Changes in Practice Scope of Pharmacy Technicians Needed to Address Community Needs During COVID-19 Outbreak

Although pandemics have occurred throughout history, with records dating back to the black plague in medieval Europe and beyond, the challenges created by the coronavirus disease 2019 (COVID-19) are unprecedented because of the interconnectedness of our global community, combined with the relative ease of transmission of this virus strain.

Required separation and isolation are concepts that feel unfamiliar but are beginning to demonstrate effectiveness in the fight against COVID-19. Health care systems worldwide are feeling the strain of a high number of patients needing care coupled with limited resources to meet those needs.

The increasing need for health care services is catalyzing exploration of novel care services, including those provided in community pharmacies. As demands for pharmacy services increase, including COVID-19 point-of-care testing (POCT), pharmacy technician roles must continue to evolve to fill gaps in care and shortages of labor capital.

Traditionally, POCT in pharmacies has been conducted by pharmacists or student pharmacists, with technician roles relegated to inventory management, scheduling, and documentation. However, a 2020 study by Hill and colleagues describes implementation of pharmacy technician-supported POCT.²

Technicians performed technical tasks for cholesterol POCT screening, including sample collection and quality control. Results demonstrated that pharmacies in which technicians were involved in POCT performed 16.8% more cholesterol screenings than the control pharmacies.²

Another important opportunity for pharmacy technicians to make a major contribution in the fight against COVID-19 is the administration of vaccinations. When a vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eventually becomes available, engaging technicians in immunization administration means having more immunizers available in pharmacies to cut down on patient wait times and increase pharmacists’ capacity.

Pharmacy technicians currently administer immunizations in 3 states (Idaho, Rhode Island, Utah), with several other states discussing waivers, ancillary utilization plans, and administrative rule changes. Research involving implementation of immunizing technicians shows that technicians are competent and comfortable in this role after completing an accredited training program.³ Integrating pharmacy technicians into immunizing workflow has the potential to greatly increase the capacity for immunizations given in community pharmacies.

Even for areas in which technicians are not allowed to administer immunizations, there are many important supportive tasks for them to play an important role. Technicians can support immunizing pharmacists by identifying patients who may be eligible for immunizations, scheduling appointments, managing vaccine and supply inventory, documenting that the vaccines are stored appropriately, immunization administration billing and documentation, and gathering immunization supplies.

These supportive roles have been shown to have a positive impact on patients in both community and hospital settings. In a 2017 study, pharmacy technicians were given the task of identifying health system patients who had not been screened or immunized for influenza and pneumococcal vaccinations and then following up with the patients via phone reminders or face-to-face interventions. The results showed a statistically significant increase in the number of influenza immunizations in the intervention group and a non-significant increase in the number of pneumococcal immunizations administered.⁴

A small chain of 5 community pharmacies in North Carolina implemented a similar program utilizing technicians to screen patients to determine immunization eligibility. As a result, additional influenza, pneumococcal, Tdap, and zoster vaccines were administered.⁵

It appears that the road ahead in the fight against COVID-19 and the implications for care delivery in its aftermath will be arduous. There are already a number of bright lights, though, as shown by pharmacy services catering to rural populations using mobile health clinics during the pandemic crisis.⁶

Technicians are on the front lines right along with pharmacists. It has been argued that they too must be considered in future decisions in restructuring of health services.⁷ Technicians are already demonstrating leadership in various practice arenas, such as patient communication and supply chain management.⁸

By preparing to advance technician roles to increase provision of clinical community pharmacy services, we are preparing the profession of pharmacy to be better equipped to increase access to care and meet the needs of our communities during times of crisis and well beyond.

References

• Hill H, Cardosi L, Henson L, et al. Evaluating advanced pharmacy technician roles in the provision of point-of-care testing [published online ahead of print, 2020 Mar 23]. J Am Pharm Assoc (2003). 2020;S1544-3191(20)30104-7. doi:10.1016/j.japh.2020.02.024
• McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training pharmacy technicians to administer immunizations. J Am Pharm Assoc (2003). 2018;58(2):174—178.e1. doi:10.1016/j.japh.2018.01.003
• Hill JD, Anderegg SV, Couldry RJ. Development of a Pharmacy Technician-Driven Program to Improve Vaccination Rates at an Academic Medical Center. Hosp Pharm. 2017;52(9):617—622. doi:10.1177/0018578717722788
• Rhodes LA, Branham AR, Dalton EE, Moose JS, Marciniak MW. Implementation of a vaccine screening program at an independent community pharmacy. J Am Pharm Assoc (2003). 2017;57(2):222—228. doi:10.1016/j.japh.2016.10.009
• Murphy JA. Rural pharmacies respond to COVID-19 pandemic with change in outreach services. Pharmacy Times. Available at: https://www.pharmacytimes.com/news/rural-pharmacies-respond-to-covid-19-pandemic-with-change-in-outreach-services. Accessed April 2, 2020.
• Cadogan CA, Hughes CA. On the frontline againstCOVID-19: Community pharmacists’ contribution during a public health crisis. Res Social Adm Pharm. https://doi.org/10.1016/j.sapharm.220.03.015.
• Harper T, Sabatini P, Ortiz R, Shea P, et al. Lessons learned: How health-system pharmacy technicians are tackling COVID-19. Pharmacy Times. Available at: https://www.pharmacytimes.com/news/lessons-learned-how-health-system-pharmacy-technicians-are-tackling-covid-19. Accessed April 2, 2020.

Authorship

Kimberly C. McKeirnan, PharmD, BCACP, Clinical Associate Professor and Director of the Center for Pharmacy Practice Research at Washington State University; and winner of the 2019 APhA-APPM Achieve in Pharmacy Practice Award, and 2019 APhA Immunization Champion Award.

Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social and Behavioral Pharmacy, Touro University California.