Author: Title:

Myhre-Oechsle, Jody M. An Analysis of the Perceived Values to Wisconsin Pharmacy Managers of Pharmacy Technician Certification, Formal Training and Registration

The accompanying research report is submitted to the University of Wisconsin-Stout, Graduate School in partial completion of the requirements for the

Graduate Degree/ Major: MS Career Technical Education

Research Adviser: Carol Mooney, Ph.D.

Submission Term/Year: Fall, 2011

Number of Pages: 100

Style Manual Used: American Psychological Association, 6 th edition

0 I understand that this research report must be officially approved by the Graduate School and that an electronic copy of the approved version will be made available through the University library website

1

0 I attest that the research report is my original work (that any copyrightable materials have been used with the permission of the original authors), and as such, it is automatically protected by the Jaws, rules, and regulations of the U.S. Copyright Office.

STUDENT'S NAME: Jody llllllhr~...n <>rt.~l

STUDENT'S SIGNATURE:

ADVISER'S NAME (Commi

ADVISER'S SIGNATURE:

=-------- DATE:

This section for MS Plan A Thesis or EdS Thesis/Field Project papers only

Committee members (other than your adviser who is listed in the section above)

SIGNATURE:

2. CMTE MEM

SIGNATURE:

SIGNATURE:

This section to be completed by the Graduat~ School ';'jl

This final research report has bee.n·'approved by the Graduate School.

(Director, Office of Graduate Studies)

DATE: \ ~ - t; " t \

DATE: ::f r:xv WI!

(Date)

2

Myhre-Oechsle, Jody M. An Analysis of the Perceived Values to Wisconsin Pharmacy

Managers of Pharmacy Technician Certification, Formal Training and Registration

Abstract

There are no uniform standards for pharmacy technicians in the United States. Varying

regulations and standards have been implemented in 44 states while Wisconsin is one of six

states with no standards for technicians. The purpose of this study was to identify the perceived

values of Wisconsin pharmacy managers on the potential pharmacy technician regulations;

certification, formal training and registration. An online survey was sent to all pharmacy

mangers statewide and to Pharmacy Society of Wisconsin (PSW) members in order to examine

current perspectives on potential technician regulations for Wisconsin. The survey questions

requested information related to the manager's demographics, current pharmacy technician staff

demographics, and their perceived value of pharmacy technician standards: certification,

training, and registration as they apply to their pharmacy setting.

Analysis of the data included descriptive statistics, frequencies, percentages, and chi-

square tests to interpret the pharmacy manager’s responses. Cross tabulation was utilized to

determine frequencies of responses from five different pharmacy settings (institutional,

community, hospital & retail, long term care & retail, and other).

Results of the study indicate the majority of state wide and PSW Wisconsin pharmacy

managers across all pharmacy practice settings perceived value towards the pharmacy technician

standards of formal training, certification, and registration. Further data analysis of this study

also indicates values vary based on the pharmacy manager’s pharmacy practice setting and

current experience with certified or formally trained pharmacy technicians.

3

Acknowledgments

First and foremost, I would like to give my sincere appreciation to those who served

on my committee: Drs. Carol Mooney, Michael Galloy, Mary Hopkins-Best, and Laura

McCullough. I greatly appreciate your time and collaboration on this project.

I would also like to express my gratitude to my colleagues who provide mutual support as

we all embarked together on our research.

And of course, I would like to thank my husband for his assistance and patience for my

pursuit of professional excellence.

4

Table of Contents

.................................................................................................................................................... Page

Abstract ............................................................................................................................................2

List of Tables ...................................................................................................................................6

List of Figures ..................................................................................................................................7

Chapter I: Introduction ....................................................................................................................8

Statement of the Problem ...................................................................................................10

Purpose of the Study ..........................................................................................................11

Assumptions of the Study ..................................................................................................12

Definition of Terms............................................................................................................13

Methodology ......................................................................................................................16

Chapter II: Literature Review ........................................................................................................17

Chapter III: Methodology ..............................................................................................................32

Research Design.................................................................................................................32

Participant Selection ..........................................................................................................33

Instrumentation ..................................................................................................................34

Data Collection Procedures ................................................................................................36

Data Analysis .....................................................................................................................37

Limitations .........................................................................................................................37

Chapter IV: Results ........................................................................................................................39

Item Analysis ....................................................................................................................40

Chapter V: Discussion ...................................................................................................................68

Conclusions .......................................................................................................................68

5

Limitations .........................................................................................................................77

Recommendations ..............................................................................................................77

References ......................................................................................................................................92

Appendix A: Electronic message for Online Survey Link ............................................................79

Appendix B: Qualtrics Online Survey Instrument .........................................................................80

Appendix C: Tables .......................................................................................................................86

Appendix D: Statewide Survey Zip Code Data by County ...........................................................88

Appendix E: PSW Pharmacy Manager Survey Zip Code Data by County………………….….89

Appendix F: “Other” Responses to Survey Questions 8, 14, & 16……………………………..90

6

List of Tables

Table 1: Surveyed Statewide Pharmacy Managers Demographics…… …………………88

Table 2: Surveyed PSW Pharmacy Managers Demographics……………………………89

Table 3: Statewide Current Hiring Conditions …………………………………………...43

Table 4: PSW Member Current Hiring Conditions………………………………………44

Table 5: Statewide Qualifications of Pharmacy Technician Applicants…………………45

Table 6: PSW Member Qualifications of Pharmacy Technician Applicants…………….46

Table 7: Current Hiring Practices………………………………………………………....47

Table 8: Statewide Current Hiring Practices by Pharmacy Setting………………………48

Table 9: PSW Member Current Hiring Practices by Pharmacy Setting………………….49

Table 10: Statewide Pharmacy Technician Pay Incentives……………………………….50

Table 11: PSW Member Pharmacy Technician Pay Incentives…………………………..51

Table 12: Reasons for No Incentives for Pharmacy Technician Certification…………...52

Table 13: Statewide Advancement of Pharmacy Technician Roles………………………63

Table 14: PSW Member Advancement of Pharmacy Technician Roles…………………64

Table 15: Statewide Impact of Pharmacy Technician Standards on Staff………………..65

Table 16: PSW Member Impact of Pharmacy Technician Standards on Staff…………...66

7

List of Figures

Figure 1: Pharmacy Technicians Supervised……………………..….……………………42

Figure 2: Statewide Value of Formal Pharmacy Technician Training by Pharmacy

Setting …………………………………………………………………………..54

Figure 3: PSW Member Value of Formal Pharmacy Technician Training by Pharmacy

Setting…………………………………………………………………………...55

Figure 4: Statewide Value of Pharmacy Technician Certification by Pharmacy Setting…57

Figure 5: PSW Member Value of Pharmacy Technician Certification by Pharmacy

Setting………………………………………………………………………..….58

Figure 6: Statewide Value of Pharmacy Technician Registration by Pharmacy Setting.....60

Figure 7: PSW Member Value of Pharmacy Technician Registration by Pharmacy

Setting…………………………………………………………………………...61

8

Chapter I: Introduction

Pharmacy technicians play an important role in today’s pharmacies. A pharmacy

technician performs various tasks under the direct supervision of a licensed pharmacist (CCP,

2009a). The shortage of pharmacists over the past decade has created advanced roles for

pharmacy technicians (CCP, 2009b). Many of the duties once solely completed by pharmacists

are now done so by pharmacy technicians. As pharmacy technicians have taken on new roles so

has the discussion of pharmacy technician standards. In 2002, the Council on Credentialing in

Pharmacy (CCP) produced a publication emphasizing the need for uniform technician

regulations (Rouse, 2003). Many states responded by implementing technician standards.

However, in recent years, the lack of specific qualifications to become a pharmacy technician

have been scrutinized due to patient safety issues and variations in regulations (Radwan, 2009).

The public currently has misconceptions on the qualifications of pharmacy technicians.

A study completed by the Pharmacy Technician Certification Board (PTCB) found that 73% of

respondents believed technicians were required by law to be trained and certified before they

could prepare prescriptions (PTCB, 2007). However, the standards for pharmacy technicians

vary amongst states (Dresselle & Schmitt, 2009). A report from the National Association of

Boards of Pharmacy (NABP), which sets standards for all state pharmacy boards, in 2011

showed there are currently 43 states with limited requirements for pharmacy technicians (NABP,

2011). These requirements range from completion of a high school diploma or GED, a

minimum age of 18, completion of a board approved certification exam or completion of either a

formal or informal training program. Wisconsin is among six states which have no qualifications

or standards for pharmacy technicians (PTCB, 2011a).

9

Pharmacy technicians traditionally have been trained on the job. The increase in

responsibilities for pharmacy technicians has driven some state pharmacy boards to require

technicians to complete a board approved training program (CCP, 2006). Formal training

programs may be developed by individual pharmacies or community colleges. In 2008, Florida

passed a bill which requires pharmacy technicians to be registered with the state pharmacy

board, be at least 17 years of age, and, effective January 1, 2011, those registering with no prior

pharmacy experience must have completed an approved pharmacy technician training program

(S.B. 1360, 2008). Florida pharmacy technicians must also register every two years, pay a $50

fee with the state pharmacy board, and complete 20 continuing education credits (C.E.) every

two years to retain certification. A portion of the C.E. must include topics in law and prevention

of medication errors. In order to standardize how states develop standards on training programs,

NABP developed a task force on standardized pharmacy technician education and training in

2009. A report from the task force has recommended national standards and a single

accreditation body to be in place for technician training programs in the near future (NABP,

2009).

Certification of pharmacy technicians has become more recognized by the profession in

recent years (Murer, 2008). Certification exams have been developed by national organizations

and individual state pharmacy boards. In 1995, the Pharmacy Technician Certification Board

(PTCB) was established to create a uniform national certification program for pharmacy

technicians in all types of practice settings. The goal of PTCB certification is to offer a

nationally recognized benchmark for pharmacy technicians (Madigan, 2008). Many states, such

as Virginia, have developed their own certification exam for technicians (18VAC110-20, 2010).

NABP’s task force on standardized pharmacy technician education and training has also

10

recommended states require certification by the PTCB (NAPB, 2009). However, participation

and compliance with the recommendations remains within the control of each state.

In recent years, medication errors have made national headlines. These errors were

primarily caused by pharmacy technicians and resulted in questions of their qualifications to

work in a pharmacy. Medication errors have sparked new legislation for pharmacy technician

regulations in some states. In 2009, “Emily’s Law” was introduced and passed by the Ohio state

legislature after a pharmacy technician incorrectly diluted a medication solution, which was not

caught by the checking pharmacists for an 18 month old girl who died shortly after receiving the

medication (Gabay, 2011).

Other states are beginning to add similar dual requirements of training along with

certification. Wisconsin currently does not require technicians to have a high school diploma,

any formal education, or be of a specific age. In 2008, the Wisconsin Pharmacy Examining

Board (PEB) along with a PSW Technician Credentialing Taskforce began to discuss pharmacy

technician credentialing (Schaafsma, 2009). The posted comments from the taskforce meeting

on PSW’s website indicates the pharmacy board would like to start looking at adding an age

requirement of 18, criminal background checks, and a state pharmacy technician registry while

training and certification were left to be voluntary (PSW, 2009a).

Statement of the Problem

Pharmacy technicians are not regulated by the state of Wisconsin. There is a need for

data to indicate the validity of having regulations such as registration, certification or education

(PSW, 2009a). There is also a need to bring about an awareness of the potential impact of

11

certification, formal education, and registration of pharmacy technicians through valid data

collection and analysis.

Purpose of the Study

The purpose of this study was to identify the perceived values of Wisconsin pharmacy

managers about pharmacy technician certification, formal training and registration in a variety of

pharmacy settings. The varying regulations and standards for pharmacy technicians in most

other states create questions for the types of standards in Wisconsin. The results of this study

can be a valuable resource for determining the direction of pharmacy technician standards for

Wisconsin and will be published in the Journal of the Pharmacy Society of Wisconsin.

Research Questions:

The outcomes of the study will be utilized to answer the following five questions:

1. What is the perceived value to pharmacy managers of pharmacy technicians with formal

education/training in community, institutional, and combination (both

institutional and community) pharmacy settings?

2. What is the perceived value to pharmacy managers of certification of pharmacy

technicians in community, institutional, and combination (both institutional and

community) pharmacy settings?

3. What is the perceived value to pharmacy managers of registration of pharmacy

technicians in community, institutional, and combination (both institutional and

community) pharmacy practice settings?

4. In the opinion of pharmacy managers, will certification, formal training or registration

advance the roles of pharmacy technicians in a variety of pharmacy practice settings?

12

5. In the opinion of pharmacy managers, how might the implementation of pharmacy

technician standards such as certification, training or registration in Wisconsin affect the

workforce in a variety of pharmacy practice settings?

Importance of the Study

The following information outlines the importance of this study:

1. The study provides data showing the attitudes of pharmacists towards training and

certification. It also shows what types of regulations are desired in various

pharmacy settings in Wisconsin.

2. The study increases the awareness of the lack of regulations involving training or

certification for pharmacy technicians in Wisconsin. This data can be used to

lobby for technician requirements at the state level.

3. The study provides data on the current pharmacy manager standards in various

pharmacy practice settings that are utilized for hiring and maintaining staff. The

data provides insight on current practices that managers find beneficial for their

practice setting.

Assumptions of the Study

The assumption of this study is that the information collected by pharmacy managers is

accurate and reflects their personal experience hiring and supervising pharmacy technicians.

Additionally, it is assumed that each pharmacy manager utilizes pharmacy technicians in their

pharmacy practice setting.

13

Definition of Terms

American Society of Health System Pharmacists (ASHP): an organization made up of

pharmacists and pharmacy technicians who practice in various institutional pharmacy settings

such as long-term care and hospitals. The mission of ASHP is to advance and support the

professional practice of pharmacists in various health systems and to serve as a collective voice

on issues related to medication use and public health (ASHP, 2011)

Certification: a voluntary process by which a non-governmental agency or an

association grants recognition to an individual who has met certain predetermined qualifications

specified by that organization. This formal recognition is granted to designate to the public that

the individual has attained the requisite level of knowledge, skill, and/or experience in a well-

defined, often specialized, area of the total discipline. Certification usually requires initial

assessment and periodic reassessments of the individual’s knowledge, skills and/or experience

(CCP, 2009a).

Combination pharmacy: a pharmacy providing services to both an institutional setting

and to the general public (retail).

Community pharmacy: a retail pharmacy which provides medication to the general

public.

Continuing education: a structured process of education designed or intended to

support the continuous development of pharmacists to maintain and enhance their professional

competence. Continuing education should promote problem-solving and critical thinking and be

applicable to the practice of pharmacy (CCP, 2006).

14

Credentialing: the process of granting a credential or a designation that indicates

qualifications in a subject or an area (CCP, 2010).

Formal education: any educational training of a pharmacy technician outside of

pharmacy employment which may include a technical college training program.

Institutional pharmacy: an inpatient pharmacy which provides medications to patients

in hospitals, nursing homes and various other institutional settings.

Licensure: the process by which an agency of government grants permission to an

individual to engage in a given occupation upon finding that the applicant has attained the

minimal degree of competency necessary to ensure that the public health, safety, and welfare will

be reasonably well protected. Within pharmacy, a pharmacist is licensed by a state board of

pharmacy (CCP, 2009a).

Pharmacist: a person licensed to engage in the practice of pharmacy (CCP, 2009b).

Pharmacy manager: a licensed pharmacist who oversees the daily operations of the

pharmacy and is typically involved in the hiring of staff.

Pharmacy Examining Board (PEB): part time body which sets standards of

professional competence and conduct for the profession under its supervision, prepares, conducts

and grades the examinations of prospective new practitioners, grants licenses, investigates

complaints of alleged unprofessional conduct and performs other functions assigned to it by law

(WI Stat. 15.01(7), 2010).

Pharmacy Technician: “an individual working in a pharmacy [setting] who, under the

supervision of a licensed pharmacist, assists in pharmacy activities that do not require the

professional judgment of a pharmacist.” (CCP, 2009a)

15

Pharmacy technician certification: a voluntary process by which an individual, who

must meet preliminary qualifications such as a high school diploma and a clean criminal

background check, successfully completes an assessment examination through either the

Pharmacy Technician Certification Board (PTCB) or the Institute for Certification of Pharmacy

Technicians (ICPT). Individuals renew their certification every two years with twenty hours of

continuing education credits.

Pharmacy technician certification exam (PTCE): a nationally recognized pharmacy

technician certification exam prepared by the Pharmacy Technician Examining Board. The

exam assesses the knowledge in three key areas of pharmacy: assisting the pharmacist in serving

patients, maintaining medication and inventory control system, and participation in the

administration and management of the pharmacy practice.

Pharmacy Society of Wisconsin (PSW): a professional organization made up of

pharmacists and pharmacy technicians in the state of Wisconsin. The mission of the Pharmacy

Society of Wisconsin is to provide a unified voice, resources, and leadership to advance the

pharmacy profession and improve the quality of medication use in Wisconsin (PSW, 2009b).

Registration: the process of making a list or being enrolled in an existing list with a

state board. Registration should be used to help safeguard the public through interstate and

intrastate tracking of the technician work force and to prevent individuals with documented

problems from serving as pharmacy technicians (CCP, 2009a).

Wisconsin Pharmacy Examining Board: a board made up of five pharmacists and two

public professionals who are appointed by the governor. The board is responsible for

administering and enforcing state pharmacy laws.

16

Methodology

The method used to obtain descriptive data about the current perceived values on

pharmacy technician regulations in Wisconsin along with current experiences with pharmacy

technicians (who either had formal and/or certification) will be the use of an online survey. This

stratified study will further examine the value placed on pharmacy technician certification,

formal training and registration of Wisconsin pharmacy managers in a variety of pharmacy

practice settings. The potential effects of regulations in each setting will also be examined.

17

Chapter II: Literature Review

This study is intended to provide data on the perceived value of potential pharmacy

technician regulations in Wisconsin. Pharmacy managers are the key population in this study

since they are directly involved in the hiring and supervision of pharmacy technicians. This

chapter will first review the designated job duties of pharmacy technicians and pharmacists. The

difference in the various tasks completed by pharmacy technicians in the various pharmacy

settings will also be clarified. A discussion of the various pharmacy technician regulations will

follow along with examples of states and other countries currently implementing technician

regulations. The chapter will conclude with a summary of past studies related to pharmacy

technician regulations.

Pharmacy Technicians

Pharmacy technicians have been instrumental in the framework of pharmacy.

Approximately 96% of all the prescriptions filled nationally involved a pharmacy technician

(Gabay, 2011). Technicians assist the pharmacist in the daily activities involved in a pharmacy.

A pharmacy technician’s scope of practice has not been sufficiently examined; this has led to

substantial variances in regulations from state to state (Rouse, 2003). In general, pharmacy

technicians serve as “supportive personnel” in the pharmacy and assist the pharmacist in

nonprofessional judgments such as providing medication counseling to patients (Rouse, 2003).

Examples of typical job duties include: accepting prescription orders from patients, preparing

labels, entering information in the pharmacy’s computer system, and retrieving medications from

inventory (CCP, 2010). Pharmacy technicians may perform more advanced roles which require

additional training such as pharmaceutical compounding of aseptic or sterile solutions, managing

18

inventory, supervising other pharmacy technicians, and handling purchasing contracts for drug

products (Myers, 2011). Many technological advances in pharmacy have also created new roles

for pharmacy technicians such as inventory management of automated dispensing cabinets used

in hospitals and quality audits to measure quality assurance (Mohr, 2011). The work completed

by the pharmacy technician must be verified by the pharmacists such as verifying the correct

medication was filled for a patient and that a medication was properly compounded.

Future of Pharmacy Technicians

Currently there are 326,300 pharmacy technicians in the United States which is expected

to rise by 31% in 2018 according to the Bureau of Labor and Statistics (2011a). The increased

demand for pharmaceutical services in the future and the current projections of pharmacist

shortage by 11% by 2030 will increase the need for uniform standards for pharmacy technicians

(Adams, 2011). Also the increased demand for the pharmacist to be involved with the clinical

medication use for patients will further advance the role of pharmacy technicians (Myers, 2011).

Pharmacists

Pharmacists play a crucial role in healthcare and have been consistently rated as one of

the most trusted professionals in Gallup polls (CCP, 2009a). The education and training to

become a pharmacist consists of undergraduate pre-pharmacy course work, acceptance into a

school of pharmacy where four years of course work and residency training occurs. The

educational requirements for pharmacists have also evolved with their new advancing roles

which increased the requirement of a Bachelor’s degree to a Doctor of Pharmacy degree (BLS,

2011b). Specialized training beyond pharmacy school may be needed for specific areas of

pharmacy. The major duties of a community or retail pharmacist include dispensing prescribed

19

medications to patients, counseling patients on the use of prescriptions and over-the-counter

medications, administering vaccinations, and advising physicians about medication therapy

(BLS, 2011b). A pharmacist working in a hospital or long term care pharmacy advises various

health practitioners, such as physicians, on the appropriate selection of medication therapy for

patients along with counseling patients prior to discharge on the proper use of the patient’s

prescribed medications. Pharmacists may also need to perform compounding of medication

doses not available from drug manufacturers. Community and Hospital pharmacies are the most

common areas in which pharmacists are employed. Other areas include pharmaceutical

manufacturing, nuclear (radiopharmaceuticals), education, managed care organizations, mail-

service, and geriatric pharmacy practice (CCP, 2009a).

The roles of pharmacists have expanded into more patient-centered care which require

additional time spent working directly with other health professionals and patients (Manasse &

Menighan, 2011). Medication Therapy Management (MTM) was developed to provide patients

with optimal therapeutic outcomes for patients. MTMs involve collaboration with the

pharmacist, the patient or caregiver, and healthcare professionals (CCP, 2009a). Pharmacists are

now focusing more of their time on providing patient counseling instead of traditional

prescription preparation orders. The increased demands of more patient centered serves along

with pharmacist shortages in some regions have created challenges with allotting available time

(Dresselle & Schmitt, 2010). The shortage of pharmacists has been estimated to be around 11%

(38,000 positions) by 2030 according to the Health Resources and Services Administration

(Adams, et.al., 2011).

20

Pharmacy Settings

Pharmacy consists of a variety of practice settings each with unique activities and tasks

technicians are able to perform. Retail pharmacy provides medication and supplies for the

community. The majority of retail pharmacies are associated with a national or regional brand

name such as CVS, Walgreens, or Health Mart. The daily tasks commonly performed in the

retail setting include handling inventory, entering prescription data into the computer system,

filling medication orders, and providing customer service in person and via phone (CCP, 2009a).

Pharmacy technicians working in this setting must be able to multitask, process prescription

orders in a concise manner and collaborate with other healthcare employees and insurance

identities. Technicians also must know how to interpret medication orders, process insurance

claims, triage customer needs and compound topical medications. The retail pharmacy

environment is typically fast paced which is dependent on volume of prescriptions and the

customer base. Approximately 180 independently owned pharmacies remain in Wisconsin (U.S.

Census Bureau, 2007). The escalating cost of healthcare and changes in Medicare

reimbursement has forced many to be sold out to other proprietary pharmacies. Location of

these independent pharmacies is commonly found in rural areas which greatly affect the

community when these pharmacies are unable to continue operating (Wahlberg, 2010). To

compensate for the loss of rural pharmacies and shortage of pharmacists, the telepharmacy has

been becoming increasingly popular in Wisconsin. Telepharmacy provides communities without

a main pharmacy an outlet to receive their medications locally instead of traveling great

distances. The staff for a telepharmacy includes onsite pharmacy technicians who prepare

medications for dispensing and perform customer service. The remote pharmacist is contacted

via televideo to check the technician’s work and provide medication counseling to customers.

21

The pharmacist communicates through the use of a computer hooked up with a camera. The

technician completes the tasks of filling prescriptions along with providing customer service

while the pharmacist monitors and checks the technician’s work(Marshfield Clinic, n.d.).

Pharmacies typically have requirements such as technician certification and specialized training

prior to working in a telepharmacy.

The aging population has created a greater demand for long-term care services in

pharmacy (BLS, 2011b). Some retail pharmacies have attached long-term care services to

provide area nursing homes, institutions, and other assisted living facilities with pharmaceutical

services. Approximately 31% of independent retail pharmacies service long-term care facilities

with the majority located in populations of less than 20,000 (NCPA, 2011).

Institutional pharmacies provide medication and services to hospitals, long-term care

facilities such as nursing homes, group homes, mental institutions, and correctional facilities.

These pharmacies may not necessarily be located in the facility to which they provide services

and may rely heavily on a delivery service to provide medications to multiple locations. The

daily tasks commonly performed in these settings tend to vary. For example, hospital

pharmacies utilize patient drawers or medication cabinets to provide medications to patients

admitted to the facility along with aseptic compounding of sterile medications to be administered

to patients (BLS, 2011b). Technicians are able to perform aseptic compounding and fill

medication dispensing systems used in the facility (BLS, 2011a). Pharmacists typically perform

prescription data entry to optimize efficiency in processing medication orders. Long-term care

pharmacies provide services to a wide range of facilities. The demand for long-term care

services has risen due to an increasing aging population. Technicians working in long-term

facilities typically fill unit of use medication systems such as Opus, and punch cards. Additional

22

tasks may include: aseptic and topical compounding, delivery of medications, entering

prescription data into a computer system, and triaging with other healthcare professionals (BLS,

2011a).

Other pharmacy settings include nuclear, managed care, mail order, military, home

infusion, and compounding (BLS, 2011b). The most common pharmacy setting of these is

nuclear. Nuclear pharmacy provides radiopharmaceuticals for diagnostic and treatment of

diseases such as cancer. Work safety is a priority when working with radiopharmaceuticals

which are considered radio reactive. Equipment such as lead shields are needed at all times to

prevent accidental exposure to the radioactive material. Specialized training is provided for

pharmacy technicians working in nuclear pharmacy (Purdue, 2011). The use of home infusion

pharmacies is also on the rise due to the increased numbers of people utilizing hospice or home

care. Home infusion pharmacies prepare sterile solutions such as intravenous solutions (Horner,

n.d.).

Vision for Pharmacy Practice

The Joint Commission of Pharmacy Practitioners (JCPP) has written the “Future Vision

for Pharmacy Practice 2015” which outlines the desired standards and new roles of both

pharmacists and pharmacy technicians (CCP, 2009a). The main theme for the 2015 initiative is

to expand the pharmacist roles into more patient centered services which will create more

advanced roles for pharmacy technicians. The American Society of Health System Pharmacists

(ASHP) also has a 2015 initiative which reflects similar goals in the JCPP vision. The ASHP

initiative outlines six goals, all centered around both hospital inpatients and outpatients, in either

long term care or home care settings. One goal is to gear more of the pharmacist’s time towards

23

reconciliation of medication orders or to ensure effective medication use upon admission,

transfer or discharge of the patient along with more collaboration with other members of the

health-care team (ASHP, 2008). Improving medication safety is another major goal which

includes both the pharmacist and pharmacy technicians. ASHP would like 50% of all new

pharmacy technicians entering a health system practice such as a hospital to have completed an

ASHP approved training program and to have 85% of all pharmacy technician staff to be

certified through PTCB by 2015 (ASHP, 2008).

Advancing Roles

The advancement of pharmacy technician roles in various pharmacy settings has

increased the awareness of developing technician standards nationwide (Rouse, 2003). The role

of the pharmacy technician to pharmacists has become increasingly more advanced in order for

the pharmacists to keep up with their new evolving roles in pharmacy (Manasse & Menighan,

2011). Pharmacy technicians checking the order-filling accuracy of another pharmacy technician

or tech-check-tech in (TCT) is an example of an advanced pharmacy technician role designed to

allow the pharmacist to designate more time to direct patient care services (Adams, et.al., 2011).

Currently TCT is authorized for use by pharmacies in nine states. Technicians performing the

final check of filled orders in the TCT system must complete either an educational or training

requirement as designated by the state pharmacy board.

A Veterans Affairs medical center in Mississippi created a clinical pharmacy technician

position which successfully maximizes the efficiency of the pharmacist resources (Weber, et.al.,

2005). The clinical technician assists the pharmacist by generating reports pertaining to patient

lab values, conducting clinic inspections to ensure stocked medications are properly labeled,

24

unexpired, and they provide basic patient triaging by forwarding patient requests to the

appropriate pharmacist. Technicians in this role are required to be certified, completed a specific

training program by the facility, and participated in the department’s continuing-education

program.

Current Standards

A 2011 report from the National Association of Boards of Pharmacy (NABP), which sets

the standards for all state pharmacy boards, identified 43 states with limited requirements for

pharmacy technicians (NABP, 2011). This has recently changed to 44 states with Georgia

implementing first time technician regulations this year (PTCB, 2011a). These requirements

range from completion of a high school diploma or GED, a minimum age of 18, completion of a

board approved certification exam or completion of either a formal or informal training program.

NABP has recommended that all state pharmacy boards put in place certification requirements

for technicians by the year 2015 (NABP, 2010). Currently, the Wisconsin pharmacy examining

board has not implemented regulations or any credentialing standards for pharmacy technicians

(PTCB, 2011a).

Certification

Certification is a voluntary process by which a non-governmental agency or association

awards a specific designation for meeting specific criteria (CCP, 2006). The majority of health

occupations require certification prior to working in their designated field after completion of

required education or training (Myers, 2011). Pharmacy technician certification currently is

conducted through the Pharmacy Technician Certification Board, established in 1995, and the

Institute for the Certification of Pharmacy Technicians (ICPT), established in 2005 (CCP,

25

2009a). According to the Bureau of Labor Statistics (2010c), there are currently 333,500

actively working pharmacy technicians in the United States. In Wisconsin there are 7,310

pharmacy technicians of whom 4,436 are certified in Wisconsin (BLS, 2011c: PTCB, 2011). A

practice analysis for pharmacy technicians indicated certified technicians were performing newer

roles in pharmacy and taking on more advanced roles (Muenzen, et.al, 2005).

Traditionally there has been opposition by pharmacists towards the expansion of

technician roles and implementation of technician regulations (CCP, 2003). As pharmacy

technician roles have expanded into the traditional roles of pharmacists, the attitudes of

pharmacists has started to shift. A recent national survey conducted by the Pharmacy Technician

Certification Board (PTCB, 2007) has shown 83% of pharmacists value technician certification

and have seen various other benefits of technician certification such as trust in delegating tasks

and reduction in medication errors. Desselle & Schmitt (2009) completed a limited study on the

attitudes of pharmacists towards certification of pharmacy technicians. The results of their study

indicated pharmacists had a positive attitude towards technician certification and indicated

certified technicians were able to perform higher skilled pharmacy tasks. This study also

indicated that a major barrier to certification is the lack of professional recognition by the public

and by healthcare professionals.

Formal Training

Training programs for pharmacy technicians have become more structured since they

were first introduced back in the 1940s. In 1966, the American Society of Hospital pharmacists

(ASHP) recommended organized training programs for hospital pharmacy technicians (Myers,

2011). Formal training programs were soon developed in the 1970s through vocational or

26

technical colleges in response to requests from hospital pharmacy administrators. The ASHP, in

the early 1980s, created guidelines for both formal and onsite training programs (Rouse, 2003).

Currently there are about 150 ASHP accredited and 600 nonaccredited training programs in the

nation (Myers, 2011). States with training requirements will require the training program to be

either ASHP accredited to follow a set of standards as outlined by the state pharmacy board. The

standards for pharmacy technician training vary among the current thirty-three states with either

formal or onsite pharmacy training requirements (NABP, 2011). Florida is a state that, as of

2010, requires any individual seeking initial pharmacy technician registration must complete a

state board approved training program or be certified (S.B.1360, 2008). Currently many

pharmacies will train a new pharmacy technician through an onsite training program as opposed

to completing a formal training program (Myers, 2011). The large chain pharmacies (e.g. CVS,

Walgreens, and Rite Aid) have developed onsite ASHP approved pharmacy technician training

programs (Manasse & Menighan, 2011). Pharmacies can vary greatly on how they operate. This

requires some specific site training regardless of previous work experience or training. It has

been suggested that formal training can complement the site-specific training a new pharmacy

technician completes (Rouse, 2003). Further research is needed on the value of employing

formally-trained pharmacy technicians and their ability to perform certain tasks (Dresselle &

Schmitt, 2010).

Registration

The registration requirement for pharmacy technicians varies among states. Some states

will use the term “licensure” which is similar to a registration requirement for pharmacy

technicians (Rouse, 2003). Licensure applied in other occupations requires an individual to

complete an assessment with the state board to ensure they have met the requirements of their

27

profession. Licensure has been opposed for pharmacy technicians in many states due to the

potential of creating a new level of practitioners (Wilson, et.al, 2010). Current registration

practices of pharmacy technicians in most states include an age requirement, passing a criminal

background check, and an annual renewal fee with the state board. In Minnesota, the process of

registration requires that the pharmacy technician complete a registration application and submit

a $25 annual fee. Minnesota’s registration of pharmacy technicians is meant to identify, track,

and impose disciplinary action for any violations of pharmacy law (Ch. 6800, 2008). As of

2009, thirty-eight states require registration or “licensure” of pharmacy technicians (NAPB,

2010). Limited studies have been conducted about the value of such registration. In 2008, the

Wisconsin pharmacy examining board created a taskforce through the Pharmacy Society of

Wisconsin. The purpose of this study was to obtain quantitative data about a potential

registration requirement for pharmacy technicians in Wisconsin. They found that 70% of PSW

pharmacists and technicians surveyed approved of having a registration requirement (PSW,

2008).

Pharmacy Technicians in Canada and the United Kingdom

The roles of pharmacy technicians in Europe greatly vary from the United States.

Pharmacy technicians in the United Kingdom (UK) are able to perform more sophisticated

responsibilities such as more managerial duties and provide clinical care in healthcare settings.

Clinical pharmacy technicians in the UK work closely with other healthcare professionals and

review medication charts to ensure effective and safe use of medications; a duty that is solely

done by the pharmacist in the US. The (UK) has recently moved from voluntary to mandatory

registration of pharmacy technicians (Alkhateeb, et.al, 2011).

28

In Canada, the providences of Ontario and British Columbia recently implemented

regulatory standards for pharmacy technicians. Ontario became the first province in Canada to

develop formal regulations to develop the pharmacy technician into a health professional. The

new regulation coincides with newer legislation to expand the pharmacist’s scope of practice

(“Ontario,” 2011). Individuals desiring to work as a pharmacy technician must now complete a

university degree or diploma in pharmacy or pass a pharmacy technician program, pass the

PEBC Evaluation Examining for pharmacy technicians, complete a Structured Practical Training

program (12 weeks in length), complete an approved International Pharmacy Technician Bridge

Training program, provide proof of professional liability insurance, and meet several background

check requirements (“Ontario,” 2011). Currently employed pharmacy technicians are allowed a

grace period to obtain the requirements of passing the PEBC Evaluating Examination,

completion of the Bridging Education Program (4 continuing education courses offered at a

community college), successful completion of a structured Practical Evaluation, and proof of

professional liability insurance. The Canadian province of British Columbia soon followed with

very similar regulations for pharmacy technicians (“British Columbia,” 2011).

Patient Safety Issues

Patient safety is a main concern in pharmacy when providing medication services. Some

errors initially made by a pharmacy technician that were not caught by the pharmacist have made

national headlines. Questions of pharmacy technician qualifications have been raised as the

result of these serious medication errors. A pharmacy technician entered an incorrect strength of

the drug warfarin, a blood thinner, to a patient in Florida. The patient received a dose higher

than was prescribed and resulted in the patient’s death (Myers, 2011). Medication errors have

sparked new legislation for pharmacy technician regulations in some states. The most infamous

29

case of a medication error was the death of two year old Emily Jerry in Ohio (Brady & McCoy,

2008). Emily was undergoing her final treatment of chemotherapy when the medication error

occurred. A pharmacy technician mistakenly compounded her chemo medication at an

extremely high concentration. The pharmacist reviewing the technician’s work failed to catch

the error and the medication was administered incorrectly. Emily died within days. In 2008,

Representative Steven LaTourette, (R-Ohio) introduced a bill called Emily’s Act which was

developed to set mandatory education, training and regulatory standards for all pharmacy

technicians (H.R. 5491, 2008). The Ohio bill was passed in 2009 as Emily’s Law. In addition to

a minimum age of 18, technicians in Ohio must now pass a board-certified exam, also must

possess a high school diploma or GED, and submit to a criminal background check (Sub. S.B.

203, 2009). Several other state pharmacy boards are implementing similar regulations. In 2008,

the Washington State Pharmacy Board adopted new regulations for pharmacy technicians which

include passing a board certified exam and completion of a training program (WAC 246-901,

2008).

Currently no data exists on the extent of errors occurring with pharmacy technicians who

are certified versus those who have completed a formal training program (Myers, 2011).

However, a national survey conducted by PTCB showed that over 80% of pharmacists surveyed

agreed that certification supports proper drug preparation and distribution, reduces the number of

medication errors and improves patient safety (Manasse & Menighan, 2011).

Pharmacists currently spend 55% of their work time performing dispensing tasks and

only 16% of their time to direct patient care services (Doucette, et.al., 2009). Pharmacists in this

study also rated their workload as “high” or “excessively high.” This ultimately affects the

quality of care and reduces the opportunities to solve drug therapy problems and reduce potential

30

errors. In 1977, the Joint Commission of Pharmacy Practitioners (JCPP) was formed to serve as

a forum for discussion of important issues in the pharmacy profession (AMCP, 2004). The

JCPP’s 2015 Vision states that “the pharmacist will be the health-care professional responsible

for providing patient care that ensures optimal medication outcomes” (AMCP, 2004). ASHP

also created a similar “2015 Initiative” in 2003 for hospital system pharmacists (ASHP, 2008).

Pharmacy Society of Wisconsin Study

Some research has been done on potential pharmacy technician regulations in Wisconsin.

In 2008, the Pharmacy Society of Wisconsin (PSW) conducted a study about current insights on

training and credentialing of pharmacy technicians among PSW pharmacists and technician

members (PSW, 2008). This study was initiated by the increased interest and heightened

awareness of medication safety along with the increased complexity of medication preparation.

The survey found that 63% of the respondents favored a certification requirement and 70% of

respondents favored registration or licensure of pharmacy technicians. The survey also allowed

participants to provide suggestions towards training and credentialing requirements of

technicians. The general consensus from the survey was brought forth to a PSW assigned

taskforce in 2009 and recommendations were made in favor of a technician registration

requirement along with a high school diploma and an age requirement of 18 years for technicians

employed within the state (PSW, 2009). The taskforce indicated that registration is considered

the minimum standard used by other states and can be easily implemented. The taskforce did not

recommend certification due to the lack of evidence that the exam would provide competent

technicians. Additionally, the implementation of a training program requirement was not

recommended due to the potential of a workforce shortage in qualified technicians. The

recommendations of the taskforce were brought forth to Wisconsin’s Pharmacy Examining

31

Board (PEB). Further research on the actual perceived value of certification, formal training and

registration of technicians is warranted among Wisconsin pharmacists especially with managers

involved in the supervision and hiring of pharmacy technicians.

32

Chapter III: Methodology

The purpose of this study was to identify the perceived values of Wisconsin pharmacy

managers about pharmacy technician certification, formal training, and registration in a variety

of pharmacy practice settings. Varying regulations and standards for pharmacy technicians has

been implemented in most states except Wisconsin. A survey was utilized in this study to

examine current perspectives on potential technician regulations for Wisconsin.

This chapter will describe the research design, population and sample, instrumentation,

data collection and analysis, and the limitations of the study.

Research Design

The research design utilized in this study was a descriptive and non-experimental

quantitative research methodology using a survey method for data collection. A cross-sectional

design was used to gather data on the perceived values of pharmacy managers towards pharmacy

technician certification, registration and formal training in their current pharmacy practice

setting. A multi method approach was utilized during this study to gather data from several

different pharmacy practice settings throughout Wisconsin. The study also examined the number

of years of pharmacy managerial experience, community population size, and current pharmacy

hiring standards, incentives practiced within their organization. Two different methods were

used to reach the desired population. The population consisted of pharmacy managers in

Wisconsin. To reach this population, a sample of statewide pharmacy managers was reached

via web searching by pharmacy organizational websites. Secondly, the PSW provided a means

of sending a survey link via Fast Facts, an electronic weekly newsletter, to all PSW members in

order to survey members who were pharmacy managers. Survey data was collected separately

33

from the statewide survey and the PSW survey. Further dissemination of the PSW data will be

completed through a future PSW assigned technician credentialing task force.

Participant Selection

The population studied was registered pharmacists acting as the manager of a pharmacy in

various pharmacy settings in Wisconsin. Pharmacy managers were selected for this study based

on previous research which indicated non-managing pharmacists may not be familiar with hiring

practices and the voluntary credentials for pharmacy technicians (Wilson, et.al., 2010). The

population sample consisted of pharmacy managers in Wisconsin. To reach this population, a

sample of statewide pharmacy managers was reached via web searching by the available

pharmacy organization’s website. The PSW sample was reached through the PSW electronic

newsletter Fast Facts which is sent weekly in an email to members. The study was conducted

through an online survey link through Qualtrics, a University of Wisconsin Stout supported

online survey tool. Each sample population was independently surveyed.

Statewide Sample

Survey distribution was done through stratified sampling by county and pharmacy setting

completed to ensure that a variety of practice settings in various state-wide locations were

included in this study. Due to limited availability of access to an online source for contact of

some pharmacy organizations, the selection of the pharmacies was based on whether the

pharmacy utilized a webpage and/or email services. Larger pharmacy organizations with

multiple chains in Wisconsin were contacted via telephone for mass distribution of the survey

link. Several organizations were not allowed to participate in research projects due to a

34

corporate policy. This greatly reduced the number of pharmacy managers able to participate in

the survey.

In October 2011, a total of 251 electronic messages sent via email or through a web contact

page containing the survey link.

PSW Member Sample

The PSW member sample was added to provide additional data in order to perform a

comparative analysis of a previous PSW study (PSW, 2008; 2009a). The PSW member study

included all Wisconsin PSW pharmacist members. To determine the managerial status of PSW

members, an additional question was added in the survey to specify if the member was a

manager. The survey was sent electronically through the PSW’s Fast Facts which is an

electronic newsletter.

By mid-November 2011, a total of 2,130 pharmacist members received the newsletter with

755 members viewing the newsletter content at the time of data collection.

Instrumentation

The instrument that was used during for this study was an online survey. A national

Canadian survey for pharmacy managers on the demographics and attitudes towards pharmacy

technician standards was used to construct the survey questions for the survey (Vision, 2007).

The survey consisted of closed-ended questions with response choices for each question utilizing

a Likert scale. An opportunity was provided for the managers to type in additional comments

after their responses for questions utilizing a Likert scale. The survey was developed in the

University of Wisconsin Stout supported online survey tool, Qualtrics and consisted of sixteen

35

questions (see Appendix B). Total completion time of the survey was approximately five

minutes.

The consent to participate in research was asked prior to the viewing of any questions. The

survey questions requested information related to the manager's demographics, current pharmacy

technician staff demographics, hiring practices of pharmacy technicians and their perceived

value of pharmacy technician certification, training, and registration as applied in the pharmacy

setting. The survey for PSW members included an additional demographic question to specify if

they were a manager so that only pharmacy managers could be analyzed for this study. At the

request of PSW, two additional questions were added at the end of the survey in order to gather

comments on what additional technical duties may be assigned to credentialed technicians and

any other comments. The following research questions were the focus of the survey:

1. What is the perceived value to pharmacy managers of pharmacy technicians with formal

education/training in community, institutional, and combination (both

institutional and community) pharmacy settings?

2. What is the perceived value to pharmacy managers of certification of pharmacy

technicians in community, institutional, and combination (both institutional and

community) pharmacy settings?

3. What is the perceived value to pharmacy managers of registration of pharmacy

technicians in community, institutional, and combination (both institutional and

community) pharmacy practice settings?

4. In the opinion of pharmacy managers, will certification, formal training or registration

advance the roles of pharmacy technicians in a variety of pharmacy practice settings?

36

5. In the opinion of pharmacy managers, how might the implementation of pharmacy

technician standards such as certification, training or registration in Wisconsin affect the

workforce in a variety of pharmacy practice settings?

Data Collection

Upon approval of the survey through the Institutional Review Board for the Protection of

Human Subjects Data from the University of Wisconsin-Stout, the survey was dispersed

electronically through the online survey system Qualtrics. Two separate survey links were

created to keep the statewide pharmacy manager data separate from the data of PSW members.

An additional survey question was added to the PSW member survey to determine which

respondents were managing pharmacists. A database of statewide pharmacy managers was not

available, therefore, a directory of all community, long-term care and other practice setting

pharmacies in Wisconsin listed by county was obtained from two Medicare pharmacy benefit

managers (United Healthcare, 2010; WPS, 2010). A list of all Wisconsin Hospital pharmacies

was obtained from the Wisconsin Department of Health Services (DHS, 2011). Pharmacy

managers were contacted either through a listed email address on their pharmacy organization’s

website or through indirect contact through an online request system. A total of 251 electronic

messages along with the survey link were sent for pharmacy managers.

The district managers of several chain pharmacies were contacted for permission to

distribute the survey. Smaller community, and all hospital pharmacies were contacted based on

electronic communication capabilities. Distribution of the survey included a brief electronic

message identifying the researcher and the purpose of the study along with directions on

accessing the Qualtrics link (see Appendix A). Data was collected electronically in Qualtrics

during a two month period from October to November 2011.

37

The survey link for PSW members was sent to the PSW’s manager of publications and

communication. The survey was included in the PSW’s electronic newsletter Fast Facts in an

email message for all PSW members. Data was collected electronically in Qualtrics during a one

month period in November 2011.

Data Analysis

Analysis of the data was completed with Qualtrics, an online survey tool provided through

the University of Wisconsin-Stout. A total of 65 completed statewide manager surveys and 62

PSW manager surveys were included in the analysis. The surveys were statistically analyzed

separately as was the reporting of the data. Descriptive statistics, frequencies, percentages, and

chi-square tests were used to interpret the pharmacy manager’s responses. Cross tabulation was

utilized to determine frequencies of responses from five different pharmacy practice settings

(institutional, community, hospital & retail, long term care & retail, and other). A one-way

analysis of variance (ANOVA) was completed on the differences in the values amongst

pharmacy managers of the different pharmacy practice settings. Several chi-square tests were

used to determine any significance (p= 0.05) of the manager’s years of experience, number of

technicians supervised with certification or formal training, pharmacy setting, and hiring

conditions compared to their value of technician certification, registration and formal training.

Limitations

There were several limitations to this study particularly with the distribution of the online

survey link. Access to electronic means of sending an online survey to pharmacy managers was

very limited. Several large pharmacy organizations were not allowed to participate in outside

research studies due to corporate policies which limited the number of available pharmacy

38

managers. Distribution of the survey link may not have been directly sent to most pharmacy

managers. Lack of available time for the pharmacy manager to complete the survey may have

impacted response rates. Finally, several pharmacy organizations did not have electronic means

to forward the survey to the pharmacy manager.

39

Chapter IV: Results

The purpose of this study was to identify the perceived values of Wisconsin pharmacy

managers about pharmacy technician certification, formal training and registration. An online

survey was developed to capture the value placed on pharmacy technician certification, formal

training, and registration in a variety of pharmacy practice settings. The survey started with

questions collecting demographic information of the pharmacy manager and their current

pharmacy technician staff. The remainder of the survey contained questions centered around the

value and impact of potentially having certification, formal training and registration implemented

on the state level.

The survey was conducted using the University of Wisconsin-Stout supported online

survey tool, Qualtrics. Two separate survey links were created to keep the statewide pharmacy

manager data separate from the data of PSW members. An additional survey question was added

to the PSW member survey to determine which respondents were managing pharmacists. An

electronic message, found in Appendix A, was sent to the pharmacy manager at 251 pharmacy

locations out of the 1,107 listed pharmacies throughout Wisconsin. Several large pharmacy

chains were not able to participate in this study due to corporate policies. This reduced the

number of managers contacted by 41% throughout the state. A total of 78 surveys were

completed during the months of October and November 2011 for a response rate of 31%. Data

analysis was conducted only on the fully completed surveys which totaled 65. The findings of

the survey are reported in a descriptive and tabular format in the beginning of this chapter and

then applied to the research questions of this study in the latter half of the chapter.

40

The PSW cohort survey utilized the same survey in Qualtrics as found in Appendix A. A

total of 2,120 pharmacists received the PSW Fast Facts newsletter through an email message.

The PSW manager of publications and communication was able to monitor how many Fast

Facts emails were viewed. At the time of data collection, a total of 755 Fast Facts newsletter

messages were opened by both PSW pharmacists and pharmacy technician members. The

number of pharmacists within the PSW membership acting as the managing pharmacist is

unknown, therefore, an accurate response rate could not be calculated. A total of 153 surveys

were started and only 107 were fully completed by both managing and non-managing

pharmacists. Data analysis was conducted only on the fully completed surveys by the pharmacy

manager. This totaled 62 surveys. The findings of the survey questions are reported in a

descriptive and tabular format alongside the data results of the state wide survey.

Demographics

Respondents were pharmacy managers from a variety of pharmacy settings across the state

of Wisconsin. The online survey used to collect data for this study is found in Appendix B.

The demographics of the statewide pharmacy managers indicated 55% of managers have

been working for over 20 years as a licensed pharmacist, 13% had 15-20 years of experience,

16% had 10-15 years of experience, and a total of 18% had 1-10 years of experience as shown in

Table 1 in Appendix C. The majority of respondents were from community or retail pharmacy

(62%) with 20% from a pharmacy servicing an institutional setting. Community size was also

measured with the majority of respondents located in a large city of 6,000 to 50,000 people

(35%) or major metro area (46%) with more than 50,000 people while 15% were from a small

41

city of 1,000 to 6,000 people and 3% from a small rural town. Additional demographic data

from the pharmacy managers are found in Table 1 under Appendix C.

The zip code data indicated 32 Wisconsin counties out of 71 counties with pharmacy

locations and one Michigan county (bordering Wisconsin) were represented in this study to give

a 45% representation of the entire state by county (Appendix D). Florence was the only county

in Wisconsin with no pharmacy locations (DHS, 2009).

The PSW member survey respondents were pharmacy managers from a variety of

pharmacy settings across the state of Wisconsin. The same online survey in Qualtrics used to

collect data for this study and is found in Appendices B.

The demographics of the PSW pharmacy managers indicated 53% of managers have been

working for over 20 years as a licensed pharmacist, 15% had 15-20 years of experience, 8% 10-

15 years of experience, and a total of 24% had 1-10 years of experience as shown in Table 2

under Appendix C. The majority of respondents were from community or retail pharmacy (40%)

with 31% from a pharmacy servicing institutional settings. Community size was also measured

with 36% of respondents located in a large city of 6,000 to 50,000 people and 36% located in a

major metro area with more than 50,000 people while 23% were from a small city of 1,000 to

6,000 people and 5% from a small rural town. Additional demographic data from the pharmacy

managers are found in Table 2.

The zip code data indicated 39 Wisconsin counties out of 71 counties with pharmacy

locations and one Winona County in Minnesota, (bordering Wisconsin) were represented in this

study to give a 55% representation of the entire state by county (Appendix E).

42

Pharmacy Technician Demographics

Respondents were asked several questions regarding the pharmacy technicians currently

working in their pharmacy. The respondents reported the number of technicians they currently

supervised in their pharmacy setting. A cross-tabulation of the respondent’s pharmacy setting by

the number of technicians was completed. The overall average of pharmacy technicians

supervised for the statewide survey was 5.9 technicians (SD = 9.94) based on the average mean

from each of the five pharmacy settings. The PSW survey indicated pharmacy managers

supervised an average of 19.3 technicians (SD = 41.73). Figure 1 summarizes the average

number of pharmacy technicians by the respondent’s pharmacy setting.

Figure 1

The respondents were also asked to describe their current hiring conditions by the

availability of applicants. A cross-tabulation analysis by pharmacy setting indicated the majority

of settings had about the “right number” or “too many applicants” as shown in Table 3 and Table

4.

0

5

10

15

20

25

30

35

40

45

Freq

uenc

y

Number of Pharmacy Technicians

Pharmacy Technicians Supervised

Statewide PharmacyManagers

PSW PharmacyManagers

43

In the statewide survey, a cross-tabulation by community size was completed on the

community pharmacy setting which had 17.5% of respondents indicating “not enough

applicants” (Table 3). The majority of community pharmacy setting respondents (n = 40, 86%)

indicating “not enough applicants” were from communities of greater than 6,000 people and one

respondent from a community size of less than 6,000 people.

Table 3

Statewide Current Hiring Conditions

Institutional Community Long-term & Community

Hospital & Community

Other

n % n % n % n % n %

Too Many Applicants

1 8.3 10 25 0 0 0 0 2 33.3

About the right number

11 91.6 23 57.5 1 50 3 100 4 66.6

Not enough 0 0 7 17.5 1 50 0 0 0 0

44

The majority of surveyed PSW members from an institutional practice setting indicated

“not enough applicants” (n = 19, 47.4%) while majority of the remaining practice setting all

indicated “about the right number of applicants.” The majority of PSW respondents from a

rural, small city and large city all indicated “about the right number” of applicants (n = 4, 75%, n

= 15, 47% and n = 22, 50% respectively). A majority of respondents from a major metro

population had indicated “not enough” applicants (n = 24, 50%).

Table 4

PSW Member Current Hiring Conditions

Institutional Community Long-term & Community

Hospital & Community

Other

n % n % n % n % n %

Too Many Applicants

4 21 2 8 1 20 0 0 0 0

About the right number

6 31.6 11 44 3 60 3 50 3 42.8

Not enough 9 47.4 7 28 0 0 3 50 3 42.8

45

When asked how qualified applicants were in their area, the statewide respondents were

split equally at 47.5% for the selections of most applicants were “not well qualified” and

applicants were “adequately qualified.” Only 4.9% of respondents indicated most applicants

were “well qualified”. A cross-tabulation by pharmacy setting shows variance among the

different settings as represented in Table 5. Community pharmacy setting respondents were

equally split for “not well qualified” and “adequate qualifications” of applicants at 49% (n = 37)

while the majority of institutional (n = 13, 54%) respondents felt there was “adequate

qualifications” of applicants.

Table 5

Statewide Qualifications of Pharmacy Technician Applicants

Institutional Community Long-term & Community

Hospital & Community

Other

n % n % n % n % n % Most applicants not well qualified

5

38.5

18

48.6

1

50

2

66.6

3

50

Adequate qualifications

7 53.8 18 48.6 0 0 1 33.3 3 50

Most applicants well qualified

1 7.7 1 2.7 1 50 0 0 0 0

46

The majority of PSW members across all practice settings indicated applicants were “not

well qualified” as shown in Table 6 in ( x = 60%, SD = 16). A cross-tabulation by community

size determined that rural/small town respondents felt the qualifications of applicants were

“adequate.” This is in contrast to the other community sizes who felt that the majority of

technician applicants were “not well qualified.”

Table 6

PSW Members Qualifications of Pharmacy Technician Applicants

Institutional Community Long-term & Community

Hospital & Community

Other

n % n % n % n % n % Most applicants not well qualified

13

68.4

16

64.0

2

40

5

83.3

3

42.8

Adequate qualifications

5 26.3 5 20.0 2 40 1 16.6 3 42.8

Most applicants well qualified

1 5.2 1 4.0 0 0 0 0 0 0

Not sure 0 0 3 12.0 1 20.0 0 0 1 14.3

47

The current hiring practices of respondents was asked in a multiple choice format with

the following selections: requiring a high school diploma, minimum of one year of prior

experience, greater than one years of experience, certification, formal training and any other

option which allowed them to specify an additional practice not listed. Respondents were able to

select multiple hiring practices. Therefore the frequencies compiled will not equal 100%. The

majority of statewide and PSW respondents (70% and 77% respectively) indicated a high school

diploma requirement was desired when hiring a pharmacy technician (Table 7). A minimum of

one year of experience was sought by 23% of statewide and 18% of PSW respondents.

Certification and greater than one year of experience each received a 19% response rate amongst

statewide respondents.

Table 7

Current Hiring Practices

Statewide Hiring Condition n %

PSW Members n %

High School Diploma 45 70 48 77

Minimum of 1 year prior experience 15 23 11 18

>1 year of prior experience 12 19 5 8

Certification 12 19 9 15

Formal Training 2 3 4 6

Other 10 16 4 3

Note. Respondents were able to select a variety of hiring conditions.

48

A cross-tabulation of hiring practices by statewide respondents’ pharmacy setting

indicated that high school diploma was ranked the highest among the major pharmacy settings

except for the “other” practice setting which ranked (50%) minimum of one year of experience

as the top selection (Table 8). Both institutional also tend to hire based on a “minimum of 1 year

of experience” (n = 28, 33%) and “certification” (n = 28, 33%).

Table 8

Statewide Current Hiring Practices by Pharmacy Setting

Pharmacy Setting Hiring Condition Institutional Community

Combination - Long term Care & Retail

Combination - Hospital & Retail

Other

n % n % n % n % n % High school diploma

13 86.6 27 65.8 3 100 3 100 2 33.3

Minimum of 1 year prior experience

5 33.3 7 17.1 1 33.3 0 0 3 50.0

>1 year of prior experience

4 26.7 8 19.5 0 0 0 0 1 16.7

Certification

5 33.3 6 14.6 1 33.3 0 0 1 16.7

Formal training (college, on line program, etc.)

2 13.3 1 2.4 0 0 0 0 0 0

Other

2 13.3 6 14.6 0 0 1 33.3 1 16.7

Note. Respondents were able to select a variety of hiring conditions.

49

PSW respondents also were in the majority of selecting a “high school diploma” as a

hiring condition. A cross-tabulation by all of the respondents’ pharmacy setting found all

practice settings had a “high school diploma” requirement when hiring (Table 9). The

institutional and other respondents had also indicated a “minimum of 1 year of experience” as

the next most selected hiring condition (n = 27, 19% and n = 9, 33% respectively).

Table 9

PSW Member Current Hiring Practices by Pharmacy Setting

Pharmacy Setting Hiring Condition Institutional Community

Combination - Long term Care & Retail

Combination - Hospital & Retail

Other

n % n % n % n % n % High school diploma

14 51.9 19 57.6 5 100 5 71.4 5 55.5

Minimum of 1 year prior experience

5 18.5 3 9.0 0 0 0 0 3 33.3

>1 year of prior experience

1 3.7 4 12.1 0 0 0 0 0 0

Certification

3 11.1 4 12.1 0 0 2 28.6 0 0

Formal training (college, on line program, etc.)

3 11.1 1 3.0 0 0 0 0 0 0

Other

1 3.7 2 6.0 0 0 0 0 1 20.0

Note. Respondents were able to select a variety of hiring conditions.

50

Respondents were asked if pay incentives were given for various credentials of pharmacy

technicians. Higher pay for technicians with certification was the highest recorded response by

statewide respondents (70%), while years of experience came in second with 61% of respondents

and 47% indicated specialized training received higher pay wages (Table 10).

Table 10

Statewide Pharmacy Technician Pay Incentives

“Yes” Reponses Does your pharmacy… n % Pay higher wages to technicians with specialized training or education?

27 47

Pay higher wages to technicians with more years of experience?

35 61

Pay higher wages to certified technicians?

40 70

Pay for technicians’ continuing education courses? 15 26

Note. Respondents were able to select a variety of pay incentives.

51

The majority of PSW respondents indicated higher wages were paid to technicians with

more years of experience and certification (79% and 63% respectively) as shown in Table 11.

PSW respondents (40%) tend to offer payment for continuing education courses for technicians.

This is more than statewide respondents (26%).

Table 11

PSW Member Pharmacy Technician Pay Incentives

“Yes” Reponses Does your pharmacy… n % Pay higher wages to technicians with specialized training or education?

18 32

Pay higher wages to technicians with more years of experience?

45 79

Pay higher wages to certified technicians?

36 63

Pay for technicians’ continuing education courses? 23 40

Note. Respondents were able to select a variety of pay incentives.

Further background information was gathered on the pharmacy manager’s experience

working with pharmacy technicians who had either certification and/or formal training.

Respondents were first asked to indicate the percent of currently supervised pharmacy

technicians who were certified. Statewide pharmacy managers supervising technicians with

certification was at 71% of the total respondents while 29% had no pharmacy technicians with

certification. Institutional pharmacy managers had the highest percent of pharmacy technician

staff certified at 77%, while only 30% of community pharmacy managers reported staff with

certification. The percent of certified staff reported by respondents was 57%. PSW respondents

52

also had similar results with 74% supervising certified technicians with only 26% supervising no

certified technicians.

The types of incentives for certified pharmacy technicians was also gathered. The

number of statewide respondents indicating incentives was slightly higher (59%) than those with

no incentives (41%). PSW respondents also indicated a majority (66%) provided incentives for

certified technicians. Respondents providing incentives were further asked to indicate the types

of incentives provided for certified technicians. Statewide respondents indicated wage increase

was the highest selected incentive at 72% and payment of the certification exam along with the

renewal fee each received 10%.

The respondents who indicated no incentives were asked to select or specify a reason.

This is summarized in Table 12. Financial reasons, no interest by management and other reasons

received the most selections from the respondents. The majority of PSW respondents (46%)

stated that management had no interest and 29% indicated a lack of interest by pharmacy

technicians.

Table 12

Reasons for No Incentives for Pharmacy Technician Certification

Statewide Reasons n %

PSW Members n %

Not familiar with certification 2 6 1 4

Financial reasons 9 29 2 8

No interest by management 7 23 12 46

Lack of interest by technicians 2 6 5 19

Does not apply to pharmacy setting 3 10 6 6

Other 8 26 7 7 Note. Respondents were able to select several incentives.

53

Data collection on the number of respondents supervising formally trained technicians

followed. The number of statewide respondents with no formally trained pharmacy technicians

was the majority at 60% in contrast to the PSW member survey which had 52% of respondents

with no formally-trained technicians. Respondents with formally trained technicians were asked

to provide a percentage of technicians with formal training. The statewide respondents indicated

an average of 36% (SD = 29) of their staff had formal training. PSW respondents averaged 20%

(SD = 15) of trained staff. A cross-tabulation by pharmacy practice setting indicated the majority

of both statewide and PSW respondents from an institutional setting were supervising a formally

trained technician (n = 13, 77% and n = 19, 74%).

The type of training that a newly-hired pharmacy technician goes through was also asked

of the pharmacy managers. The majority of statewide respondents indicated either one (59%) or

two (88%) pharmacy staff was involved with training a new hire. The majority of PSW

respondents (84%) indicated multiple staff members were required for training of newly hired

technicians.

The last four survey questions covered the five research questions addressed in this study.

Responses are based on a Likert scale. Results of these final survey questions will be analyzed

by their correlation to the research questions.

Research Question 1: What is the perceived value to pharmacy managers of pharmacy

technicians with formal education training in various practice settings?

This question on the survey sought the perceived value of the pharmacy manager to

pharmacy technician formal training, certification, and registration. A Likert scale (strongly

54

value, value, neutral, somewhat value, and no value) was utilized to rate their value level for

each technician standard. Formal training had the majority of statewide respondents indicating

“strongly value” at 44% while 30% selected “value.” No statewide respondents indicated a

selection of “no value” for formal training. A cross-tabulation by pharmacy practice setting

found that a high percentage of statewide institutional respondents indicated a “strongly valued”

view towards formal training in comparison to other the practice settings as shown in Figure 2 (n

= 13, 77%). A chi square analysis of statewide respondents was conducted to compare the value

of formal training among managers who supervised and those who did not supervise formally-

trained technicians. The difference between these respondents was significant, X2 (4, N = 63) =

9.63, p = .05. A one-way analysis of variance (ANOVA) further indicated a significant

difference among the respondents’ experience supervising formally- trained technicians, F(1, 61)

= 7.82, p <.01. Statewide respondents who supervised formally- trained technicians significantly

valued formal training more than respondents supervising no formally- trained technicians.

Figure 2

02468

10121416

StronglyValue

Value Neutral SomewhatValue

No Value# of

Man

agin

g Ph

arm

acis

ts

Value of Formal Training

Statewide Value of Formal Pharmacy Technician Training by Pharmacy Setting

Institutional (hospital, longterm care, etc..)Community

Combination - Long termcare & RetailCombination - Hospital &RetailOther

55

PSW members also “strongly value” at 47% and 29% “value” formal training with only

one respondent indicating “no value.” A cross-tabulation by pharmacy practice setting indicated

a high percentage of PSW institutional respondents “strongly valued” formal training in

comparison to other practice settings as shown in Figure 3 (n = 19, 74%). A chi square analysis

of PSW respondents was conducted to compare the value of formal training among managers

who supervised and those who did not supervise formally-trained technicians. The difference

between these respondents was significant, X2 (4, N = 62) = 12.03, p = .02. Using a one-way

analysis of variance (ANOVA), a higher value was significantly placed on formal training

among the PSW respondents supervising formally trained technicians, F(1, 60) = 9.18, p < .01.

Figure 3

02468

10121416

StronglyValue

Value Neutral SomewhatValue

No Value# of

Man

agin

g Ph

arm

acis

ts

Value of Formal Training

PSW Member Value of Formal Pharmacy Technician Training by Pharmacy Setting

Institutional (hospital, longterm care, etc..)Community

Combination - Long termcare & RetailCombination - Hospital &RetailOther

56

When asked how likely the respondents would support a formal training requirement,

60% (n = 64) of statewide respondents indicated they would support a future training

requirement. An opposition for a future formal training requirement was indicated by 27% (n =

64) of statewide respondents. The majority of PSW respondents (n = 61, 69%) also indicated

support of a future formal training requirement while 18% did not. Using a one-way analysis of

variance (ANOVA), significant differences for the support of a future formal training

requirement among the PSW respondents was determined across the different pharmacy practice

settings, F(4, 56) = 5.10, p = .001. PSW institutional and the hospital/community combination

practice setting respondents were all in consensus at 100% of support towards a formal training

requirement. An analysis of respondents supervising certified technicians indicated a significant

difference in the support for formal training, F(1, 59) = 5.13, p < .05. There was also a

significant difference among respondents supervising formally-trained technicians, F(1, 60) =

10.25, p < .01. The PSW community pharmacy practice setting respondents had the most

opposing views among the different practice settings (n = 25, 32%).

57

Research Question 2: What is the perceived value to pharmacy managers of certification

of pharmacy technicians in a variety of pharmacy practice settings?

Certification also had the majority of statewide respondents indicating a “strongly value”

to “value” rating (31% and 29% respectively). A cross-tabulation by pharmacy settings indicates

respondents from all settings except the institutional & community practice settings all had a

≥60% indication of a “strongly value” to “value” rating towards certification (Figure 4). A one-

way analysis of variance (ANOVA) was performed on the various demographic variables in

relation to responses for this question. This led to no significant differences in the data.

Figure 4

0

2

4

6

8

10

12

StronglyValue

Value Neutral SomewhatValue

No Value# of

Man

agin

g Ph

aram

cist

s

Value of Certification

Statewide Value of Phamacy Technician Certification by Pharmacy Setting

Institutional (hospital,long term care, etc..)Community

Combination - Long termcare & RetailCombination - Hospital &RetailOther

58

The majority of PSW members also indicated a “strongly” to “value” rating towards

certification of pharmacy technicians (36% and 34% respectively). A cross-tabulation by

pharmacy setting indicates respondents from across all pharmacy practice settings had a >60%

indication of a “strongly value” to “value” rating towards certification (Figure 5). A chi square

analysis of PSW respondents was conducted to compare the value of certification with managers

who supervised to those who did not supervise certified technicians. The difference between

these respondents was significant, X2 (4, N = 62) = 21.94, p < .01. Using a one-way analysis of

variance (ANOVA), a higher value was significantly placed on certification among the PSW

respondents supervising certified technicians, F(1, 57) = 15.62, p < .001.

Figure 5

When asked how likely the respondents would support a certification requirement, 60%

(n = 62) of statewide respondents indicated they would “strongly” to “somewhat” support a

future certification requirement. “Strongly” to “somewhat” opposition for a future certification

requirement was indicated by 27% (n = 62) of statewide respondents.

0

2

4

6

8

10

12

StronglyValue

Value Neutral SomewhatValue

No value# of

Man

agin

g Ph

aram

cist

s

Value of Certification

PSW Member Value of Pharmacy Technician Certification by Pharmacy Setting

Institutional (hospital, longterm care, etc..)Community

Combination - Long termcare & RetailCombination - Hospital &RetailOther

59

PSW respondents also indicated in the majority (n = 60, 68%) of “strongly” to

“somewhat” support for a future certification requirement while 15% (n = 60) had a “somewhat”

to “strongly” opposing view. A chi square analysis of PSW respondents was conducted to

compare the support for a certification requirement among managers who supervised and those

who did not supervise certified technicians. The difference between these respondents was

significant, X2 (4, N = 60) = 12.13, p = .02. A chi square analysis of PSW respondents by

community size also indicated a significant difference, X2 (12, N = 59) = 24.42, p = .02. Using a

one-way analysis of variance (ANOVA), significant differences of the support for a future

certification requirement among the PSW respondents was determined across the different

pharmacy practice settings, F(4, 55) = 3.26, p < .05. PSW institutional and hospital/community

combination practice setting respondents were all in consensus at 100% for support towards a

certification requirement. An analysis of respondents supervising certified technicians indicated

a significant difference in the support for certification, F(1, 58) = 7.28, p < .01.

60

Research Question 3: What is the perceived value to pharmacy managers of registration of

pharmacy technicians in a variety of pharmacy practice settings?

Registration values of the statewide and PSW member respondents had the greatest

variance of the three pharmacy technician standard values. The majority of statewide resondents

indicated either a “strongly value” or “value” at 42% while 30% felt neutral. A cross-tabulation

by pharmacy setting indicates respondents from across all pharmacy practice settings had a

≥50% indication of a value rating towards registration (Figure 6). A chi square analysis of

statewide respondents was conducted to compare various demographic variables of respondents

in relation to responses for this question. This led to no significant differences in the data.

Figure 6

0

2

4

6

8

10

12

14

16

StronglyValue

Value Neutral SomewhatValue

No Value

# of

Man

agin

g Ph

arm

acis

ts

Value of Registration

Statewide Value of Pharmacy Technician Registration by Pharmacy Setting

Institutional (hospital,long term care, etc..)Community (retail)

Combination - Longterm care & RetailCombination - Hospital& RetailOther (please specify)

61

PSW respondents also indicated a “strongly value” or “value” at 56% with 20% feeling

“neutral” and 18% finding “no value” towards registration. A cross-tabulation by pharmacy

setting indicates that community respondents were equally spilt at 40% (n = 25) between a

valued and neutral rating towards registration (Figure 7). The long term care & community

combination practice setting was equally spilt at 40% (n = 5) between a “value” and a “no value”

rating. Institutional along with the hospital & community combination practice setting

respondents had a higher percentage valuing registration (n = 19, 85% and n = 6, 100%). A chi

square analysis of PSW respondents was conducted on the various demographic variables in

comparison to this question. A significant difference among respondents who supervised and

those who did not supervise certified technicians was found, X2 (4, N = 61) = 17.83, p < .01.

Using a one-way analysis of variance (ANOVA), a higher value was significantly placed on

registration among the PSW respondents supervising certified technicians, F(1, 60) = 16.12, p <

.001.

Figure 7

0

2

4

6

8

10

12

StronglyValue

Value Neutral SomewhatValue

No Value# of

Man

agin

g Ph

aram

cist

s

Value of Registration

PSW Member Value of Pharmacy Technician Registration by Pharmacy Setting

Institutional (hospital, longterm care, etc..)Community

Combination - Long termcare & RetailCombination - Hospital &RetailOther

62

When asked how likely the respondents would support a registration requirement, 55% (n

= 62) of statewide respondents indicated they would support a future registration requirement.

An opposition for a future registration requirement was indicated by 21% (n = 62) of statewide

respondents. PSW respondents also indicated in the majority (n = 60, 63%) for a support of a

future registration requirement while 20% (n = 60) opposed a registration requirement. A chi

square analysis of PSW respondents was conducted to compare the support for a registration

requirement with managers who supervised to those who did not supervise certified technicians.

The difference between these variables was significant, X2 (4, N = 60) = 20.51, p < .01. A chi

square analysis of PSW respondents by community size also indicated a significant difference,

X2 (12, N = 59) = 24.07, p = .02. The majority of PSW respondents (n = 14, 43%) from a small

city indicated a “neutral” view towards registration while a high percentage of major metro

respondents (n = 22, 92%) valued a registration requirement for technicians.

Overall, registration received the highest selection of a “no value” rating among the

statewide and PSW respondents (n = 60, 17% and n = 62, 18% respectively).

63

Research Question 4: In the opinion of pharmacy managers, will certification, formal

training or registration advance the roles of pharmacy technicians in a variety of pharmacy

practice settings?

To address this research question, a Likert scale with the selections of high advancement,

some advancement, neutral, and no advancement was provided. The selection of “some

advancement” received the majority vote among statewide respondents with an overall response

average of 44% (SD = 2.9) as shown in Table 13. A chi square analysis of statewide

respondents was conducted to compare various demographic variables of respondents in relation

to responses for this question. This led to no significant differences in the data.

Table 13

Statewide Advancement of Pharmacy Technician Roles

High Advancement

Some Advancement

Neutral No Advancement

n % n % n % n % Certification 12 18.5 29 44.6 12 18.5 12 18.5

Formal Training

11 16.9 31 47.7 12 18.5 11 16.9

Registration 5 7.8 26 40.6 15 23.4 18 28.1

64

PSW respondents viewed “some advancement” with certification and registration (54%

and 28% respectively) with “high advancement” placed on formal training (41%) as shown in

Table 14. A chi square analysis of PSW respondents was conducted on various demographic

variables in comparison to this question by each technician standard. A significant difference

among respondents from the different community sizes was found in relation to certification, X2

(9, N = 60) = 17.61, p = .04. Respondents from a small city were split between “some

advancement” and a “neutral” selection towards certification while the majority of other

community sizes selected an advancement rating towards certification. A significant difference

among respondents supervising formally-trained technicians was found in relation to formal

training, X2 (3, N = 61) = 9.57, p = .02. In addition, a significant difference was determined

among respondents from the different practice settings in relation to registration, X2 (15, N = 61)

= 36.08, p < .01. Using a one-way analysis of variance (ANOVA), a significant difference was

indicated among the different pharmacy practice settings towards registration, F(4, 56) = 5.46, p

= .001. The majority of community practice setting respondents viewed registration as providing

no advancement for pharmacy technicians (n = 25, 40%).

Table 14

PSW Member Advancement of Pharmacy Technician Roles

High Advancement

Some Advancement

Neutral No Advancement

n % n % n % n % Certification 14 23.0 33 54.1 8 13.1 6 9.8

Formal Training

25 41.0 20 32.8 11 18.0 5 8.2

Registration 8 13.1 17 27.9 21 15.0 15 24.6

65

Research Question 5: In the opinion of pharmacy managers, how might the

implementation of pharmacy technician standards such as certification, training or

registration in Wisconsin affect the workforce in a variety of pharmacy settings?

Pharmacy managers were asked to provide their opinion on how the implementation of a

pharmacy technician standard would impact the workforce in their pharmacy setting. A Likert

scale (strong positive impact, positive impact, neutral, negative impact, and strong negative

impact) was provided for each of the three standards being studied. When comparing

respondents from all pharmacy settings amongst statewide managers, certification was

considered a “positive impact” in 32% and 34% indicated a “neutral” impact (Table 15). Formal

training was viewed by the majority of respondents to have a “positive impact” at 39% and 26%

felt “neutral”. The majority of respondents (49%) indicated a “neutral” view towards the impact

of registration on their technician staff. On average, 21% (SD = 1.46) of respondents felt a

“strong negative to negative impact” towards each technician standard.

Table 15

Statewide Impact of Pharmacy Technician Standards on Staff

Strong Positive Impact

Positive Impact

Neutral Negative Impact

Strong Negative Impact

n % n % n % n % n % Certification 8 12.3 21 32.3 22 33.8 10 15.4 4 6.1

Formal Training

7 10.8 25 38.5 19 29.2 10 15.4 4 6.1

Registration 4 6.1 17 26.2 32 49.2 9 13.8 3 4.6

A chi square analysis of statewide respondents was conducted on various demographic

variables in comparison to this question by each technician standard. A significant difference

66

among respondents from the different community sizes was found in relation to certification, X2

(12, N = 65) = 21.61, p = .04. Certification was valued by the majority of respondents from

across all community sizes (≥50%).

When comparing PSW respondents from all pharmacy settings, certification was reported

to be a “positive impact” in 46% (Table 16). Formal training was viewed by the majority of

respondents to have a “strong positive impact” at 32%. The majority of respondents (42%)

indicated a “neutral” view towards the impact of registration on their technician staff.

Table 16

PSW Member Impact of Pharmacy Technician Standards on Staff

Strong Positive Impact

Positive Impact

Neutral Negative Impact

Strong Negative Impact

n % n % n % n % n % Certification 14 23 28 45.9 12 18.7 6 9.8 1 1.6

Formal Training

20 32.3 18 29 14 22.5 8 12.9 2 3.2

Registration 9 14.5 15 24.2 26 41.9 9 14.5 3 4.8

A chi square analysis was also conducted on PSW respondents based on the various

demographic variables in comparison to this question by each technician standard. A significant

difference among respondents supervising certified technicians was found in relation to

certification, X2 (4, N = 61) = 13.94, p < .01. PSW respondents supervising certified technicians

tend to view the impact of certification as positive (n = 46, 80%) while those who supervise no

certified technicians tend to feel more “neutral” towards the impact of certification (n= 15, 40%).

A significant difference among PSW respondents was also found in the different practice settings

67

in relation to the impact of formal training, X2 (15, N = 61) = 36.08, p < .01. Using a one-way

analysis of variance (ANOVA), a significant difference was found among the different pharmacy

practice settings towards the impact of formal training, F(4, 57) = 6.95, p < .001. The

community pharmacy practice setting had the highest number of PSW respondents indicating a

“neutral” and a “strong negative” to “negative impact” of formal training among the practice

settings (n = 25, 32% and n = 25, 32% respectively). A final chi square analysis was performed

on PSW respondents based on the impact of registration compared to the various demographics.

A significant difference among PSW respondents was found among the different community

sizes towards the impact of registration, X2 (12, N = 61) = 21.08, p = .05. A one-way analysis of

variance (ANOVA), showed there was a significant difference among the different pharmacy

practice settings towards the impact of formal training, F(3, 57) = 3.97, p < .01. The majority of

PSW respondents from a small city and large city both indicated a neutral view towards the

impact of registration (n = 14, 50% and n = 55% respectively) while major metro respondents

indicated an overall positive impact towards registration (n = 22, 68%).

68

Chapter V: Discussion

The purpose of this study was to identify the perceived values of Wisconsin pharmacy

managers about pharmacy technician certification, formal training, and registration in a variety

of pharmacy practice settings and demographics. A secondary purpose was to provide data for

PSW for future collaboration of a taskforce focused on potential credentialing requirements for

pharmacy technicians in Wisconsin. This chapter will discuss the results of the study as it relates

to past research, as well as current and future implications of the research. The limitations of the

survey will also be examined and final recommendations for future studies on pharmacy

technician standards will be discussed.

Conclusions

Pharmacy technicians are not regulated by the state of Wisconsin. Varying regulations

and standards for pharmacy technicians in many other states pose questions for the types of

standards Wisconsin should implement. PSW conducted a member-only study in 2008 on

medication safety and pharmacy technician credentialing (PSW, 2009). The general consensus

from the survey was brought forth to a PSW assigned taskforce in 2009 with recommendations

favoring a requirement that technicians have a high school diploma, be 18 years of age and be

registered through the state (PSW, 2009). The survey was constructed to provide a very limited

view towards technician credentialing. The results of this study provided a multifaceted view of

both PSW members and statewide pharmacy managers’ values towards credentialing.

69

Formal Training

The standards for pharmacy technician training vary among the current thirty-three states

with either formal or onsite pharmacy training requirements (NABP, 2011). Wisconsin currently

has no requirements on the training of pharmacy technicians. The majority of managers in this

study indicated that they relied on multiple staff members to assist in the training of newly-hired

pharmacy technicians. There are very few health occupations that practice this in-the workplace

training (Myers, 2011). Educational requirements along with certification standards are typically

required prior to employment for most medical occupations such as medical clinical laboratory

technologists and dental assistants (Myers, 2011).

This study also found that a large percentage of statewide and PSW pharmacy managers

indicated a valued rating towards formal training in their practice setting (n= 63, 89% and n= 62,

82% respectively). These findings are similar to a national Canadian pharmacy manager study

which found 86% of pharmacists supported a formal training program provided by a community

college for pharmacy technician training (Vision, 2007). Pharmacy managers supervising

formally-trained pharmacy technicians had a significantly higher value towards formal training

(p < .05). Given this information, it can be assumed that managers supervising technicians with

formal training tended to have a stronger value towards formal training due to their experience

supervising a formally-trained technician. This finding provides some indication that formal

training may be adequately preparing a person to work as a technician and managers are satisfied

with how formal training prepares technicians to work in their practice setting. However, there

is very limited information available about formally-trained technicians and their performance

(Dresselle, 2005). A future study on the formal training of pharmacy technicians across all

70

practice settings would be beneficial in providing further data on how formal training affects a

technician’s job performance.

A closer examination of all responses by practice setting shows that statewide and PSW

managers from the institutional practice setting all indicated a valued rating towards formal

training (100%) in comparison to the managers of community practice settings (n=40, 85% and

n=25, 76% respectively). The majority of managers within the institutional practice setting were

from a hospital pharmacy where technician tasks tend to require extensive training (Myers,

2011). The ASHP (American Society of Health-System Pharmacists) is an accrediting body for

pharmacy technician programs that have been proactive in pushing for standardized technician

training (ASHP, 2011). Hospital pharmacy managers may be more aware of the benefits of

formal training for technicians due to the complex medication preparation required for patient

care.

Currently many community pharmacies will train a new pharmacy technician through an

onsite training program as opposed to completing a formal training program (Myers, 2011). Due

to the variances in how pharmacies operate, site-specific training is typically required regardless

of previous work experience. The value of formal training may not be viewed as a necessity due

to the site-specific training a new hire must already complete. However, it has been suggested

that formal training can complement the site-specific training a new pharmacy technician

completes (Rouse, 2003). Further research is warranted among community pharmacists and their

views towards formal training for pharmacy technicians working in their practice setting.

In 2009, the PSW taskforce indicated that the implementation of a training program

requirement for Wisconsin pharmacy technicians was not recommended due to the potential of a

71

workforce shortage in qualified technicians (PSW, 2009). To address PSW’s concerns of a

shortage of qualified technicians if a formal training requirement was implemented, a review of

other states with similar requirements needs to be examined further. Florida is a state that, as of

2010, requires any individual seeking initial pharmacy technician registration must be 17 years

of age, register with the Florida Boards of Pharmacy, and complete a state board approved

training program or be certified (S.B.1360, 2008). Florida’s Board of Pharmacy gradually

implemented the various technician standards over several years along with providing

exemptions for experienced technicians (Wilson, et.al., 2010). A study by Wilson, et.al (2010),

has shown the transition of the various standards in Florida has little effect on the existing

pharmacy technician workforce. Another international example of how new pharmacy

technician standards can be implemented is Ontario, Canada’s new standards. The recent

implementation of a formal training requirement in Ontario has provided current technicians a

grace period and special programs such as the “Bridging Education Program” which replaces the

mandatory completion of a formal training program for current technicians (“Ontario,” 2011).

Certification

The majority of health occupations require certification prior to working in a designated

field after completion of required education or training (Myers, 2011). Traditionally, there has

been opposition by pharmacists towards the expansion of technician roles and implementation of

technician regulations (CCP, 2003). As pharmacy technician roles have expanded into the

traditional roles of pharmacists, the attitudes of pharmacists has begun to shift. The results of

this study concur with a national survey conducted by the Pharmacy Technician Certification

Board (PTCB, 2007) which indicated 83% of pharmacists studied nationally value technician

certification. The pharmacy managers in this study placed value on certification in their

72

pharmacy practice setting. PSW managers valued certification slightly higher than statewide

managers (n = 59, 76% and n = 58, 71% respectively). This coincides with the past PSW survey

conducted in 2008 which found 63% of all members favored a certification requirement for

pharmacy technicians.

The majority of statewide and PSW managers in this study indicated they supervised a

technician with certification (n = 65, 71% and n = 62, 74% respectively). Wisconsin currently

has 4,436 certified technicians which accounts for 61% of all technicians working in the state

(BLS, 2011c: PTCB, 2011). Further analysis across the different practice settings found that a

high percentage of statewide and PSW managers from an institutional setting supervised certified

technicians (n = 13, 77% and n = 19, 94%). Similar results are seen in a national Canadian study

of pharmacy managers that indicated hospital-based (institutional) were twice as likely to report

employing certified and college-educated technician on staff (Vision, 2007). This high

percentage of hospital pharmacy managers with certified technicians may be related to ASHP’s

2015 initiatives which recommends that 85% of technicians in a health system be certified by

2015 (ASHP, 2008).

When looking across the demographics of managers, PSW managers with experience

supervising certified pharmacy technicians had a significant valued response towards

certification versus those with no experience (p < .001). This was also true across all pharmacy

practice settings among the statewide and PSW managers, certification was considered to have

value by the majority of managers (≥60%). The data in this study provides an indication that

Wisconsin pharmacy managers supervising certified technicians tended to have a positive view

towards the value of certification. This is consistent with previous studies that indicated

73

pharmacists who have worked with certified technicians tended to have a positive view towards

technician certification (Dresselle & Schmitt, 2009; 2010).

The majority of statewide and PSW managers felt certification would advance the roles

of pharmacy technicians in a variety of practice settings (n= 65, 63% and n = 61, 77%

respectively). This result questions the previous PSW taskforce recommendations in 2009 which

did not recommend a certification requirement for pharmacy technicians in Wisconsin due to the

lack of evidence that the exam would provide competent technicians. Desselle & Schmitt

(2009) completed a limited study on the attitudes of pharmacists towards certification of

pharmacy technicians. The results of their study indicated pharmacists had a positive attitude

towards technician certification and that certified technicians were able to perform higher skilled

pharmacy tasks. This study also indicated that a major barrier to certification is the lack of

professional recognition by the public and healthcare professionals.

Currently no data exists on the extent of errors occurring with pharmacy technicians who

are certified versus those who have completed a formal training program (Myers, 2011).

However, a national survey conducted by PTCB showed that over 80% of pharmacists agreed

that certification supports proper drug preparation and distribution, reduces the number of

medication errors and improves patient safety (Manasse & Menighan, 2011). In Wisconsin there

are 7,310 pharmacy technicians of whom 4,436 are certified in Wisconsin (BLS, 2011c: PTCB,

2011). Further studies on the performance of pharmacy technicians with certification in

Wisconsin may be warranted to provide further data on the impact of certification in relation to

technician competencies for specific pharmacy practice settings.

74

Registration

The registration requirement for pharmacy technicians varies among states (NAPB,

2011). Current registration practices of pharmacy technicians in most states include an age

requirement, passing a criminal background check, and an annual renewal fee with the state

board. The Minnesota State Pharmacy Board utilizes registration of pharmacy technicians as a

means to identify, track, and impose disciplinary action for any violations of pharmacy law (Ch.

6800, 2008). Limited studies have been conducted about the value of registration requirements

for pharmacy technicians. The PSW taskforce utilized the results of a PSW member survey in

2008 to recommend a technician registration requirement along with a high school diploma and

age requirement of 18 years for technicians employed in the state (PSW, 2009). The taskforce

indicated that registration is considered the minimum standard used by other states and can be

easily implemented. The results of this study found registration to be the least-valued standard

for technicians.

When reviewing the results from this study, pharmacy managers expressed a “value” to

“neutral” response towards technician registration. This was lower than the combined valued

responses of both statewide and PSW mangers in this study (53% and 61% respectively).

Perhaps this is an indication that more clarity to the details of a registration requirement is

necessary for those with a “neutral” point of view. A higher percentage of statewide and PSW

managers indicated no value for registration in comparison to formal training and certification

(n= 10, 17% and n= 11, 18%). Another interesting result was that PSW respondents supervising

no certified technicians significantly indicated registration had “no value” towards their practice

setting (p < .01). The previous PSW member (2008) study had indicated 70% of respondents

favored a registration or licensure requirement for Wisconsin technicians.

75

Of the responses towards the type of advancement for pharmacy technicians, PSW

pharmacy managers from a community pharmacy setting significantly view registration as

providing no advancement for pharmacy technician roles in their practice setting (n= 25, 40%, p

< .01). As indicated by Rouse (2003), registration is a list and does not indicate or guarantee the

knowledge and skills of a pharmacy technician. This is an interesting finding, since technicians

working in institutional practice settings tend to require more skills than those in a community

setting (Myers, 2011). The majority of statewide respondents indicated “some advancement”

with certification (44.6%), formal training (47.7%) and registration (40%). Implementing a

registration requirement for pharmacy technicians is viewed as a potential negative impact to

technician staff by the majority of PSW community pharmacy setting managers (n= 25, 32%).

When comparing the community size of the PSW responses, a significant number of managers

from both a small city and large city indicated a “negative impact” on their technician staff if

registration was implemented (p > .01). This result indicates that specific community sizes and

the community practice setting managers have a tendency to view registration as having a

negative impact on technician staff. Perhaps managers from smaller community settings are

concerned with technicians willing to comply with new requirements (PSW, 2009). A national

Canadian pharmacy manager study indicated a majority of rural to small community sized

practice settings tend to have less hiring conditions due to the lack of well-qualified applicant

pools (Vision, 2007). This study found that 100% (n = 2) of the statewide rural and 52% (n =

14) of small city PSW managers indicated technician applicants were not well qualified. Further

research should focus on determining reasons for the negative view on technician registration.

76

Future Support

Future support of formal training, certification, and registration for pharmacy technicians

is supported by the majority of all pharmacy managers surveyed. In Canada, similar results were

found in a national survey designed to measure the attitudes of pharmacists towards future

technician standards (Vision, 2007). When reviewing responses across practice settings,

community setting managers had the greatest variance in values placed on each technician

standard. This finding may indicate potential concerns community chain pharmacies tend to

have towards mandating technician standards…especially training and certification (Alkhateeb,

2011). These concerns range from economic factors, accessibility of training for technicians,

and demand for higher wages coinciding with new standards. An additional finding was that a

significant number of PSW mangers supervising certified technicians indicated a “strongly

value” to “value” response towards both certification and registration (p < .001 & p < .001).

According to a qualitative study by Dresselle & Schmitt (2009), pharmacists with certified

technician staff had also indicated an overall positive perception of technician certification.

Advancing Roles of Pharmacy Technicians

Based on the findings of this study, the advancement of pharmacy technician roles with

either certification, formal training or registration was indicated by majority of pharmacy

managers as providing “some advancement.” Further analysis of how each standard can advance

the roles of pharmacy technicians is needed. PSW managers from a community pharmacy

setting significantly viewed registration as providing no advancement for pharmacy technicians

(p = .001). Perhaps the community managers feel registration is a current duplication of their

77

current hiring practice…such as conducting a background check which registration provides on

the state level (PSW, 2009). This is an interesting finding which requires further investigation.

Limitations

Several limitations should be taken in consideration when reviewing the results of this

study. The sample size was limited by availability of contact information for pharmacies in

Wisconsin and issues of approval of the survey being sent to pharmacy managers within larger

organizations. Several requests submit electronically and via email were not sent directly to the

pharmacy manager. This may have affected survey response numbers.

A second limitation was the demographics of the sample responding to the survey. The

majority of respondents were from a large to major metro area. Differences between

geographical areas should be taken into consideration when analyzing and drawing conclusions

from this data.

A third limitation is that the survey was restricted to pharmacy managers in the state of

Wisconsin. A sample of all pharmacists may provide more generalized data on the perceived

value of the pharmacy technician standards in this study. However, the sample of pharmacy

managers in this study does provide data on pharmacists who are directly involved with hiring

and supervising pharmacy technicians.

Recommendations

With the increasing number of states implementing a blend of pharmacy technician

standards, the current recommendation by PSW (2009) to implement only a registration standard

needs to be re-examined. The majority of pharmacy managers both statewide and from PSW

78

have indicated they support future implementation of a formal training requirement, certification,

and registration in Wisconsin. A review of other states and countries with standards can be

utilized to carefully develop and implement technician standards with minimal affects across all

pharmacy practice settings.

Future research may want to explore pharmacy managers’ perceived value towards

technician regulations in smaller cities to rural pharmacy practice settings since this survey

received a low response rate from that population. The few respondents in this study from small

cities and rural practice settings indicate a majority feel uncertain or negative towards

implementing regulations for pharmacy technicians. A future study with a larger sample could

further examine the value placed on pharmacy technician standards among small to rural practice

settings.

Throughout this study, community practice pharmacy managers had a larger percent of

those indicating an opposing or negative view towards pharmacy technician formal training,

certification, and registration in compared to other practice settings. Further research could

investigate reasons as to why pharmacy technician standards are not supported.

Finally, the results of this study can be further disseminated in collaboration with PSW

members. An invitation has been made by PSW for participation in a future taskforce focused

on pharmacy technician credentialing for Wisconsin and publication of this study in their journal

(JPSW). The data collected in this study can provide guidance for PSW’s future

recommendations for the state pharmacy board on the direction Wisconsin should go with

pharmacy technician standards.

79

Appendix A: Electronic Message for Online Survey Link

October 2011

Dear Pharmacy Manager,

I am a graduate student at the University of Wisconsin Stout conducting a thesis study on the perceived

value of potential Wisconsin pharmacy technician regulations. The purpose of this survey is to gather

insights from pharmacy managers across Wisconsin in order to gain perspectives on the current desired

direction for various potential technician regulations.

Below is a link to a brief confidential online survey through Qualtrics which is a university approved

survey system. This survey is comprised of a variety of multiple choice questions about your perceived

value towards various pharmacy technician regulations. The survey should only take 5 minutes to

complete. Responses from the survey will be kept anonymous. The report of the survey will not include

any information that will make it possible to identify you.

I hope you will take a few minutes to complete this survey. Your input is greatly appreciated.

Survey Link: https://uwstout.qualtrics.com/SE/?SID=SV_d11Z5BuZquje3bu

If you have any questions or concerns about completing the survey or about participating in this study,

you may contact me at (715) 852-1390 or at myhreoechslej@my.uwstout.edu. If you have any questions

about your rights as a research subject, you may contact the UW-Stout Institutional Review Board (IRB)

by email at 152 Vocational Rehabilitation Bld., UW-Stout, Menomonie, WI 54751, by phone at (715) 232-

1126, or by e-mail at foxwells@uwstout.edu. This study was approved by the IRB on October 3, 2011.

Sincerely,

Jody Myhre-Oechsle

Jody Myhre-Oechsle, CPhT MS in Career Technical Education Graduate Student

University of Wisconsin – Stout

80

Appendix B: Qualtrics Online Survey Instrument

Consent to Participate In UW-Stout Approved Research

Title: “An Analysis of Potential Pharmacy Technician Regulations in Wisconsin”

Investigator: Research Sponsor: Jody Myhre-Oechsle Carol Mooney UW-Stout UW-Stout Menomonie, WI Menomonie, WI Phone: 715-852-1390 Phone: 715-232-1444 Email: myhreoechslej@my.uwstout.edu Email: mooneyc@uwstout.edu Description: The purpose of this survey is to gather insights from pharmacy technicians and pharmacists on the various potential regulations for pharmacy technicians in Wisconsin. Risks and Benefits: There are no known risks associated with participation in this study. Information collect from this survey will only be based on the perceptions of the current field of work. Participants may become more aware and/or have an increased interest in the future of pharmacy technician regulations in Wisconsin. Special Populations: By completing this questionnaire, I agree to participate in this study and state that I am at least 18 years of age and a U.S. citizen. Time Commitment: Participation of this survey is voluntary. The survey should only take less than 10 minutes to complete. Confidentiality: Responses from the survey will be kept anonymous. Report of the survey will not include any information that will make it possible to identify you. The surveys will be kept in a secure online file; only the researcher for this study will have access to the records. Right to Withdraw: Your participation in this study is entirely voluntary. You may choose not to participate or stop at any time without any adverse consequences to you. IRB Approval: This study has been reviewed and approved by The University of Wisconsin-Stout's Institutional Review Board (IRB). The IRB has determined that this study meets the ethical obligations required by federal law and University policies. If you have questions or concerns regarding this study please contact the Investigator or Advisor. If you have any questions, concerns, or reports regarding your rights as a research subject, please contact the IRB Administrator.

81

Investigator: IRB Administrator Jody Myhre-Oechsle Sue Foxwell, Director, Research Services 715-852-1390 152 Vocational Rehabilitation Bldg. myhreoechslej@my.uwstout.edu UW-Stout Menomonie, WI 54751

foxwells@uwstout.edu Advisor: Carol Mooney 715-232-1444 mooneyc@uwstout.edu Statement of Consent: By completing the following survey you agree to participate in the project entitled, “An Analysis of Potential Pharmacy Technician Regulations in Wisconsin”. YES NO

1. How long have you been working as a licensed pharmacist?

◊ 1-5 years ◊ 5-10 years ◊ 10-15 years ◊ 15-20 years ◊ >20 years

2. How long have been working as a pharmacy manager?

◊ 1-5 years ◊ 5-10 years ◊ 10-15 years ◊ 15-20 years ◊ >20 years

3. What is your current pharmacy work setting?

Institutional (hospital, long-term care, etc..) a. Please indicate your community size ◊ rural/small town (population <1,000 people) ◊ small city (population 1,000-6,000 people) ◊ large city (population 6,000-50,000 people) ◊ major metro area (population >50,000 people)

82

Community (retail, clinic, etc..) a. Please indicate type of community pharmacy ◊ large national chain/franchise ◊ small chain or independent pharmacy b. Please indicate your community size ◊ rural/small town (population <1,000 people) ◊ small city (population 1,000-6,000 people) ◊ large city (population 6,000-50,000 people) ◊ major metro area (population >50,000 people) Combination – Long-term care & Retail a. Please indicate your community size ◊ rural/small town (population <1,000 people) ◊ small city (population 1,000-6,000 people) ◊ large city (population 6,000-50,000 people) ◊ major metro area (population >50,000 people) Combination – Hospital & Retail a. Please indicate your community size ◊ rural/small town (population <1,000 people) ◊ small city (population 1,000-6,000 people) ◊ large city (population 6,000-50,000 people) ◊ major metro area (population >50,000 people) Other (please specify)____________ a. Please indicate your community size ◊ rural/small town (population <1,000 people) ◊ small city (population 1,000-6,000 people) ◊ large city (population 6,000-50,000 people) ◊ major metro area (population >50,000 people)

4. What is the postal zip code of your primary pharmacy workplace? __________ 5. How many pharmacy technicians do you supervise? ___________ 6. Currently in your area, what are the hiring conditions for pharmacy technicians? Number of applicants

◊ Not Enough Number of Applicants ◊ About Right Applicants ◊ Too many applicants

83

Qualifications of applicants

◊ Most applicants not well qualified ◊ Adequate qualifications ◊ Most applicants well qualified

7. What are your current hiring practices for pharmacy technicians? (Please select all that apply) ◊ High school diploma ◊ Minimum of 1 year prior experience ◊ > 1 year of prior experience ◊ Certification ◊ Formal training (college, online program, etc.) ◊ Other (Please specify) _____________ 8. Does your pharmacy…(Please select all that apply) ◊ Pay higher wages to technicians with specialized training or education? ◊ Pay higher wages to technicians with more years of experience? ◊ Pay higher wages to certified technicians? ◊ Pay for a technician’s continuing education courses? 9. Do you currently supervise any pharmacy technicians who are certified through PTCB (Pharmacy Technician Board Exam)? Yes

a. What percent of your pharmacy technician staff is certified? _____ No

10. Does your pharmacy provide incentives for pharmacy technicians to receive certification? Yes a. Check incentives that apply ◊ wage increase ◊ paid CE opportunities for maintaining certification ◊ payment of certification exam fee ◊ payment of biannual certification renewal fee No

a. If no incentives are provided for certification, please select all that apply for reasoning.

◊ not familiar with certification ◊ financial reasons ◊ no interest by management ◊ lack of interest by technicians ◊ does not apply to pharmacy setting ◊ other (please specify) _____________

84

11. Do you currently supervise any pharmacy technicians with formal training such as a technical college diploma or an online certificate program? Yes

a. What percent of your pharmacy technician staff has formal training? __ No

12. What type of training do your newly hired pharmacy technicians complete? (Please select all that apply.) ◊ one on one training with another staff member ◊ training with multiple staff members ◊ self- training through an online program or written manual ◊ ASHP accredited training program provided by pharmacy ◊ Other (please specify) _______________ 13. Rate the following technician standards on the value to your current pharmacy practice setting. Formal training

◊ Strongly Value ◊ Some Value ◊ Neutral ◊ Somewhat Value ◊ No Value Certification (completion of competency exam such as the PTCB exam)

◊ Strongly Value ◊ Some Value ◊ Neutral ◊ Somewhat Value ◊ No Value Registration (completion of a State Pharmacy Board issued application and fee on a yearly

or biannual in order to monitor technician workforce)

◊ Strongly Value ◊ Some Value ◊ Neutral ◊ Somewhat Value ◊ No Value 14. In the future, how likely would you be to support the following pharmacy technician standards in Wisconsin… Establishing a mandatory formal training requirement for pharmacy technicians?

◊ Strongly Support ◊ Somewhat Support ◊ Neutral ◊ Somewhat Oppose ◊ Strongly Oppose Comments______________ Establishing a mandatory certification requirement for pharmacy technicians?

◊ Strongly Support ◊ Somewhat Support ◊ Neutral ◊ Somewhat Oppose ◊ Strongly Oppose Comments______________

Establishing a mandatory registration requirement for pharmacy technicians?

◊ Strongly Support ◊ Somewhat Support ◊ Neutral ◊ Somewhat Oppose ◊ Strongly Oppose Comments______________

85

15. In your opinion, will the following standards advance the technical roles (such as delegating more or new responsibilities) of pharmacy technicians in your current pharmacy setting? Pharmacy Technician Certification ◊High Advancement ◊Some Advancement ◊Neutral ◊Some Advancement ◊No Advancement Comments____________ Formal Training for Pharmacy Technicians ◊High Advancement ◊Some Advancement ◊Neutral ◊Some Advancement ◊No Advancement Comments____________ Registration of Pharmacy Technicians ◊High Advancement ◊Some Advancement ◊Neutral ◊Some Advancement ◊No Advancement Comments____________ 16. How might the implementation of the following pharmacy technician standards affect your pharmacy technician staff? Pharmacy Technician Certification

◊Strong Positive Impact ◊Positive Impact ◊Neutral ◊Negative Impact ◊Strong Negative Impact Comments_____________ Formal Training for Pharmacy Technicians

◊Strong Positive Impact ◊Positive Impact ◊Neutral ◊Negative Impact ◊Strong Negative Impact Comments_____________ Registration of Pharmacy Technicians ◊Strong Positive Impact ◊Positive Impact ◊Neutral ◊Negative Impact ◊Strong Negative Impact Comments_____________

86

Appendix C: Tables

Table 1

Surveyed Statewide Pharmacy Manager Demographics

Years of Experience n %

1-5 years 5 8

5-10 years 6 9

10-15 years 10 16

15-20 years 8 13

>20 years 35 55

Years as a Pharmacy Manager 1-5 years 16 25 5-10 years 11 17

10-15 years 11 17 15-20 years 9 14

>20 years 18 28

Current Pharmacy Setting

Institutional (hospital, long-term care, etc.) 13 20

Community (retail) 40 62

Combination (long-term care & retail) 3 5

Combination (hospital and retail) 3 5

Other

Home Infusion (2)

Clinic (3)

Hospital Outpatient (1)

6 9

Community Size

Rural/small town (<1,000) 2 3

Small city (population 1,000-6,000) 10 15

Large city (population 6,000-50,000) 23 35

Major metro area (population >50,000) 30 46

87

Table 2

Surveyed PSW Pharmacy Manager Demographics

Years of Experience n %

1-5 years 5 8

5-10 years 10 16

10-15 years 5 8

15-20 years 9 15

>20 years 33 53

Years as a Pharmacy Manager

1-5 years 13 21 5-10 years 11 18

10-15 years 9 15 15-20 years 10 16

>20 years 19 31

Current Pharmacy Setting

Institutional (hospital, long-term care, etc.) 19 31

Community (retail) 25 40

Combination (long-term care & retail) 5 8

Combination (hospital and retail) 6 10

Other

Clinic (5)

Nuclear (1)

Managed Care (1)

7 11

Community Size

Rural/small town (<1,000) 3 5

Small city (population 1,000-6,000) 14 23

Large city (population 6,000-50,000) 22 36

Major metro area (population >50,000) 22 36

88

Appenda D: State'flrfde Pharmacy Manager Survey Zip Code Daua by County

0 No Respondents

~ . Respondents <5

~ Respondents >S

Respondents > 10

: . . .. ~> :::. ·:· AshlaDd

Vn~~~ .. ·.· ~ . _:: "--. ....---'---.. ... ...J _ _ _ __,

• • • • Sawyer · ' •• . .. ·. ·:.

•. . ... .. :-..

89

Appendix E: P N Pbarmaey Manager urvey Zip Code Data by County

' ... , .. : ..

SMyer

.... , .. ,. , . .., , .. L::&rron. ·. ' ....... ..... " · . • .... ' -1------.j : ~ .. · .. •· .. ~

Rusk

Pike

Taylor

D No Respondents

~ Respondents <S

~ Respondents >S

• Respondents > 10

90

Appendix F: “Other” Responses to Survey Questions 8, 14, &16

State Wide Respondents

Question 8: What are your current hiring practices for pharmacy technicians?

Based on interview and application Certification if less than 1 year experience Become certified in 1 year By the individual Most new hires do not have any experience in rx We like previous experience and certification but it is not required. One of our

best technicians was hired secondary to customer service and attention to detail skills

Hire off floor Prefer experience but will train if appear suitable Previous hospital experiment as a technician preferred, retail experience minimum

experience preferred.

Question 14: If no incentives are provided for certification, please select all that apply for reasoning.

Afraid of taking the test Pay raise based on yearly evaluation Unsure Upper management can’t get through corporate people It is not required for work Certification is a requirement Experience has proven more beneficial than certification

Question 16: What type of training do your newly hired pharmacy technicians complete?

IV room competency Work with other techs at location Site-based training module In store testing USP 797, EPIC We have internal training guide that needs to be completed

PSW Respondents

Question 8: What are your current hiring practices for pharmacy technicians?

91

Certification preferred and not required 18+ years old personality, attitude, desire must commit to formal training program

Question 14: If no incentives are provided for certification, please select all that apply for reasoning.

Certification exam does not apply to nuclear pharmacy Incentives provided would not let me answer more than 1 choice! we also have

wage increase, paid CE opportunities Do not see value in retail setting Certification does not teach what I want them to know Requirement of the position

Question 16: What type of training do your newly hired pharmacy technicians complete?

developed our own training tools Specific corporate training with a requirement to spend time at Quality and

Regulatory department with final supervised test through corporate Q&R department

92

References

Academy of Managed Care Pharmacy (AMCP). (2004). Future Vision of Pharmacy Practice.

Retrieved from http://www.amcp.org/uploadedFiles/Horizontal_Navigation/Publications/

Professional_Practice_Advisories/JCPP%20Future%20Vision%20of%20Pharmacy

%20Practice%20web%20intro.pdf

Adams, A., Martin, S., & Stolpe, F. (2011). “Tech-check-tech”: A review of the evidence on its

safety and benefits. American Journal of Health-System Pharmacists, 68, 1824-1833.

Alkhateeb, F., Shields, K., Broedel-Zaugg, K., Bryan, A., & Snell, J. (2011). Credentialing of

pharmacy technicians in the USA. International Journal of Pharmacy Practice, 19, 219-

227. doi: 10.1111/j.2042-7174.2011.00095.x

American Society of Health System Pharmacists (ASHP). (2011). Mission Statement. Retrieved

from http://www.ashp.org/menu/AboutUs.aspx

American Society of Health-System Pharmacists (ASHP). (2008). 2015 Initiative. Retrieved

from http://www.ashp.org/2015

Brady, E. & McCoy K. (2008, February 29). Rx for errors: Drug error killed their little girl.

USA TODAY, p. 03b.

British Columbia becomes second providence to register regulated pharmacy technicians with

expanded training and scope of practice. (2011, January/February). Canadian

Pharmacists Journal, 144(4), 155.

Council on Credentialing in Pharmacy (CCP). (2006, July). Credentialing in Pharmacy.

Retrieved from

http://www.pharmacycredentialing.org/ccp/Files/CCPWhitePaper2006.pdf

93

Council on Credentialing in Pharmacy (CCP). (2009a, February 25). Scope of Contemporary

Pharmacy Practice: Roles, Responsibilities, and Functions of Pharmacists and Pharmacy

Technicians. Retrieved from

http://www.pharmacycredentialing.org/ccp/Contemporary_Pharmacy_Practice.pdf

Council on Credentialing in Pharmacy (CCP). (2009b, August 5). Council on Credentialing in

Pharmacy: Pharmacy Technician Credentialing Framework. Retrieved from

http://www.pharmacycredentialing.org/ccp/Files/CCP%20technician%20framework_08-

09.pdf

Council on Credentialing in Pharmacy (CCP). (2010, November). Credentialing in Pharmacy:

A Resource Paper. Retrieved from

http://www.pharmacycredentialing.org/ccp/Files/CCPWhitePaper2010.pdf

Dresselle, S. (2005). Certified pharmacy technicians’ views on their medication preparation

errors and education needs. American Journal of Health-System Pharmacists, 62, 1992-

1997.

Dresselle, S. & Schmitt, M. (2009). Pharmacists’ attitudes toward technician certification: a

qualitative study. Journal of Pharmacy Technology, 25(2), 79-88.

Dresselle, S. & Schmitt, M. (2010, Nov./Dec.). Pharmacists’ perceptions of the value of

technician certification through a nationally accredited certification program. Journal of

Pharmacy Technology, 26(6), 340-351.

Doucette, W., Gaither, C., & Kreling, D. (2009). Final report of the 2009 national pharmacist

Workforce Survey. Retrieved from

http://www.aacp.org/resources/research/pharmacymanpower/Documents/2009%20Nation

al%20Pharmacist%20Workforce%20Survey%20-%20FINAL%20REPORT.pdf

94

Final Analysis (Emily’s Law), Sub. S.B. 203, Ohio Legislative Service Commission. § 4729.42

(2009). Retrieved June 1, 2010, from

http://lsc.state.oh.us/analyses/analysis127.nsf/c68a7e88e02f43a985256dad004e48aa/443d

Gabay, M. (2011, February). Emily’s Law: Requiring Minimum Education and Training

Standards for Pharmacy Technicians. Hospital Pharmacy, 46(2), 103-104.

Horner, P. (n.d.). No place like home infusion pharmacy. American Pharmacist Association.

Retrieved from

http://www.pharmacist.com/AM/Template.cfm?Section=Home2&TEMPLATE=/CM/Co

ntentDisplay.cfm&CONTENTID=21902

Madigan, M. (2008). Pharmacy Technician Regulation: An Evolution in Progress. [PowerPoint

slides PDF file]. Retrieved from ASHP Advantage C.E. Presentation Notes Web site:

http://onlinece.ashpadvantage.com/pharmtech

Manasse, H. (2007). Ensuring the competence of pharmacy technicians. American Journal of

Health-System Pharmacists, 64, 816. doi : 10.2146/ajhp0701398

Manasse, H. & Menighan, T. (2010). Single Standard for Education, Training, and Certification

of Pharmacy Technicians. American Journal of Health-System Pharmacists, 67, 348-

349. doi : 10.2146/ajhp100018

Manasse, H. & Menighan, T. (2011). Pharmacy technician education, training, and certification:

Call for a single national standard and public accountability. Journal of the American

Pharmacists Association, 5(3), 326-327. doi : 10.1331/JAPhA.2011.11525

Marshfield Clinic. (n.d.). Pharmacy Services Offered via Televideo Connection. Retrieved from

http://www.marshfieldclinic.org/patients/?page=cattails-2011-summer-west-pharmacy-

services

95

Myers, C. (2011). Opportunities and challenges related to pharmacy technicians in supporting

optimal pharmacy practice models in health systems. American Journal of Health-System

Pharmacists, 68, 1128-1136.

Murer Corrigan, M. (2008). Pharmacy Technician Certification: The National Standard

[PowerPoint slides PDF file]. Retrieved from ASHP Advantage C.E. Presentation Notes

Web site: http://onlinece.ashpadvantage.com/pharmtech

Mohr, M. (2011). PTCB Hosts C.R.E.S.T. Summit. Journal of Pharmacy Technology, 27, 141-

143.

Muenzen, P., Corrigan, M., Smith, M., & Rodrigue, P. (2005). Updating the Pharmacy

Technician Certification Examination: A practice analysis study. American Journal of

Health-System Pharmacists, 62, 3542-3546.

National Community Pharmacists Association (NCPA). (2011). National Community

Pharmacists Association (NCPA) on Section 3310 of the Patient Protection and

Affordable Care Act. Retrieved from http://www.ncpaltc.org/index.php/short-cycle-

fill/3-national-community-pharmacists-association-ncpa-on-section-3310-of-the-patient-

protection-and-affordable-care-act

National Association of Boards of Pharmacy (NABP). (2009, October). Report of the Task Force

of Pharmacy Technician Education and Training Programs. Retrieved from

http://www.nabp.net/news/assets/TF-PharmTechEduc.pdf

National Association of Boards of Pharmacy (NABP). (2010, August). Model State Pharmacy

Act and Model Rules of the National Association of Boards of Pharmacy. Retrieved from

http://member.nabp.net/NABP/NABP/Resources/LibraryDocuments/Default.aspx?Librar

yKey=16ba5cb8-4639-4bd9-9c5a-f5deeacad344

96

National Association of Boards of Pharmacy (NABP). (2011, January). 2011 NABP Survey of

Law. Retrieved from (per email request)

http://www.nabp.net/news/2011-survey-of-pharmacy-law-now-available/

Ontario College of Pharmacists (OCP). (2011). Pharmacists and Pharmacy Technician.

Retrieved from

http://www.healthforceontario.ca/Work/OutsideOntario/HealthProfessionalsOutsideOntar

io/PracticeRequirements/pharmacists_pharmacy_technicians.aspx

Ontario leads the country in creating new class of health professional – the pharmacy technician.

(2011, January/February). Canadian Pharmacists Journal, 144(1), 11.

Paolini, N & Rouse, M. (2010). Scope of contemporary pharmacy practice: roles,

responsibilities, and functions of pharmacists and pharmacy technicians executive

summary. American Journal of Health System Pharmacist 67, 1030-1031. doi :

10.2146/ajhp100057

Pharmacy Ancillary Personnel, WAC 246-901, Washington Administrative Code. §030 & 060

(2008). Retrieved June 2, 2010, from http://apps.leg.wa.gov/WAC/default.aspx?cite=246-

901

Pharmacy Society of Wisconsin (PSW). (2008). Pharmacy Technician and Medication Safety

Regulatory Requirements. Issue Paper.

Retrieved from http://www.pswi.org/technician/tip.pdf

Pharmacy Society of Wisconsin (PSW). (2009a). PSW Technician Credentialing Taskforce –

Recommendations Approved by the PSW Board of Directors February 2009. Retrieved

from http://www.pswi.org/technician/pswtech_recommend0209.pdf

97

Pharmacy Society of Wisconsin (PSW). (2009b). Mission Statement. Retrieved June 3, 2010,

from http://www.pswi.org/about/

Pharmacy Technicians, S.B. 1360, Florida Legislature Senate. § 465.014 (2008). Retrieved June

1, 2010, from http://www.flsenate.gov/cgi-

bin/view_page.pl?Tab=session&Submenu=1&FT=D&File=sb1360er.html&Directory=se

ssion/2 008/Senate/bills/billtext/html/

Pharmacy Technician Certification Board (PTCB). (2007). New Survey Results Press Release:

Survey shows broad support among Americans for pharmacy technician certification.

Retrieved from

https://www.ptcb.org/AM/TemplateRedirect.cfm?template=/CM/ContentDisplay.cfm&C

ontentID=2752

Pharmacy Technician Certification Board (PTCB). (2011a). Active PTCB CPhTs and State

Regulations as of November 8, 2011. Retrieved from

https://www.ptcb.org/AM/Template.cfm?Section=Regulations&Template=/CM/HTMLD

isplay.cfm&ContentID=4108

Pharmacy Technician Certification Board (PTCB). (2011b). PTCB C.R.E.S.T. Summit

Proceedings. Retrieved from

https://www.ptcb.org/AM/Template.cfm?Section=CREST_Summit&Template=/CM/Con

tentDisplay.cfm&ContentID=4231

Pharmacy Technician Certification Board ( PTCB). (n.d.). Exam Preparation. Retrieved June 15,

2010, from

https://www.ptcb.org/AM/Template.cfm?Section=Exam_Preparation&Template=/CM/C

ontentCombo.cfm&NavMenuID=806&ContentID=3269

98

Pharmacy Technician Training and Registration Act of 2008 or Emily’s Act, H.R. 5491, 110th

Congress 2d, (2008). Retrieved June 1, 2010, from

http://www.govtrack.us/congress/bill.xpd?bill=h110-5491

Purdue University. (2011). What is Nuclear Pharmacy? Retrieved from

http://nuclear.pharmacy.purdue.edu/what.php

Radwan, C. (2009, August 25). Pharmacy technicians face states’ scrutiny, regulation. Drug

Topics E-News. Retrieved from

http://drugtopics.modernmedicine.com/drugtopics/Associations/Pharmacy-technicians-

face-states-scrutiny-regulati/ArticleStandard/Article/detail/621364

Regulations Governing the Practice of Pharmacy, 18VAC110-20, Virginia Board of Pharmacy

Laws & Regulations. §103 (2010). Retrieved June 15, 2010, from

http://www.dhp.state.va.us/pharmacy/leg/PharmacyRegs_03172010.doc

Rouse, M. (2003, January 1). White paper on pharmacy technicians 2001: Needed changes can

no longer wait. American Journal of Health-System Pharmacists, 60, 37-51.

Rositch, J. & Sutter, S. (2004). The Status of Technician Education and Training in

Wisconsin. Journal of the Pharmacy Society of Wisconsin, March/April, 49-55.

Schaafsma, K. (2009). Steps toward credentialing. Journal of the Pharmacy Society of

Wisconsin, March/April, 15-17.

Scott, B. (2008). Advancing the Practice of Pharmacy Technicians. [PowerPoint slides PDF

file]. Retrieved from ASHP Advantage C.E. Presentation Notes Web site:

http://onlinece.ashpadvantage.com/pharmtech

Structure of the Executive Branch. WI Statue 15.01, Wisconsin Legislature. §7 (2009). Retrieved

June 8, 2010, from

99

http://nxt.legis.state.wi.us/nxt/gateway.dll/Statutes%20Related/Wisconsin%20Statutes/im

g/pdf%20icon

United States Census Bureau. (2007). U.S. Rural Communities with Independent Pharmacies.

Retrieved from http://www.unmc.edu/ruprihealth/Pubs/PB2007-_PharmLocBrf_1127.pdf

U.S. Department of Labor, Bureau of Labor Statistics (BLS). (2011a). Pharmacy Technicians.

Occupational Outlook Handbook, 2010-11 Edition. Washington D.C.: U.S. Government

Printing Office. Retrieved from http://www.bls.gov/oco/ocos325.htm

U.S. Department of Labor, Bureau of Labor Statistics (BLS). (2011b). Pharmacists.

Occupational Outlook Handbook, 2010-11 Edition. Washington D.C.: U.S. Government

Printing Office. Retrieved from http://www.bls.gov/oco/ocos079.htm

U.S. Department of Labor, Bureau of Labor Statistics (BLS). (2011c). Pharmacists.

Occupational Employment and Wages, May, 2010. Washington D.C.: U.S. Government

Printing Office. Retrieved from

http://www.bls.gov/oes/current/oes292052.htm?wwparam=1321378160#nat

UnitedHealthcare. (2010, August). Pharmacy Directory: Medicare Prescription for Groups

(PDP). Retrieved from

https://www.uhcmedicarerxforgroups.com/online_documents/ovation/pdf/pdp/en/2011/W

isconsin.pdf

Vision Research. (2007, March). The Pharmacy Technician Workforce in Canada: Roles,

Demographics and Attitudes. Retrieved from

http://blueprintforpharmacy.ca/docs/pdfs/2011/04/19/96.pdf?Status=Master

Wahlberg, D. (2010, April 25). Disappearing drugstores: Small-town

health suffers as rural pharmacies close. Wisconsin State Journal. Retrieved from

100

http://host.madison.com/wsj/special-section/rural_health/article_fb3f8f5f-f0d3-5465-

a227-e6e7434007d3.html

Weber, E., Hepfinger, C., & Koontz, R. (2005, December 1). Pharmacy technicians supporting

clinical functions. American Journal of Health-System Pharmacists, 62, 2469-2472.

Wilson, D., Kimberlin, D., Brushwood, D., & Segal, R. (2010). Investigation of the Potential

Effects of Registration Requirements on Florida Pharmacy Technician Credentials.

Journal of Pharmacy Technology 26(3), 116-122.

Wisconsin Department of Health Services (DHS). (2009). Florence County Public Health Files.

Retrieved from http://www.dhs.wisconsin.gov/localdata/counties/florence.htm

Wisconsin Department of Health Services (DHS). (2011). Hospital Provider Directory for All

Regions. Retrieved from

http://www.dhs.wisconsin.gov/bqaconsumer/healthcare/HospitalCty.pdf

Wisconsin Department of Safety & Professional Services. (2011). Credential Type Table.

Retrieved from http://165.189.60.145/docview.asp?docid=962&locid=0

WPS. (2010, September). WPS MedicareRx Plan: Pharmacy Directory Wisconsin. Retrieved

from http://www.wpsic.com/partd/pdfs/2011_pharmacy_directory.pdf