The specific research questions that were explored included:
 1. What is the profile of the pharmacist involved in the study, inclusive of academic, demographic, and employment information?
 2. What is the importance that pharmacists place on specific activities performed by pharmacy technicians?
 3. What is the importance that pharmacists place on specific educational needs for a pharmacy technician?
 4. What is the pharmacist attitude toward the potential for licensure of pharmacy technicians?
 5. What is the relationship between selected academic, demographic and employment variables of pharmacists and their attitude toward a formalized education program for pharmacy technicians and their possible licensure?

Methodology and Procedures
      This survey was a non-experimental, descriptive study comparing differences in attitudes among a cross-section of Michigan pharmacists.  The descriptive study made use of a self-developed questionnaire, first tested with three pharmacists and a researcher from Ferris State University.   A copy of the complete survey follows as an appendix to this report.
      The population surveyed were those pharmacists of residence within the State of Michigan, with active licensure, as of 12 February 2001.  The pharmacists' names were drawn from the database on file at the Michigan Pharmacists Association.   This represented a  pharmacist population of approximately 8100.   A random sampling of 1000 pharmacists was chosen from this database; a time frame of 3 weeks was allowed for the response to the survey, at which point 455 usable responses were obtained.  367 minimum responses were necessary to achieve a margin of error of +/- 5% in such a population.
      The final results were analyzed statistically, making use of means, frequencies, percentages, charts and graphs, and chi-square.

Results of the Survey–Demographics
      The average age (mean) of the respondents was 48.48 years, with a range of 24 to 80 years. 69.2% were male, 30.8% were female.  Graduates from Ferris State University predominated, at 61.8%, followed by graduates from Wayne State University (20.7%) and the University of Michigan (9.2%).  Non-Michigan pharmacy graduates accounted for 8.4%, with 1.1% coming from Ohio State University.  41.5% of respondents had been practicing for over 25 years, 36.5% had been at work from 11-25 years, and 17.2% had been pharmacists for 6-10 years.  4.8% of the respondents had been working for 5 years or less.
      Bachelor’s degrees also predominated, at 85.5%.  Another 10.5% had obtained some graduate work beyond their Bachelor’s degree, not necessarily toward a PharmD.  PharmD degrees accounted for 2.6% of respondents, with another 1.3% having pursued education beyond the PharmD level.
      Pharmacists in the retail setting accounted for 65.9% of the respondents, further broken down into independent (37.8%) and community chain (28.1%, a chain being defined as more than 3 pharmacies).  Hospital pharmacists represented 23.1%, with 3.7% serving in a consultant capacity and 0.7% focused on long-term care.  6.6% fell into the “other” category, with hospital management, pharmaceutical representative, and semi-retired being cited as specific occupations.
      96% of the respondents worked with pharmacy technicians; 33.4% worked with five or more.  Further, of those surveyed, 54.9% indicated that they worked in a pharmacy with at least one certified pharmacy technician (17.1% indicated that they worked in a pharmacy with five or more certified technicians).

Results of the Survey--Responses to the survey questions
      There were a total of 40 questions posed in the questionnaire related to pharmacists’ attitudes regarding various aspects of technician duties, training, educational requirements, and licensure.    A general summary of the responses follows:
      Note: Values in parentheses represent the portion of the percent that is “strong agreement” or “strong disagreement”

Table I.
Statement: “A pharmacy technician's duties should include...”

Table II.
Statement: “A pharmacy technician should...”

Table III.
Statement: “A Certified Pharmacy Technician should...”

Table IV.
Statement: “A pharmacy technician's training should include...”

Table V.
Statement: “Regarding pharmacy technicians...”

      When it came to technicians teaching patients the proper use of multi-dose inhalers, 57.2% of University of Michigan graduates disagreed (14.3% strongly), while Ferris graduates were 45.9% in disagreement (10% strongly), and 38.2% of Wayne graduates took issue with the statement (19.1% strongly).

Table VI:
Technicians teaching MDI use

      When asked whether a technician should “hold at least an associate’s degree (4 semesters) from a college setting,” 71.4% of University of Michigan graduates disagreed (11.9% strongly), with Ferris graduates dissenting at 67.1% (12.1% strongly) and Wayne State graduates disagreeing at 57.5% (16% strongly).

Table VII:
Technicians holding Associate’s Degree

      When discussing possible course work for pharmacy technicians, University of Michigan graduates found disagreement with  organic chemistry at 71.5% (16.7% strongly), with Wayne State disagreeing at 62.8% (12.8% strongly), and Ferris State at 59.8% (8.9% strongly).

Table VIII:
Organic Chemistry in Course work

      On the other hand, biology as a subject drew agreeable responses from 56.4% of Wayne graduates (2.1% strongly), 53.4% of Ferris graduates (5% strongly), and 45.2% of University of Michigan graduates.

Table IX:
Biology in Course work

Table X:
Algebra in Technician Course work

      The statement, “I encourage my technicians to become certified” also demonstrated a significant variety of responses based on pharmacy degree.  91.7% of PharmD graduates agreed (41.7% strongly), while Bachelor’s degree graduates who have gone for further education agreed 85.4% (62.5% strongly), and 71.9% of Bachelor’s degree only agreed (26.7% doing so strongly).
 

Table XI:
Encourage Technicians to Become Certified

Table XII: Statement: A technician “advising a patient which OTC cough or cold preparation to take.”

Similarly, the statement “advising a patient on which dietary or nutritional supplement to take” showed a significant variance between these groups.

   Table XIII: Statement, “advising a patient on which dietary or nutritional supplement to take”

 Significant variations emerged on technicians teaching glucometers, both in agreement and disagreement:

   Table XIV: Statement, “instructing a patient on the proper use of a glucometer”

  And with multiple dose inhaler teaching:
   Table XV: Statement, “instructing a patient on the proper use of a multi-dose inhaler”
 

 Regarding potential technician course work, years of practice indicated variances in the need to include algebra.
   Table XVI: Technician training should include algebra

 Variances again emerged when asked whether nutritional supplement and OTC products should be part of a technician training:

   Table XVII: Technician training should include nutritional supplements and OTC products

       a. Technician Duties
       Variances emerged when asked whether a technician should take new orders over the phone from a doctor’s office or nursing floor
   Table XVIII: Taking new orders from a doctor’s office or nursing floor

 Variances emerged when asked whether a technician should interpret drug interactions
   Table XIX: Technicians interpreting Drug Interactions

 Variances were noted when asked whether technicians should calculate administration times for IV drugs
   Table XX: Technicians calculating IV administration times
 

Variances emerged when asked whether technicians should check other technicians prior to having drugs dispensed from the pharmacy.
   Table XXI: Technicians checking other technicians prior to dispensing

 Variances emerged when asked whether technicians should advise on OTC cough and cold preparations.
    Table XXII: Technicians advising on OTC cough and cold preparations
 

 Variances emerged when asked whether technicians should advise on nutritional or dietary supplements
   Table XXIII: Technicians advising on nutritional or dietary supplements
 

 Variances appeared when asked whether technicians should instruct patients on the proper use of a glucometer.
   Table XXIV: Technicians instructing patients on glucometer use

 Variances also appeared when asked whether technicians should instruct patients on proper use of multi-dose inhalers (MDI).
   Table XXV: Technicians instructing patients on MDI use

        b. Technician Education
       Variances emerged when asked whether technicians should hold at least a certificate-level (2-3 semesters) of training
   Table XXVI: Technicians holding certificate-level training

  Variances appeared when asked whether technicians should be certified
   Table XXVII: Certification of technicians

  Variances also appeared when asked whether technicians should be licensed by the State of Michigan.
   Table XXVIII: Licensing technicians by the State

        c. Comments on certified technicians
       Variances emerged when pharmacists were asked whether a certified pharmacy technician should be paid more than a non-certified technician.
  Table XXIX: Certified technicians should be paid more than non-certified technicians

       d. Technician training
      Variances on technician training revolved around the subjects of pharmacology, algebra, anatomy and physiology, and nutritional and OTC products.
   Table XXX: Pharmacology

   Table XXXI: Algebra

   Table XXXII: Anatomy and Physiology

   Table XXXIII: Nutritional and OTC products

       e. General comments on pharmacy technicians
      Variances emerged when the pharmacists were asked about whether technician certification was necessary, whether they encouraged their technicians to become certified and obtain further education, and whether certification and licensure of technicians represented a threat to pharmacist job security.

   Table XXXIV: Certification of technicians is unnecessary

   Table XXXV: Encourage technicians to become certified

   Table XXXVI: Encourage technicians to obtain advanced, formalized training

   Table XXXVII: Certification and licensure of technicians represent a threat to pharmacist job security

Conclusion
      The fact that most pharmacists encourage their technicians to pursue certification and to obtain advanced formalized training appears incongruent with the generally negative responses shown when they are asked whether this training should culminate in a certificate or associate’s level degree.  This is additionally perplexing with a 69.9% agreement that a technician’s additional training should be in a “classroom setting.”
      The particular comparative resistance registered by independent pharmacists is also interesting. Their possible reluctance to an expanded technician role (with certification, possible licensure, and the generally agreed accompaniment of enhanced salary) could be based on their intimacy with fiscal concerns not shared by hospital and chain pharmacists, but this would have to be explored specifically in a different study.
      And while considering new studies, some trends witnessed here beg additional questions.  For example, while it is pointedly expressed by pharmacists that organic chemistry would not be a useful part of a technician’s training, it would be interesting to pursue why graduates of the University of Michigan in particular believe so, just as why they appear more resistant to having technicians teach patients on the use of  multi-dose inhalers.
      Michigan began the trend for pharmacy technician certification over 20 years ago, and many states are following, even elaborating upon, its example.  However,  Michigan pharmacists seem to be struggling with the amount of freedom to grant their technicians, as well as defining their role as coworkers.

Jim Middleton, Pharmacist
Battle Creek, Michigan
January, 2003
email: jimmiddleton@juno.com

3. The pharmacy in which you work is
 _____ community chain (over 3 pharmacies)
 _____ community independent
 _____ hospital-based
 _____ long-term care based
 _____ consultant/relief
 _____ other

4. Year you were born: 19____

5. Pharmacy college for your pharmacy degree:
 _____ Ferris State
 _____ Wayne State
 _____ University of Michigan
 _____ Ohio State
 _____ Other: ____________________________

6. The degree you hold is
 _____ Bachelor of Science, Pharmacy
 _____ Pharm.D.
 _____ Bachelor of Science, Pharmacy, with
   graduate work
 _____ Pharm.D., with graduate work

7. Number of pharmacy technicians with whom you work at your primary pharmacy:
 _____ none (martyr martyr martyr)
 _____ 1
 _____ 2
 _____ 3
 _____ 4
 _____ 5 or more

8. Number of pharmacy technicians with whom you work at your primary pharmacy who are certified (CPhT):
 _____ none
 _____ 1
 _____ 2
 _____ 3
 _____ 4
 _____ 5 or more

9. The zip code of your primary pharmacy: ________________

Survey Portion– For the following questions, mark an "x" beneath the response you feel is the most appropriate.
A pharmacy technician's duties should include:
                                                 strongly  agree  no       disagree  strongly
                                                 agree                opinion              disagree
10. Answering the telephone      _____  _____  _____  _____  _____

11. Answering the telephone to take refill orders from patients
  (this applies to a retail setting)    _____  _____  _____  _____  _____

12. Answering the telephone to take refill orders from a doctor's office
      or nursing floor                       _____  _____  _____  _____  _____

13. Answering the telephone to take new prescription orders from
      a doctor's office or nursing floor     _____  _____  _____  _____  _____

14. Prescription or drug order data entry into the computer   _____  _____  _____  _____  _____

15. Interpreting insurance company information for entry into a computer _____  _____  _____  _____  _____

16. Interpreting situations involving drug interactions   _____  _____  _____  _____  _____

17. Calculating dosages based on patient age or weight   _____  _____  _____  _____  _____

18. Calculating administration times for IV drugs    _____  _____  _____  _____  _____

19. Contacting physician or physician office regarding hospital
      or insurance company formulation change requirements   _____  _____  _____  _____  _____

20. Contacting insurance companies for vacation supply overrides
      in a retail setting       _____  _____  _____  _____  _____

21. Contacting insurance companies for prior authorization on
     non-formulary drugs in a retail setting      _____  _____  _____  _____  _____

22. Checking the work of other technicians prior to dispensing from
      a pharmacy        _____  _____  _____  _____  _____

23. Advising a patient on which OTC cough or cold preparation to take _____  _____  _____  _____  _____

(You’re doing great!)
         strongly  agree  no   disagree strongly
         agree    opinion    disagree

24. Advising a patient on which nutritional or dietary supplement to take _____  _____  _____  _____  _____

25. Instructing a patient on the proper use of a glucometer   _____  _____  _____  _____  _____

26. Instructing a patient on the proper use of a multi-dose inhaler
      (ie albuterol)        _____  _____  _____  _____  _____

A pharmacy technician should
27. Receive all of his or her training on-site     _____  _____  _____  _____  _____

28. Receive additional training in a formalized classroom setting  _____  _____  _____  _____  _____

29. Hold at least a certificate degree (2-3 semester program) from
     a college setting       _____  _____  _____  _____  _____

30. Hold at least an associate's degree (4 semesters) from a college setting _____  _____  _____  _____  _____

31. Should be certified        _____  _____  _____  _____  _____

32. Should be licensed by the State of Michigan    _____  _____  _____  _____  _____
 

A certified pharmacy technician (CPhT)
33. Should still have on-site training before taking on additional
     responsibilities       _____  _____  _____  _____  _____

34. Should be paid more than a non-certified technician   _____  _____  _____  _____  _____

35. Should be allowed to perform routine dispensing functions under
      minimal supervision by a pharmacist     _____  _____  _____  _____  _____

A pharmacy technician's training should include
36. Pharmacology       _____  _____  _____  _____  _____

37. Organic Chemistry       _____  _____  _____  _____  _____

38. Algebra        _____  _____  _____  _____  _____

39. Skipping lunch, losing sleep, and learning to like the taste of Maalox _____  _____  _____  _____  _____
  (just had to see if you were paying attention)

40. Drug interactions       _____  _____  _____  _____  _____

41. Biology        _____  _____  _____  _____  _____

42. Anatomy and physiology      _____  _____  _____  _____  _____

43. Herbal medicine       _____  _____  _____  _____  _____

44. Nutritional supplements and OTC products    _____  _____  _____  _____  _____

45. Preparation toward a pharmacist's degree    _____  _____  _____  _____  _____

Regarding pharmacy technicians,
46. Certification of a pharmacy technician is unnecessary   _____  _____  _____  _____  _____

47. Certification of a pharmacy technician means the same whether
      done by a national examination or by an on-site self-developed program _____  _____  _____  _____  _____

48. Certification and licensure of technicians represents a threat to
     pharmacist job security      _____  _____  _____  _____  _____

49. I encourage my technicians to become certified    _____  _____  _____  _____  _____

50. I encourage my technicians to obtain advanced, formalized training
 (whether by attending CE programs, taking college courses, or enrolling
in a specific college program for pharmacy technician training)  _____  _____  _____  _____  _____