Technicians and pharmacy's quadruple aim

In the current issue of JACCP, Borchert et al propose, in a White Paper, that the expansion of pharmacy technician roles to support clinical pharmacy services such as comprehensive medication management (CMM) is necessary. There is no question that, in the course of delivering CMM, many of the functions commonly performed by pharmacists do not require an advanced degree, for example, conducting early steps of medication reconciliation, performing point of care testing, rooming patients, appointment scheduling and reminders, etc. Having a pharmacist perform these and similar functions is an expensive proposition given that technician salaries are typically 1/4th to 1/3rd of pharmacist salaries. In the same way that medical assistants and nurses help ensure that physicians spend the majority of their time with patients applying their professional skills and knowledge, clinical pharmacy technicians help optimize the time of clinical pharmacists. The White Paper correctly points out that more research is needed to fully clarify the specific functions and value of clinical pharmacy technicians. Indeed, we can anticipate significant changes over the next 5 to 10 years in pharmacy technician advanced training, credentialing, and certification, both locally and nationally. At the same time, this should not be a reason to wait for further guidance before challenging appropriately trained pharmacy technicians with clinical duties to advance clinical programs and policy efforts. For example, a study from Cedars-Sinai Medical Center (CSMC) in California found that pharmacists and pharmacy technicians were equally effective in reducing admission medication history errors and related admission medication orders. Dr. Rita Shane, CSMC Chief Pharmacy Officer, highlighted her research in drafting and advocating for Senate Bill 1254 in California, which requires pharmacists, interns, or technicians to obtain accurate medication profiles/lists for high-risk patients admitted to hospitals with more than 100 beds. The bill was signed into law on September 22, 2018 and marks the first mandate in the state for pharmacy to engage directly with patients in hospitals. As with any patient care role, sufficient training must be provided for technicians. Using our grant from the Center for Medicare and Medicaid Innovation (CMMI), we developed a training curriculum to enable technicians to become clinical pharmacy technicians. The program includes home study and live hands-on training, followed by an implementation and practice period and a subsequent second live training session to address new questions or concerns. The curriculum was shared with several pharmacy technician schools in Southern California that now graduate pharmacy technicians with these clinical skills. As a result of integrating well-trained clinical pharmacy technicians into our CMMI-funded program, we experienced a 50% increase in daily patient visit volume. Furthermore, by having clinical pharmacy technicians check in periodically with patients who have successfully reached treatment goals, the technicians are able to identify patients early on who are beginning to fall out of chronic disease control. These patients are referred to the clinical pharmacist for further evaluation and possible re-enrollment into CMM services, thus ensuring that the patients remain at goal. Another important value of clinical pharmacy technicians is unrelated to technical skills. In our experience, pharmacy technicians in multicultural regions of the U.S., such as Los Angeles, are well-aligned culturally and linguistically with patients served, more so than pharmacists. This provides technicians with an excellent opportunity to build better relationships with patients and help engage and activate selfcare behaviors that support medication optimization. In fact, patients often named the clinical pharmacy technicians as key members of the clinical pharmacy team in the patient satisfaction surveys conducted for our CMMI grant. As pharmacy transitions along with the rest of healthcare to align with value-based payment models, the profession needs to identify effective methods of lowering the cost of delivering high-impact services such as CMM without compromising quality. Clinical pharmacy technicians are highly underutilized given the broad range of value and support they provide for patient care services at a very reasonable cost. In our experience, patients love their clinical pharmacy technicians, and perhaps just as importantly, clinical pharmacy technicians love their jobs and the opportunity to serve their communities. Better health outcomes, satisfied patients, satisfied team members, and lower cost of delivering care could technicians be the key quadruple aim solution for the next iteration of pharmacy?