Abstract
Background
Federal Requirement Guidance for PREP Act Coverage for Pharmacy Technicians on Administering Vaccines.
Since the HHS declaration of U.S. national emergency on March 13, 2020, there was a notable drop in childhood vaccines as shown by the Vaccines for Children Program (VFC) provider orders and Vaccine Safety Datalink (VSD) doses administered. 2 The primary reason for this drop was due to limited in-person office visits and increase of telehealth visitations to contain the pandemic. However, pharmacies continued to play an integral role in public health by having uninterrupted access to services such as COVID-19 point-of-care testing, immunizations, and prescriptions. 3 The goal of the PREP Act guidance for qualified pharmacy technicians was to increase access to childhood and COVID-19 vaccines during the pandemic. 2
While the PREP Act is an opportunity for pharmacy technicians to expand their roles, the federal authorization is not a permanent change. Currently, the federal government has not specified an end date to the current PREP Act guidance. However, without an authorized change to the pharmacy technician scope of practice, pharmacy technicians who have been trained through ACPE accredited programs may not be able to administer vaccines once the public health emergency has ended. 4 Prior to the PREP ACT, only a limited number of states had authorized pharmacy technicians to administer vaccines. The states with legislation for pharmacy technicians to administer vaccines were Idaho, Rhode Island. Utah. Kentucky, Michigan, Minnesota, Nebraska, New Mexico, Tennessee, and Washington are states which did not explicitly prohibit technicians from administering vaccines.5,6 Expansion of the pharmacy technician role in vaccine administration could increase access and help improve vaccination rates.
Current available research on the perception of pharmacy technician-administered vaccines is limited. A research study completed in 2018 prior to the COVID-19 pandemic, found 24% of pharmacists surveyed agreed that pharmacy technicians should be able to administer vaccines. 7 Even though the PREP Act is considered temporary, this could be an opportunity to expand the pharmacy technician’s scope of practice. This study looks at the perceptions of pharmacists and pharmacy technicians in Ohio regarding pharmacy technician-administered vaccines. The hypothesis of this study is continued pharmacy technician-administration of vaccines post-COVID-19 pandemic would be supported by pharmacists and pharmacy technicians in the state of Ohio.
Objectives
The primary objective of this study was to evaluate the perception of licensed pharmacists and pharmacy technicians in the state of Ohio regarding pharmacy technician-administered vaccines. The secondary objective was to analyze the correlations between varying demographic and work factors related to the perception of pharmacy technician-administered vaccines.
Methods
Survey Design and Implementation
An electronic Qualtrics® (Qualtrics, Provo, UT) survey, including 24 questions of 5-point Likert-scale and ranking-type questions, was distributed to all licensed pharmacists and pharmacy technicians in the state of Ohio. The survey was sent to e-mails from the professional license roster maintained by the State of Ohio Board of Pharmacy public registry. The e-mail with the survey link included an information sheet describing voluntary participation, the purpose of the study, duration, risks and benefits, cost, confidentiality, and conflicts of interest. The survey link generated by Qualtrics® used “Prevent ballot box stuffing” which kept participants from taking the survey more than once. The survey was administered over a 6-week period with initial dissemination in July 2021 and re-administered through 2 equally spaced reminders to non-respondents. All survey responses tabulated were anonymous. This research study received an exempt status of approval from the institutional review board at Northeast Ohio Medical University.
Statistical Analysis
All survey data was imported into IBM® SPSS® Statistics v.28 (IBM Corp. Armonk, NY) and summarized in three different cohort groups: (1) pharmacists, (2) pharmacy technicians, and (3) combined summary. Summaries included frequencies and percentages for categorical data and means and standard deviations for numeric data. Stratified summaries were produced by profession (pharmacist vs pharmacy technician), setting, prior vaccination training, experience with vaccine-trained pharmacy technicians, administration of vaccines at their workplace, and length of time in profession. Associations between strata, demographics, and Likert-scaled questions were determined via Kendall’s tau tests which account for the ordinal scale of the data. Kendall’s tau is a correlation coefficient valued between 0 and 1 to measure of relationships between groups of ranked data. A value of 0 is considered no correlation, whereas a value of 1 is a perfect correlation. Statistical tests were two-sided with P < .05 considered statistically significant.
Results
Respondent Characteristics
Demographic and Baseline Characteristics.
Results of Primary Outcome
Primary Objectives.
Negative Kendall’s tau value indicates an agree preference for pharmacists and technicians/disagreement preference for pharmacists.
Positive Kendall’s tau value indicates a disagreement preference for pharmacists and technicians/agreement preference for pharmacists.
When asked if employers should require pharmacy technicians to be trained in administering vaccines to patients, there was a similar distribution amongst those who agreed and disagreed within both cohorts (Kendall’s tau = .02, P = .385). A statistically significant difference was reported between cohorts as it related to the acceptable length of training for pharmacy technicians to administer vaccines (Kendall’s tau = −.135, P < .001). The top selected choice for acceptable length of training among the pharmacist cohort was 5-10 hours (n = 195, 35.2%) vs pharmacy technician cohort was 2-5 hours (n = 333, 37.6%) (Table 3).
Both cohorts, pharmacist (n = 410, 74%) and pharmacy technician (n = 698, 78.8%), agreed trained pharmacy technicians should be able to administer vaccines to patients during the COVID-19 pandemic. Results indicated a significant difference (Kendall’s tau = −.078, P = .001) amongst the pharmacist cohort (n = 91, 16.5%) and pharmacy technician cohort (n = 74, 8.3%) as related to the number who disagreed with the above statement (Table 3).
Pharmacists (n = 365, 65.9%) and pharmacy technicians (n = 675, 76.2%) agreed trained pharmacy technicians should be able to administer vaccines to patients post-COVID-19 pandemic. A statistically significant difference (Kendall’s tau = −.145, P < .001) was determined between the pharmacist cohort (n = 127, 22.5%) and pharmacy technician cohort (n = 85, 9.6%) as related to the number who disagreed that pharmacy technicians should be able to administer vaccines to patients post-COVID-19 pandemic (Table 3).
Results of Secondary Outcomes
During COVID-19 Pandemic
Secondary Outcomes.
Post-COVID-19 Pandemic
Pharmacists and pharmacy technicians who worked more years in the profession of pharmacy disagreed more with pharmacy technicians administering vaccines post-COVID-19 pandemic. Conversely, those who worked less years in the profession of pharmacy agreed more with pharmacy technicians administering vaccines post-COVID-19 pandemic (Kendall’s tau = .119, P < .001). Pharmacists who have previously worked with a pharmacy technician who has administered vaccines were more agreeable to pharmacy technicians administering vaccines post-COVID-19 pandemic compared to pharmacists who have not previously worked with a pharmacy technician who has administered vaccines (Kendall’s tau = −.232, P < .001). Pharmacists reporting agreement with an increase in workload due to the COVID-19 pandemic were more agreeable to pharmacy technicians administering vaccines post-COVID-19 pandemic (Kendall’s tau = .099, P < .001) (Table 4).
Results of Other Outcomes
Work Time Distribution Pre- and During COVID-19 Pandemic.
P-values for paired data and unpaired COVID specific data from single sample t-tests.
The impact on each profession was deemed equivalent on average via independent samples.
t-test: Pharmacist 19.4 (17.59), Pharmacy technician 18.5 (17.90), (P = .397).
Pharmacy Technician Barriers to be Trained Immunizers.
Discussion
The respondents of this research survey included pharmacists and pharmacy technicians licensed in the state of Ohio. This study was designed to evaluate the expanded role of pharmacy technician-administered vaccines during the COVID-19 pandemic and the potential for extending this role post-COVID-19 pandemic. One of the resulting consequences of the COVID-19 pandemic was a significant decrease in childhood immunization rates.2,8 The response from HHS to allow for pharmacy technicians to administer vaccines focused on increasing access to preventative and lifesaving immunizations.1,9
At the time the survey was administered, results showed a 22.2% increase in pharmacist work time spent on COVID-19 related tasks including vaccinations and testing. Since then, the pandemic has resulted in increased demand for COVID-19 testing and additional doses of COVID-19 vaccines.10-14 This increased demand may result in an increased proportion of work time spent on COVID-19 related tasks in the pharmacy.
A study conducted in 2018 by the University of Iowa College of Pharmacy examined pharmacy technician willingness to perform emerging tasks in community practice. Of those surveyed, 47.1% of pharmacy technicians were unwilling to administer vaccinations, whereas only 9.6% of pharmacy technicians surveyed in our study disagreed to administering vaccines. Doucette and Schommer attributed the low willingness to lack of familiarity and training. 15 However, their study was performed during a time when most pharmacy technicians were not administering vaccines and clear guidance and training requirements were lacking. Another study evaluating training requirements for pharmacy technician-administered vaccines found extending live training from 2 to 4 hours demonstrated increased knowledge of immunization administration and confidence in vaccine administration skills. The authors concluded pharmacy technician-administered vaccines could increase immunization rates and decrease workflow burden on pharmacists. 16
A study by Bertsch et al reported community pharmacists were receptive to trained pharmacy technicians administering vaccines when supervised by a pharmacist. This aligns with similar pharmacy practice requirements for pharmacy technicians to perform pharmacy-related tasks under the direct supervision of a pharmacist. 17 In addition, there was a positive effect on the morale of the pharmacy team and an increase in the number of vaccines administered. 18 A pharmacy technician immunization program implemented by Washington State University discovered seven trained pharmacy technicians administered 4852 vaccines to underserved patients in 1 year. 19 With increased expansion of pharmacy-based services, it is important to engage the entire pharmacy team to address enduring problems facing public health. 20 However, a positive perception is required from all team members to engage pharmacy technicians in expanded roles such as immunization services.
Limitations of this study included a low response-rate, which could be attributed to multiple factors including survey design, completion time, and contact method. Overall, survey response rates amongst health care workers have been declining in recent years, especially during the COVID-19 pandemic due to survey fatigue.21-23 Studies of perceptions evaluating qualitative data must be noted for constraints of result reproducibility. However, perception studies can be utilized from a practice perspective to guide implementation of new services such as trained pharmacy technician-administered vaccines. 20 Additionally, respondents may have exhibited forms of response bias, such as acquiescence bias based off the wording of the survey questions. The use of 5-point Likert scale questions in collective societies, such as pharmacists and pharmacy technicians, could lead to a higher rate of neutral responses. However, our results indicated the absence of higher rates of neutral responses and the presence of extreme responses, suggesting pharmacists and pharmacy technicians consider themselves more as an individual than as part of a collective profession. This study was limited to pharmacists and pharmacy technicians registered in the state of Ohio, when the federal guidance was a national update.
There has been minimal research since the HHS PREP Act guidance allowed qualified pharmacy technicians to administer vaccines during the COVID-19 pandemic evaluating the perceptions of pharmacy technician-administered vaccines. This research evaluated the perception of licensed pharmacists and pharmacy technicians in the state of Ohio regarding pharmacy technician-administered vaccines. The results indicated an overall positive perception for pharmacy technician-administered vaccines including impact on the profession of pharmacy and workload distribution. Our study indicated 66% of pharmacists supported this technician role compared to a study by Kulczycki et al conducted prior to the pandemic which indicated only a 24% support from pharmacists.
Experience working with a pharmacy technician trained to administer vaccines increased the support for continuing this role once the national emergency declaration expires. Based on this research, as more pharmacy technicians are trained to administer vaccines the support from pharmacists for this expanded role should continue to increase. Another correlation showed as the number of years in the profession of pharmacy increased, support for continued pharmacy technician-administered vaccines decreased. This could be attributed to concerns over a diminished pharmacist’s role. Both pharmacists and pharmacy technicians agreed training is required to administer vaccines, however the acceptable length of training differed amongst both groups. Pharmacists preferred more hours of training for pharmacy technicians. This could be due to reported concerns of inadequate training leading to a potential increase in malpractice and safety risks. Both pharmacists and pharmacy technicians support pharmacy technician-administered vaccines to patients during the COVID-19 pandemic upon completion of adequate training.
Many pharmacy technicians have assumed an increased responsibility for the healthcare needs of the general population by completing the federal training requirements to administer vaccines. According to the Federal Retail Pharmacy Program (FRPP) for COVID-19 Vaccination more than 215.9 million doses have been reportedly administered by community pharmacies across the nation as of January 12, 2022. 24 There are currently more qualified pharmacy technicians trained to administer vaccines than ever before who have risen to the challenge of expanding their scope of practice and the support for their continued role is now higher than before. Without changes to current legislation, the ability for pharmacy technicians to administer vaccines once the COVID-19 pandemic has ended would be severely compromised.
Conclusion
In conclusion, licensed pharmacists and pharmacy technicians in the state of Ohio participating in this study support the continued administration of vaccines by trained pharmacy technicians post-COVID-19 pandemic. Furthermore, this expanded role is perceived to have an overall positive impact on the profession of pharmacy. This study validates the need for legislative change to authorize pharmacy technician-administered vaccines.
Footnotes
Author Contributions
KF: Conceptualization, methodology, software, validation, investigation, resources, writing-reviewing and editing, visualization, supervision, project administration, and funding acquisition. KA: Conceptualization, methodology, software, validation, investigation, resources, data curation, writing-reviewing and editing, supervision, visualization, and project administration. MD: Methodology, software, validation, formal analysis, and data curation. EM: Conceptualization, writing-original draft preparation, and funding acquisition. All authors listed in the manuscript have contributed sufficiently to the project to be included as authors. All the authors have read and approved the final manuscript, and all authors have read and approve of the data being presented in the manuscript.
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.
