained by self-report in response to 17 items reflecting general qualities and skills acquired from a review of the literature, focusing primarily on the aforementioned White Paper²⁹; a source from community pharmacy identifying desirable technician skills for taking on unconventional or emerging roles³⁰; and from 2 reports in hospital pharmacy of successful programs where technicians used certain skills to provide new services.^31,32 These 17 items were measured on a 4-point linear scale ranging from 1 = not at all able, to 4 = very able, with the sum of 16 of them (excluding 1 item with a “not applicable” choice) serving as the “general abilities” scale. The surveys also elicited demographic and work environment data. Employer and profession commitment were each ascertained using a 1-item measure depicting commitment scenarios on an ordinal scale, with previous evidence of validity.²⁷ Rather than just select a numeric value on a scale, each value represented a brief description, or scenario. For example, the “1” value for employer commitment was “I would have left or am looking to leave at the first opportunity,” versus “3” (relatively strong but not highest commitment) was “I feel modest commitment and do no plan significant changes unless something unexpected happens.” For analysis purposes, both variables were treated as summative scores ranging from 1 to 4. Technicians and pharmaconomists also self-reported their “rank” in position. US technicians were asked to indicate entry level (tech 1), tech 2, tech 3 or higher, or specialty tech/other. Danish pharmaconomist simply selected entry-level versus advanced pharmaconomist based upon feedback from the Association indicating that anything more specific was quite rare.

Data Analysis

Data were entered into and analyzed using SPSS, version 21.0. The analysis consisted of descriptive statistics and bivariate analyses of personal and practice environment variables with scopes on the general abilities scale within the US and Danish respondents. Data from the ordinal scales employed in this study were evaluated using parametric tests, with means and standard deviation reported. Doing so has been adjudicated many times in previous literature, with challenges to these methods being unfounded and parametric methods being used without concern for “getting the wrong answer.”³³ There was no attempt to compare the responses between the 2 directly with inferential statistics. There was also no attempt to impute missing data. So if data were missing, then the entry from that survey respondent was excluded from analysis. Details on missing data are shown in the respective tables, which describe the number of respondents to the various survey questions.

Results

Participant Characteristics (US Technicians)

Responses were acquired from 612 respondents, 494 of whom were working as a technician and not enrolled in a PharmD program (12.2% response rate, 9.9% responses of use). Response rates were similar from each of the 8 states considering the states’ overall populations (low of 8.8% usable responses from Maine and high of 10.7% usable responses from Utah).³⁴ There were 24.9% working part time, and 23.7% were male. There were 34.4% who indicated practice as an entry-level technician, with approximately 26.9% as “tech 2”, 22.3% as “tech 3”, and 15.4% as a “specialty” technician. A total of 66.4% came from community pharmacy (chain and independent), 16.9% came from hospital, and another 16.7% came from all other settings, combined. The average age of respondents was 42.3 ± 10.7 years. Respondents had been working as a technician for 8.2 ± 6.1 years and had been with the current employer for 5.6 ± 5.0 years.

Respondent Characteristics (Danish Pharmaconomists)

Usable responses were acquired from 313 respondents (52.2% response rate). Just over half of the respondents were working full time. Just over one-third (34.4%) were working at an entry level, versus 65.6% at an “advanced” level. All survey respondents selecting an option for gender were female. Nearly half (48.8%) of respondents were working in community pharmacy, while 26.1% and 25.1% were working in hospital or some other setting, respectively. The participants’ average age was 44.6 ± 11.4 years. They averaged having worked 18.0 ± 13.3 years as a pharmaconomist, with 9.3 ± 9.2 years for their current employer.

Commitment to Employer and Profession

Respondent commitment to their employer and profession is shown in Table 1. For employer commitment, there were 6.2% of US technicians looking to leave at the first opportunity, versus only 2.4% of Danish pharmaconomists. At the same time, nearly 42% of technicians reported very strong employer commitment, whereas just over 34.1% of pharmaconomists who did so. The proportion of US technicians looking to leave the profession altogether was 12.5%, versus only 4.7% for pharmaconomists.

Table 1.

Employer and Profession Commitment of US Pharmacy Technicians and Danish Pharmaconomists.

Commitment Type/Item	N (%) for United States^a	N (%) for Danish^b
Employer commitment
I would have left or am looking to leave at the first opportunity	15 (6.2%)	4 (2.4%)
I do not feel much commitment, and keep my options open	25 (10.2%)	24 (14.1%)
I feel modest commitment and do no plan significant changes unless something unexpected happens	101 (41.9%)	84 (49.4%)
I feel strong commitment to the organization and am planning my career/work future with them for the long haul	100 (41.5%)	58 (34.1%)
Profession commitment
I am looking or plan to leave this career, altogether	31 (12.5%)	8 (4.7%)
I do not have other plans currently, but it might not take much for me to change careers	44 (17.7%)	36 (21.1%)
In spite of challenges or shortcomings, I feel good about this line of work and hope to make a career of it for quite some time	71 (28.6%)	52 (30.6%)
I feel completely committed and I am definitely in this career for my entire work life	102 (43.5%)	74 (43.5%)

^a For US pharmacy technicians: Totals represent valid responses, indicative of respondents omitting/skipping the question, from a total of 494 respondents.

^b For Danish pharmaconomists: Totals represent valid responses, indicative of respondents omitting/skipping the question, from a total of 313 respondents.

Preference for Involvement in Activities—Community Pharmacy

Data on US technician and Danish pharmaconomist preferences for involvement in community pharmacy roles/activities are provided in Table 2. US technicians expressed very high preferences for involvement in collecting patient information, assessing prescriptions, inputting prescriptions, managing medication stock, and engaging in professional development. Danish pharmaconomists expressed high preferences for identifying problems with prescriptions, assessing prescriptions, providing information on drug interactions and other medication use issues, and ensuring proper dosage before dispensing. Lesser preferred activities by US pharmacy technicians included administering immunizations, communicating lifestyle changes in patients, collaborating with other professionals on medication therapy effectiveness, and discussing effectiveness of treatment plans with returning patients. And lesser preferred activities by Danish pharmaconomists included communication with insurance companies, administering immunizations, repackaging nonsterile products, and assisting with prescription assistance programs. The activity preference ratings were mostly higher by US technicians compared to pharmaconomists. US technicians did not provide a mean preference rating below 2.00 for any of the 35 activities; however, Danish pharmaconomists provided a mean preference of below 2.00 for 7 of the 35 activities. For a number of activities, the discrepancy for involvement preference was quite large, such as for providing the prescription medication to the patient, repackaging/reconstituting nonsterile products, communicating with insurance companies, and accounting/record-keeping. On the other hand, 9 activities given higher preference ratings by pharmaconomists included discussing over-the-counter medications with patients, communicating lifestyle changes in patients, providing information on drug interactions/side effects, collaborating with other health professionals, and accepting verbal prescription orders from prescribers.

Table 2.

US Community Pharmacy Technician and Danish Pharmaconomist Preferences for Performing Various Tasks.

Task/Activity^a	Preference (United States)^a,b,c	Preference (Danish)^a,b,c
Collect or communicate patient information	3.50 ± 0.75	3.30 ± 0.91
Assess prescription for completeness, accuracy, authenticity, and legality	3.58 ± 0.58	3.42 ± 0.95
Input prescriptions into computer	3.46 ± 0.79	3.06 ± 1.15
Provide prescription medication to patient	3.26 ± 0.97	2.58 ± 1.27
Triage patient needs for referral to pharmacist	3.05 ± 1.01	2.59 ± 1.08
Identify any problems with prescription (eg, dosage, patient instructions, missing information, medication name, and other)	3.36 ± 0.82	3.47 ± 0.88
Discuss over-the-counter medication options with patients	2.56 ± 1.09	3.02 ± 1.16
Repackage or reconstitute nonsterile products	2.92 ± 1.11	1.65 ± 1.00
Compound prescriptions	2.51 ± 1.18	2.15 ± 1.21
Inventory management	3.23 ± 0.92	2.56 ± 1.14
Manage medications currently in stock, including organization, storage, and stock rotation	3.39 ± 0.85	2.80 ± 1.06
Maintain automated dispensing technology and other equipment	2.66 ± 1.15	2.23 ± 1.15
Communicate with insurance companies regarding patient eligibility and other issues	2.88 ± 1.12	1.38 ± 0.84
Explain use of medical equipment, appliances, or other devices to the patient	2.45 ± 1.09	2.98 ± 1.23
Communicate lifestyle changes in patients	2.19 ± 1.14	2.74 ± 1.22
Engage in your own continuous professional development	3.38 ± 0.88	3.26 ± 0.97
Supervise other technicians	2.73 ± 1.16	2.61 ± 1.08
Discuss effectiveness of treatment plan for returning patients	2.31 ± 1.19	2.11 ± 1.27
Accounting and record-keeping	2.79 ± 1.15	1.98 ± 1.14
Disposal of expired or adulterated medications	3.07 ± 1.02	2.52 ± 1.23
Assist with prescription assistance programs	2.67 ± 1.18	1.68 ± 1.06
Assume responsibility for quality assurance activities	2.74 ± 1.15	2.26 ± 1.19
Assume responsibility for disaster preparedness	2.43 ± 1.20	1.86 ± 1.12
Check patients’ medication histories	3.20 ± 0.93	2.82 ± 1.05
Ensure proper dosage and drug compatibility before dispensing	2.98 ± 1.12	3.35 ± 1.02
Label liquid medicines, ointments, powders, and other medicines before dispensing	3.52 ± 0.82	3.02 ± 1.31
Provide information to providers and patients on drug interactions, side effects, and medication storage	2.63 ± 1.14	3.35 ± 1.05
Collaborate with other health professionals to plan, monitor, review, and evaluate the effectiveness of medication therapy	2.29 ± 1.14	2.42 ± 1.23
Maintain prescription files of narcotics and habit-forming drugs in accordance with legal requirements	3.01 ± 1.08	2.53 ± 1.35
Evaluate labels, packaging, and advertising of drug products	2.59 ± 1.15	1.76 ± 1.05
Administer immunizations	2.01 ± 1.25	1.59 ± 1.08
Accept verbal prescription orders from a prescriber physician or other	2.39 ± 1.24	2.77 ± 1.17
Transfer a prescription from one pharmacy to another	2.45 ± 1.25	2.52 ± 1.21
Check the work of other technicians (check-tech-check)	2.89 ± 1.07	2.52 ± 1.13
Enter prescription data remotely from home	2.15 ± 1.31	1.42 ± 0.88

^a For the Danish survey, the word “pharmaconomist” was used in lieu of “technician” for items requiring use of the term.

^b Four-point scale anchored from “not at all” = 1 to “very often” = 4.

^c Respondents: n = 318 for US technicians; n = 141 for Danish pharmaconomists.

Preference for Involvement in Activities—Hospital Pharmacy

Respondents’ preferences for involvement in activities in the hospital setting are shown in Table 3. For pharmacy technicians, activities given high preference ratings included ensuring proper storage of medications, maintaining automated dispensing technology, replenishing dose carts and floor stock, and compounding sterile products. For pharmaconomists, highly rated activities included entering prescription orders, engaging in continuous professional development, communicating with nurses, and following up on medication distribution problems. There were 3 activities with mean ratings below 2.00 by pharmacy technicians. Activities with low preference ratings included overseeing medical assistant programs, preparation of clinical monitoring information, administering immunizations, and updating the patient’s medication administration record. Danish pharmaconomists provided preference ratings below 2.00 for 8 of the 36 items. Activities given low preference ratings included administering immunizations, running medication utilization reports, and compounding nonsterile products. Some of the activities with larger gaps in preference scores between technicians and pharmaconomists included replenishing floor stock and dose cards, maintaining automated dispensing technology, compounding sterile products, compounding nonsterile products, and helping to maintain equipment. Pharmaconomists provided a relatively high mean preference in comparison with technicians to 6 activities, including entering prescription orders, overseeing prescription assistance programs, preparing clinical monitoring information, communicating with nurses, and providing information to patients on drug interactions/side effects.

Table 3.

US Hospital Pharmacy Technician and Danish Pharmaconomist Preferences for Performing Various Tasks.

Task/Activity^a	Preference (United States)^a,b	Preference (Danish)^a,b
Enter prescription orders in computer	2.09 ± 1.13	3.31 ± 1.08
Replenish dose carts and floor stock	3.24 ± 1.08	2.20 ± 1.27
Maintain automated dispensing technology	3.29 ± 1.04	2.00 ± 1.31
Help to maintain pharmacy equipment	3.13 ± 1.04	2.20 ± 1.21
Compound sterile products	3.19 ± 0.97	1.93 ± 1.28
Compound nonsterile products	3.00 ± 1.05	1.80 ± 1.08
Perform packaging/repackaging activities	2.94 ± 1.13	1.93 ± 1.16
Purchasing and inventory management	2.69 ± 1.31	2.53 ± 1.36
Communicate with wholesale suppliers and vendors	2.12 ± 1.16	2.38 ± 1.20
Oversee activities related to medication assistance programs	1.68 ± 1.01	1.93 ± 1.16
Controlled substances system management	2.84 ± 1.04	1.93 ± 1.28
Billing and other accounting functions	2.10 ± 1.22	2.38 ± 1.41
Engage in continuous professional development	3.10 ± 1.08	3.06 ± 1.18
Check the work of other technicians (check-tech-check)	3.03 ± 1.08	2.53 ± 1.19
Supervise other technicians	2.81 ± 1.25	2.33 ± 1.40
Encourage professional development of other technicians	3.00 ± 1.13	2.29 ± 1.38
Assist with hiring other technicians	2.84 ± 1.19	2.23 ± 1.42
Determine future staffing needs	2.52 ± 1.31	2.18 ± 1.33
Reconcile errors or other issues with medication administration records	2.48 ± 1.21	2.46 ± 1.33
Update medication administration record or patient’s profile	2.03 ± 1.27	2.08 ± 1.44
Preparation of clinical monitoring information for pharmacist review	1.77 ± 1.06	2.00 ± 1.29
Assume responsibility for quality assurance programs	2.30 ± 1.21	2.21 ± 1.24
Assist with or facilitate patient transitions of care	2.19 ± 1.23	1.83 ± 1.34
Run medication utilization reports	2.55 ± 1.29	1.69 ± 1.18
Assist with distribution of medications throughout facility	3.16 ± 1.16	2.38 ± 1.45
Follow-up on medication distribution issues or problems	2.91 ± 1.03	2.85 ± 1.07
Communicate with nurses and other professionals regarding patient therapy	2.47 ± 1.22	2.92 ± 1.10
Ensure proper storage of medications	3.44 ± 0.95	2.57 ± 1.40
Participate in protocol or guideline adherence monitoring activities	2.37 ± 1.26	2.42 ± 1.44
Communication medication storage issues with nurses	3.06 ± 1.18	2.69 ± 1.38
Participate in disaster preparedness activities	2.53 ± 1.16	2.42 ± 1.31
Provide information to patients on drug interactions, side effects, and medication storage	2.03 ± 1.20	2.71 ± 1.54
Collaborate with other health professionals to plan, monitor, review, and evaluate the effectiveness of medication therapy	2.06 ± 1.12	2.31 ± 1.32
Maintain files of narcotics and habit-forming drugs in accordance with legal requirements	2.35 ± 1.33	2.15 ± 1.35
Evaluate labels, packaging, and advertising of drug products	2.60 ± 1.28	2.38 ± 1.33
Administer immunizations	1.90 ± 1.13	1.54 ± 1.13

Notes: Respondents: n = 77 for US technicians; n = 73 for Danish pharmaconomists

^a For the Danish survey, the word “pharmaconomist” was used in lieu of “technician” for items requiring use of the term.

^b Four-point scale anchored from not at all =11, to very often = 4.

Ratings of General Abilities

Table 4 provides respondents’ ratings of their own general abilities. Respondents from both countries rated their general abilities quite highly. US technicians rated highly their ability to listen attentively to others, prioritize tasks, and communicate with pharmacists. Although still very high, the self-ascribed mean ratings were just a bit lower for their ability to delegate, keep up-to-date with the profession, and communicate with other health professionals. Danish pharmaconomists rated highly their ability to show empathy, communicate with pharmacists, and communicate with those who report directly to them. Low ratings were given on self-reflection to improve, delegating responsibility, and keeping up-to-date with the profession. The ratings on general abilities were lower by pharmaconomists than technicians on many of the abilities, with large discrepancies seen on communicating with peer technicians/pharmaconomists, prioritizing tasks, and self-reflection to improve. The total mean response to the 16-item general abilities measure was 59.12 ± 4.98 for pharmacy technicians and 56.48 ± 6.00 for pharmaconomists.

Table 4.

Self-Reported General Abilities of US Pharmacy Technicians and Danish Pharmaconomists.^a

Ability/Item^b	US Response	Danish Response
Effective communication with peer technicians/pharmaconomists	3.81 ± 0.44	3.38 ± 0.87
Effective communication with pharmacists	3.83 ± 0.37	3.74 ± 0.51
Effective communication with other health-care professionals	3.59 ± 0.63	3.52 ± 0.65
Effective communication with patients	3.60 ± 0.71	3.57 ± 0.79
Showing empathy for others’ situations	3.80 ± 0.45	3.77 ± 0.52
Listening attentively to others with whom I am speaking	3.88 ± 038	3.68 ± 0.58
Prioritizing tasks	3.86 ± 0.36	3.45 ± 0.66
Managing my time effectively	3.80 ± 0.43	3.53 ± 0.53
Delegating responsibility to others	3.36 ± 0.75	3.22 ± 0.68
Gathering information to solve problems	3.80 ± 0.43	3.51 ± 0.63
Making effective decisions	3.78 ± 0.43	3.44 ± 0.57
Soliciting advice or asking others for help in solving problems	3.76 ± 0.46	3.65 ± 0.63
Keeping up-to-date with what is going on in my profession	3.45 ± 0.68	3.27 ± 0.69
Self-reflection on how I can improve myself personally and professionally	3.61 ± 0.55	3.22 ± 0.66
Understanding my own limitations	3.66 ± 0.54	3.63 ± 0.58
Critically thinking about the best solution a problem and ways to solve it	3.77 ± 0.46	3.56 ± 0.65
Communicating effectively with those who report directly to you^c	3.73 ± 0.47	3.69 ± 0.50
Response mean total (scale range of 17-68)	59.12 ± 4.98	46.48 ± 6.00

^a Respondents: n = 359 for US technicians; n = 174 for Danish pharmaconomists.

^b Measured on a scale from “1 = not at all able” to “4 = very/highly able.”

^c Offered a response choice of “not applicable”; treated as missing data for calculation of mean and standard deviation; not included in 16-item total measure of general abilities.

Differences in General Abilities Among US Pharmacy Technicians

The Wilk-Shapiro test was nonsignificant (P = .29) to allow for further testing. Significant differences in reported general abilities among US technicians are reported in Table 5. Those working full time reported higher general abilities than those working part time (P < .01). Specialty and highest tier (eg, “Tech III”) technicians reported higher general abilities than those with an entry-level position (P < .01). Technicians who reported strong employer commitment reported higher general abilities than those with modest and weaker commitment (P < .01) for those looking to leave at the first opportunity. Additionally, those who reported highest level of professional commitment reported higher general abilities than those with the lowest commitment (P < .01). There was no difference in general abilities between technicians by gender or by practice setting. There was a significant correlation between general abilities and years worked as a pharmacy technician (P < .01), but not with years worked for current employer.

Table 5.

Key Differences in General Abilities Among US Pharmacy Technicians by Various Personal and Employer-Related Characteristics.

Variable	Significant (P Value)
Employment status (full vs part time)	P < .01	Full timers reporting higher abilities
Position (entry level, advanced, vs “specialty”)	P < .01	Tech III and specialty techs reporting higher abilities
Employer commitment	P < .01	Those reporting highest commitment reported higher abilities than those with moderate and low commitment
Profession commitment	P < .01	Those reporting highest commitment reported higher abilities than those with moderate and low commitment
Experience (# of years worked as a tech)	P < .01	Correlation between number of years work and higher reported abilities

Differences in General Abilities Among Danish Pharmaconomists

The Wilk-Shapiro test was nearly significant (P = .08); however, this still allows for, or evidences adequately, the normality of distribution of the data for further testing. Significant differences in reported abilities among Danish pharmaconomists are reported in Table 6. There was no difference in general abilities between those working part time versus full time. There was a difference, however, between those working as an advanced-level pharmaconomist versus those working in an entry-level ranking (P < .05). There was also a difference among those working in different practice settings, where those working in community reporting mean general abilities of (P < .01). There was no difference between general abilities and profession commitment; however, there was a difference by employer commitment, where those feeling the strongest commitment reported higher mean general abilities than did those with the lowest commitment (P < .05). There was no correlation between general abilities and years experience nor with years with current employer.

Table 6.

Key Differences in General Abilities Among Danish Pharmaconomists by Various Personal and Employer-Related Characteristics.^a

Variable	Significant (P Value)
Position (entry level vs advanced)	P < .05	Pharmaconomists in advanced positions reported higher abilities
Practice setting (community vs hospital)	P < .01	Pharmaconomists in community reported higher abilities
Employer commitment	P < .05	Those reporting highest commitment reported higher abilities than those with moderate and low commitment

^a F, F statistic (1-way analysis of variance test); t, independent sample t test.

Discussion

This study is original in its attempt to determine pharmacy technicians’ and pharmaconomists’ preferences for job activities, broken down by individual tasks and across practice settings. It has been said that the occupational well-being of pharmacists is important not only for their own sake but for the safety of patients.³⁵ A similar argument can be made for technicians/pharmaconomists. Although pharmacists usually have responsibility for the final product being dispensed, a greater number of technician dispensing errors would likely result in greater number of errors reaching the patient. Additionally, these pharmacy staff are interacting with patients, and the well-being and performance of pharmacist support personnel is important to minimize the likelihood of errors in customer service, as well as actual dispensing errors. As such, the examination of workplace issues and commitment for pharmacy support personnel is important. Research has found that technicians and other support staff simply want to be recognized for the difficult jobs they undertake and for other professionals to appreciate the pressures they face in attempting to achieve near-perfect accuracy in doing their jobs, all the while for relatively low pay.^36,37

Although preferences for tasks cannot and should not be the only driver in reshaping pharmacy work systems, it would be remiss to consider such redesign without eliciting preferences of the persons involved and linking those preferences with redesign models, along with the education and attitude reinforcement necessary to accompany successful redesign. This is especially the case when considering the importance of role clarity for support cadres in hopes of enabling pharmacists to take on more clinical roles.³⁸

US pharmacy technicians and Danish pharmaconomists provided notable insight into their preferences for engagement in various work activities. In community pharmacy, both reported preferences for assessing prescriptions for completeness and accuracy, as well as to identify potential problems with a prescription. Both indicated preferences to engage in continuous professional development, which is an encouraging sign for assuring quality in the medication distribution process and for their occupation to transition to one of being more professional in nature.³⁹ However, both groups reported low preferences for what may be considered as emerging roles, for example, administration of immunizations, discussing effectiveness of treatment regimens with patients, and assuming responsibility for disaster preparedness. It might not be surprising that Danish pharmaconomists would have a low preference for dealing with insurance companies. There are private insurers in Denmark; however, frequent interaction by pharmacy personnel is not standard practice. US technicians indicated a high preference for providing the finished prescription to the patient. Among the activities that were rated highly by pharmaconomists were “higher order” patient communication activities, such as communicating lifestyle changes, discussing over-the-counter medications, explaining the use of devices to patients, and providing drug information to them. In total, while Danish pharmaconomists’ preference ratings were lower than those of US technicians, it is difficult to ascertain whether these lower rankings are somewhat cultural in nature (especially when considering lower self-rankings of general abilities). That Danish pharmaconomists indicating strong preferences for interacting with patients beyond customer service activities should be considered in light of the additional education they undertake and must be considered for policymakers in the United States and elsewhere. Certainly, the variability in the quality of technician training programs, faculty credentials, admission criteria, and facets of their education leaves much to be desired.⁴⁰

The study also provided ratings by Danish pharmaconomists and US technicians in the hospital setting. US technicians gave high preference ratings to medication distribution activities, such as maintenance of floor stock and equipment, and to oversight of medication storage. Both groups reported a high preference for engagement in continuous professional development. Danish pharmaconomists gave preferable ratings to activities revolving around higher order communication such as with nurses and patients but low ratings to activities having to do with distribution of medications and with compounding. Preference ratings by both sets of respondents might be commensurate with the current state of practice in their respective countries.

Respondents from both countries rated their overall general abilities quite highly. This is commensurate with previous research showing US technicians’ ratings of various task self-efficacies.²² It is also similar to a previous assessment of US technicians’ perceptions of their need for education, wherein they downplayed the need for additional skills development in time management, written and oral communication,⁴¹ as well as the need for continuing education on nonprescription medications. Although that study is over a decade old, US technicians in the current study also indicated a relatively low preference for communicating with patients on nonprescription medication. The very high ratings of self-abilities regarding communication and critical thinking are encouraging, yet might be viewed with some caution, as it is possible that these workforce support groups are overestimating their abilities. Educators and administrators of certificate programs might want to include more programming on self-awareness and reinforce the fact that while there are baseline communication skills inherent to any exchange, higher order communication activities, such as dealing with difficult patients, “managing up” one’s supervisor, and proper assertiveness with other health professionals require additional skills that can be taught and are not just innate. Technicians and pharmaconomists in the current study saw some difficulty in keeping up with the profession. This is not the first study to observe health professionals reporting similar struggles, and more thought should be put into helping pharmacy workforce personnel prioritize this responsibility and provide them the wherewithal to keep up with lay and peer-reviewed literature in their field.^42,43 This is especially the case as more pharmacy workforce support personnel are expected to assist in practice change and become required to maintain certification and/or licensure. The public remains largely unaware that persons associated with the medication distribution process need not undergo a revalidation process but expects them to do so, and this is among the many issues fueling debate on education and training requirements.⁴⁴

Differences in general abilities perceptions warrant further investigation. Advanced-level technicians and pharmaconomists reported higher abilities; however, there was also a correlation of abilities with years in the profession. As such, it should be determined whether having higher abilities (should this be the case) is the result of additional experience or the result of employers having been successful in identifying and promoting those with higher abilities. Employer commitment was associated with self-rated abilities for technicians and pharmaconomists. It cannot be determined whether a committed relationship is borne from having higher ability and thus healthier job attitudes or whether those with higher commitment perhaps seek more development opportunities. In any event, this finding bears further investigation, as commitment has also been shown to be related to self-efficacy,²² and this has potential implications for recruitment and retention strategies for pharmacy leaders and employers.

Overall, it is in a sense heartening to have observed similarities among Danish pharmaconomists and US technicians. Although not suggestive of or connoting “validity” of the surveys, similar preference ratings suggest that the respondents undertook the task of completing these surveys with sobriety and further underscore what might be called basic “human nature” to broaden one’s horizons, scope of practice, and enjoy self-actualization from greater contributions to the organization. Still, some trends in preference ratings among the 2 cohorts should be noted. Pharmaconomists all train at one institution, whereas US technicians can undergo quite substantially different training from one person to the next. The fact that pharmaconomists often report lower preferences for performing certain tasks could be indicative of what is already thought to be a broader scope of practice than those of US technicians. Thus, the addition of other putative responsibilities for pharmaconomists might be seen as overly prescriptive and too broad from providing more direct patient care. The more standardized education of pharmaconomists might evoke greater consensus among them regarding lower preferences for tasks and responsibilities for which they were not trained. One cannot underestimate the effect of cultural differences. A sincere examination of culture is well beyond the scope of this article; however, it is quite possible that Danish persons are more circumspect about both their roles as providers and in regard to expressing their attitudes on a survey questionnaire.

Study Limitations

There are a number of limitations to the study that warrant attention. The study design precludes any inference of cause and effect. The response rate for the US technicians was very low, even with multiple reminders. The survey design implementation did not force choices, and some respondents’ choices were omitted from analysis if they failed to answer a survey item. It is difficult to discern potential cultural influences that govern responses between US technicians and Danish pharmaconomists on certain items. Also, while Danish persons typically are fluent in English, and minor modifications were made to their survey, it was administered to pharmaconomists in English rather than in Danish. The activities were patterned after tasks analyses undertaken in the United States. As such, it is possible that Danish respondents were either confused by or were ambivalent toward some items. The analysis plan in this study took a very conservative approach, that is, the avoidance of summing up preferences and conducting myriad tests. This was to minimize type II error. That being said, the article makes note of certain “differences” and “high” and “low” ratings of items by observation, only, without evidence of statistical differences. The sampling procedures were different for the 2 nations. The Danish sample was presumably from persons throughout that smaller nation, whereas a stratified sampling approach was undertaken in the United States. Two states from each geographic region were acquired to promote geographic diversity; one consideration would be for the sampling of greater number of US states; however, this was not possible with the logistical and financial constraints with the current study. Although established in previous studies and evidenced in the current study through expected directional influences (correlations, statistical tests), the construct validity of the measures could not be firmly established within the context of this study design, and this is particularly so for 1-item global measures used, such as is the case for employer and profession commitment. The study lacked the necessary power to conduct a general linear models or similar such procedure to examine the unique contributions of each independent variable on overall perceptions of tasks or on general abilities. Finally, the use of self-report can result in the provision of socially desirable answers by respondents, most notably a tendency to overestimate preferences for performing myriad roles.

Conclusion

This study evaluated US technicians’ and Danish pharmaconomists’ preferences for involvement in various activities/tasks, finding some common opinions but also a number of differences within both community and hospital pharmacy practice settings that might be indicative of Danish pharmaconomists’ advanced scope of practice and uniformity in their education and training. Both groups indicated preferences for further continuous professional development but were not so favorable toward the so-called emerging roles. Both groups rated themselves highly on general abilities, and those ratings were associated with advanced job ranking and with employer commitment. This research should prove helpful and spur additional inquiry to inform leaders on the need for education reform and revalidation processes.

Footnotes

Acknowledgments

The authors would like to acknowledge the assistance of Esben Hansen, Technical Consultant with the Danish Association of Pharmaconomists, for his assistance with survey distribution and modification of survey language.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Shane P. Desselle, RPh, PhD, FAPhA

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