Description of Position Ads for Pharmacy Technicians

Pharmacy technician roles are evolving alongside the changing role of a pharmacist. There is currently no uniform definition of a pharmacy technician’s role in the pharmacy workforce. The objective of this study was to look at the United States-based pharmacy technician advertisement database from Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians. A retrospective analysis was performed on fourteen days of pharmacy technician job listings from Pharmacy Week from the year 2018. Information obtained from the listings included job title, location, setting, type of job, job duties, and job requirements. Job duties and requirements were coded by themes. Fourteen days of data resulted in 21,007 individual position listings. A majority of the job listings were for full-time positions (96.4%) and most were in the retail setting (96.78%). The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism. This study provides a description of the evolving role of pharmacy technicians through the broad variety in expectations for requirements of pharmacy technician applicants and the duties they perform when hired.


Introduction
Over the last decade, pharmacy has seen a large shift in the role of both the pharmacist and pharmacy technician. For instance, pharmacists have increasingly focused on providing clinical care, and gradually fallen away from the traditional dispensing role [1]. Pharmacy technicians are personnel "working in a pharmacy who, under the supervision of the licensed pharmacist, assists in pharmacy activities that do not require the professional judgment of a pharmacist [1]." However, as pharmacists have decreased their focus on dispensing, pharmacy technicians have been given the opportunity to fill the traditional dispensing role in the pharmacist's place. These new changes have progressively become the normal pharmacy model, and many studies have shown the added value of this model in both improved quality of patient care and pharmacy efficiency [2][3][4][5][6][7][8]. This shift is a huge building block for the future, yet at the same time, it has resulted in the formation of unique and evolving roles for pharmacy technicians. These new roles are still in the development process, and research is beginning to roll out on the safety and efficacy of advanced pharmacy technician positions [9][10][11][12]. These changes, in due course, may be considerable innovations, but at the same time, they may pose poignant risks to patient safety. This study helps to define pharmacy technicians' new roles through the use of pharmacy technician job advertisements.
While, this topic should be of great interest to employers, there is a lack of literature studying the hiring requirements and expectations of pharmacy technicians. A review of state regulations concerning entry-level pharmacy technicians in 2017 found that 86% of states required board registration or licensure. While only 16 states required any training programs for entry-level pharmacy technicians. This study reveals the legal requirements for the employment of pharmacy technicians, but did not study or discuss what employers actually look for in pharmacy technician candidates [16]. Therefore, the overall objective of this study was to look at the pharmacy technician advertisement database from the Pharmacy Week to find patterns and commonalities in the duties and qualifications of pharmacy technicians.

Materials and Methods
This study used a retrospective analysis study design to describe the current pharmacy technician job descriptions. Pharmacy technician job advertisements were obtained from Pharmacy Week for a 14 day period (26 November 2018-9 December 2018). PharmacyWeek.com was an online database of job advertisements for pharmacists, pharmacy technicians, and pharmacy interns started in 1990. Unfortunately, it is no longer maintained and can no longer be accessed. For all pharmacy technician job advertisements, the following items were obtained: (1) job title, (2) location of job (city and state), (3) what field of pharmacy job is in (hospital system, retail, [chain versus independent], long-term care, managed care, etc.), (4) position type (full or part time), (5) job duties, and (6) listed requirements for the position. Requirements within job advertisements were noted as being either required, preferred, not required, or not specified. Duties within job advertisements were noted as being either listed or not listed. Following data collection, related requirements and duties were combined into themes. These themes are detailed in Tables 1 and 2. The decision to code requirements and duties by themes verses individually was made by all researchers after listing were made of all the individual requirements and duties found in the position listing. The final themes agreed upon are depicted in the Tables 1 and 2. Data were collected and entered into an Excel document. Data were de-identified prior to Excel entry. No information was recorded in a manner that could reveal the identity. Descriptive statistics were performed for all data in IBM© SPSS v 26.0 (Armonk, NY, USA). This included frequencies and percentages.

Results
Fourteen • Other duties as assigned Data were collected and entered into an Excel document. Data were de-identified prior to Excel entry. No information was recorded in a manner that could reveal the identity. Descriptive statistics were performed for all data in IBM© SPSS v 26.0 (Armonk, New York). This included frequencies and percentages.  Pharmacy technician job listings in the managed care setting are not reflected in Figure 1 due to a sample size of 6. Figure The requirements included in the listings are displayed in Table 3. The most common requirements were registration with State Board, high school diploma, ability to perform tasks, Pharmacy technician job listing in the managed care setting are not reflected in Figure 1 due to sample size of 6.

Results
The requirements included in the listings are displayed in Table 3. The most common requirements were registration with State Board, high school diploma, ability to perform tasks, communication, and physical (N = 18,261 86.9%, N = 17,325 82.5%, N = 16,861 80.3%, N = 16,436 78.2%, and N = 15,908 75.7%, respectively). Additional information collected but not reported in Table 3 include that 9.1% (N = 1904) required some form of technician program coursework and almost 1% of listings required or preferred at least an associate's degree level of education (required N = 131, 0.6%; preferred N = 56, 0.3%).
The job duties included in the listings are displayed in Table 4. The most common job duties were general office etiquette, performing tasks under the direct supervision of the pharmacist, and professionalism (19,961 95%, 18,043 85.9%, and 10,560 50.3%, respectively. Additional information collected related to duties worth noting include 10 listings that required pharmacy technicians to have experience in patient assistance programs (0.0%, N = 10), HIV knowledge (0.0%, N = 3), maintaining narcotic coordination and investigational drug therapy (0.8%, N = 167), calculations (0.4%, N = 76), and managing difficult or emotional patient situations (0.0%, N = 2).
In Figures 2 and 3, the pharmacy technician position ad requirements and duties are indicated by job setting.
Of note in the pharmacy requirements as separated by setting, 11.7% (N = 79) of included hospital advertisements included a legal piece of some sort, whereas less than 1 % (0.3%, N = 55) of retail and 0 in managed care did.
Some individual technician ads listed unique and unheard of duties and requirements for applicants. One example of this would be a job duty listed as "be HIV knowledgeable" without further context; the same ad listed that technicians were expected to assist patients in "solving issues and problems related to AIDS." Another example was a pharmacy technician position that expected the applicant to be able to operate a forklift and hand tools. One technician position examined included requirements that technicians be willing to travel for meetings, conferences, and "field support" in order to "support and grow key customer relationships." Of note in the pharmacy requirements as separated by setting, 11.7% (N = 79) of included hospital advertisements included a legal piece of some sort, whereas less than 1 % (0.3%, N = 55) of retail and 0 in managed care did. Some individual technician ads listed unique and unheard of duties and requirements for applicants. One example of this would be a job duty listed as "be HIV knowledgeable" without further context; the same ad listed that technicians were expected to assist patients in "solving issues and problems related to AIDS." Another example was a pharmacy technician position that expected the applicant to be able to operate a forklift and hand tools. One technician position examined included requirements that technicians be willing to travel for meetings, conferences, and "field

Discussion
A review of job postings for pharmacy technicians provided a rich description of the different roles and skills currently needed across pharmacy settings. Technicians remain in many traditional settings, such as retail/community pharmacy. This is consistent with other descriptions that place technicians in supportive roles at community pharmacies and health-system pharmacies [1]. In these settings, technicians often assist with technical pharmacy functions and interact with patients. However, this can expand to other roles, such as providing support for medication therapy management (MTM) services and other clinical services [1]. Interestingly, there are emerging areas that are hiring technicians, such as managed care. As pharmacists in managed care continue to expand their opportunities to provide clinical services and chronic care management, technicians may have increasing roles to support data collection and documentation [15].
The data show that 12.3% (N = 2583) of pharmacy technicians are required to have standard certifications in pharmacy technician work such as PTCB and exCPT. Many states have a requirement that pharmacy technicians get certified either through these routes or through a standardized exam with similar content within a year of hiring, but there is little standardization across the board for these exams [17,18]. On multiple occasions, calls for standard national training and certification processes have been made, and it is clear that multiple organizations find it crucial to have this kind of a standard for certified pharmacy technicians [19,20]. While 81.5% (N = 17,114) did prefer a certified technician, it is surprising that more employers do not share the same national desire.
To fill these roles in a variety of settings, pharmacy technicians appear to need a variety of skills-many of which lie in the affective domain, i.e., professionalism and communication. Given the customer/patient service role many technicians provide, it is essential that they exhibit professionalism and can communicate appropriately in both written and verbal formats [2]. Further, analysis of the ads underscored the importance of technicians in quality assurance. Given their role in the dispensing process, inventory management, and other aspects of the pharmacy, technicians play a vital role in fostering an environment that promotes safe and effective medication use. For example, Odukoya, Schleiden, and Chui (2015), found that pharmacy technicians play a vital role in preventing e-prescribing errors by catching errors before the prescription is sent to the pharmacist to verify [16].
Expanding the roles of certified pharmacy technicians continues to be a discussion in the literature and the profession of pharmacy. States continue to explore tech-check-tech programs to free up pharmacist time to focus on clinical activities [9]. Some recent research also has explored the use of pharmacy technicians to extend medication management to the home setting, performing medication reconciliation and reiterating key counseling points from the pharmacist using motivational interviewing and the teach-back method [14]. Others have explored creating a clinical pharmacy technician to expand patient medication education [17]. While the job postings do not necessarily reflect these expansions, it would be important to continue to monitor ads to determine if the roles of pharmacists, and particularly, certified pharmacy technicians, are altering and expanding to allow pharmacists to focus on clinical activities.
As noted in the results, a small portion of the data included advertisements that required the technicians to be knowledgeable in HIV-related patient care. While this was not a substantial portion of the data, it is interesting to note that it is an area of potential growth for pharmacy technicians in the US. An article from 2013 found that a pharmacy technician-centered medication reconciliation for ART therapy of patients in the hospital was successful in assisting with the prevention of drug-drug interactions, as well as other medication errors. The program showed that ART and OI prophylaxis in HIV/AIDS patients was improved by the utilization of pharmacy technicians [21]. Similar data were collected related to a pharmacy technician-centered medication reconciliation unit at a mental health location in 2014 [22]. These articles and pieces of literature show that there is potential for pharmacy technician-led integration of prevention of med errors even in disease-specific areas of healthcare.
In order to continue integrating pharmacy technicians into the practice of pharmacy, it is important for those pharmacy technicians to be highly skilled to enhance the clinical reach of the pharmacist.
Projected pharmacy technician skills that could potentially be sought out by progressive employers include skills such as managing certain aspects of clinical tasks such as medication management and medication reconciliation, reiterating counseling points to reinforce statements made by the pharmacist, exceptional skills in communication and professionalism, as well as being able to quickly and accurately review information regarding patients' prescriptions during data collection and order entry. One systematic review found that pharmacy technicians are often utilized to support MTM through medication reconciliation and that adherence and medication utility can be improved. However, standardization for administration utilization and educational training in this setting is necessary [23].
Another study found that the implementation of pharmacy technicians into a nursing team in an acute admissions unit in a hospital setting allowed for the prevention of omitted doses and helped all members of the team make better use of their time [24]. Another similar study showed that pharmacy technicians working in hospital wards in order to improve medication management and to prevent the utilization of expired or misplaced medications caused significant cost savings, as well as per-patient time savings for the nurses also working in the wards [25]. These and other studies like it allow us to see the benefit of utilizing pharmacy technicians in expanded definitions of the traditional pharmacy tech role. These articles and trials of expanding the role of pharmacy technicians have given insight into ways to continue utilizing pharmacy technicians well. Due to the vast amount of pharmacy technician positions in the US, and the variety in settings that pharmacy technicians can explore, it is expected that these potentially beneficial positions will continue to develop in the United States as pharmacy practice continues to move forward.
In addition to defining potential expansion of the role for technicians, the literature also emphasizes the importance of education and training in order to standardize patient care and to ensure best practice is being followed. Pharmacy technicians must be competent, able to communicate, and behave in a professional manner. Given their integral role in the profession of pharmacy, providing opportunities for pharmacy technicians to develop professionally is vital. Multiple professional organizations have provided outlines of competencies and training/education to assist pharmacy settings in providing these opportunities [1,13]. Opportunities also remain for technicians to become certified, and some jobs preferred or required this additional training [1,13]. However, the benefits of completing additional training for technicians may not yet be balanced with the costs of obtaining it [18].

Limitations
This study, though novel, was limited in several ways. First, the available data were only taken from one source, Pharmacy Week. While Pharmacy Week does have a variety of job listings that encompass the entire United States, there are other sources of advertisements that are used to hire pharmacy technicians. The short data collection window only provides a brief snapshot of what jobs were being advertised during that time frame. While the sample size is robust for 14 days, it only reflects the needs at that specific time. Further, data collection was performed by four different researchers. While they all received training on the research protocol and data collection tools, no assessment for interrater reliability was performed.

Conclusions
This study represents a unique view of the state of pharmacy technician practice in the United States. Data showed demand for a broad variety of duties ranging from traditional to clinical to managerial. This represents an increased demand for skills and training requirements for pharmacy technicians. Further, due to the lack of standardization in certification and training for pharmacy technicians, it is important to research the future potential of policy, practice, and educational innovation in order to ensure safety and proper utilization of the pharmacy technician workforce.