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In this episode, Jessica Langley-Loep interviews a leading researcher on the pharmacy technician practice, Dr. Kenneth Hohmeier, associate professor, director of community affairs and the community based pharmacy residency program director for the University of Tennessee Health Science Center.  Together, they discuss how pharmacies can expand the roles of pharmacy technicians to improve workflow.

Introduction:

Welcome to access on air from NHA. This podcast is dedicated to providing educators and employers of frontline healthcare workers with expert perspective on trends impacting and elevating the industry. These discussions can help you achieve your goals as you continue to pave pathways toward professional success for those working in allied health. Thanks for listening.

Jessica Langley-Loep:

Hello, this is Jessica Langley. I'm the executive director of education and advocacy for the national health career association. And we are lucky enough today to have Dr. Kenneth Hohmeier, who is the associate professor director of community affairs and the community based pharmacy residency program director for the university of Tennessee health science center, the department of clinical pharmacy and translational science. Ken, thanks so much for being here today.

Dr. Kenneth Hohmeier:

Excited to be here. Thanks for having me.

Jessica Langley-Loep:

Awesome. Can you tell us so you have done an amazing job at writing. One of our articles for our access 2020 allied health journal, and it is entitled expanding the role of pharmacy technicians, how advanced skills and moving the industry forward. Start a little bit and just describe some of the work that you're currently doing and how that kind of translated into you writing this article for us.

Dr. Kenneth Hohmeier:

Sure. absolutely. So the, the work that I, and some of my colleagues are doing at the university of Tennessee right now is around expanding access to patient care services through the community pharmacy. So that's really where all of this starts, and there's a group of us there ranging from experts in economics, healthcare economics to large scale database analysis. And then what I kind of bring is the community pharmacist side as that's really where my my training and then my practice experience has been. And so in doing that work over the past 10 or 15 years one thing that's, that's really resonated in my mind is none of these great things that pharmacists can do can be done without a really strong team. And that team is primarily made up of our pharmacy technician colleagues which brings us to some of the studies at hand that I discussed in the article and things we're working on at Tennessee.

Dr. Kenneth Hohmeier:

And, and those range from what's known as technician, product verification sometimes known as tech check tech pharmacy technician roles and therapy management roles in vaccination screening and recommendation. And that's here in, in Tennessee by the way. But we're also working with our colleagues in Idaho where the patients can actually administer vaccines. So we're seeing some of that work being done and, and excited about that. And then the other piece that we're really excited to be working on is the pharmacy technicians role in point of care testing, which is extremely relevant to today's ever changing public health emergency around the Kobe crisis where we're seeing a big demand obviously for testing and screening for that, that virus. And a lot of very big key decision makers are saying we're where does pharmacy fit into this? And I think part of that conversation is where's the pharmacy technician fit into this,

Jessica Langley-Loep:

Right. I know I have been you know, flooded in social media and with emails and association updates on the valuable role that the pharmacy professionals are, are playing right now. And I think you kind of hit it right on the noses, really in order to advance both the pharmacist and the farm tech profession forward, it really comes down to putting the patients at the center of that and having both of them, you know, kind of advance at the same time one can't do it without the other. And I really feel like that's kind of the reason and, and kind of the background for why individuals like yourself and organizations like the university of Tennessee are focusing on this research and really thinking about what has to happen in order for that, you know, to be successful on both ends. So I really want to jump in to the four different advanced skills areas that you just outlined and that you also outlined in the access article and just talk very briefly about each one and kind of what the skill is and how that can be valuable. Having the pharmacy technician perform this particular role and what benefit that brings to maybe the pharmacist and, or the pharmacy, you know, operations and efficiency. So let's start with technician product verification. What is this skill? And how can technicians, you know, do it effectively to help increase maybe operational efficiencies or revenue in a pharmacy setting.

Dr. Kenneth Hohmeier:

So at a very basic level, like mission product verification is simply the pharmacy technician stepping into what is traditionally pharmacist's workflow and ensuring that the product that was selected by the medication filled technician is the one which was appropriately verified by a pharmacist previously. So that those two items match we've seen on the computer screen as the needed medication and the one that's actually in that technician's hand, which was filled by another technician.

Jessica Langley-Loep:

Gotcha. So does the research support this as being safe and can a technician perform this function just as well as a pharmacist?

Dr. Kenneth Hohmeier:

Absolutely. So this has been studied probably going on 15 years now in the health system world with really strong literature behind it to demonstrate safety. And we'll, we'll talk about efficacy here in a moment. It's so we, we borrowed a lot from that methodology and the community pharmacy setting and have studied it in several States now, Tennessee being one of them Wisconsin and Iowa being two others. And there's some others in addition to that as well. And what we found across all of these States is that indeed this is safe. And in some situations actually we've got a a higher degree of error detection by the pharmacy technician doing PPV than the pharmacist. And we're still really digging into that into those numbers. But I think for those of us who have been on the front lines long enough, it's easy to understand that the pharmacist is pulled in 20 different directions.

Dr. Kenneth Hohmeier:

There's the phone ringing the problem at the drive through you've got a patient like for a vaccine. And so that, that multitasking is is well known to be a cause of, of errors, medication errors in the pharmacy. I think that's probably what we're seeing there. So safety. Yes. I think that's pretty well established at this point. Efficacy. That's a really important thing. That's, that's the exciting thing that I latch on to what we can do now with pharmacy technician stepping up into this new role is to provide in some cases the same care better, but in a lot of cases, new types of patient care and increasing quantities of patients here in Tennessee, we have something called the collaborative practice agreement, which allows us to order laboratory tests, prescribed medications alter medications as needed. We've been able to at our study sites implement at least one collaborative practice agreements at each of those pharmacies, those things didn't exist before that the tech product verification model was in place.

Dr. Kenneth Hohmeier:

We've been able to increase the number of medication therapy management or MTM visits, a total number of patients seen for clinical services in general, all these numbers have gone up in a very huge way. And the analogy I keep giving folks to understand the magnitude of this is if somebody was trying to water a garden and somebody else was stepping on the hose near where the is you'd get some water into the garden, but it wouldn't be a lot. And it doesn't matter how high you crank the water on the spigot. You're still gonna get that same amount, that little amount of water coming out of the hose nozzle. And so those things represent, you know, metrics and coaching and training. We can do all of that until we're blue in the face, but until someone takes their foot off of the hose and that's what technician product verification does.

Dr. Kenneth Hohmeier:

The water's really not going to flow in the way that it's meant to. And so for those sites that sort of had built up a queue of available services to provide a whole bunch of MTMs maybe lined up or a large population that needed vaccines, but you just don't have the time to screen and recommend those vaccines. We see those pharmacies performing at such a high level that they quickly become the Allstars within their division for if it's a chain and for independence. What we've seen is that other independence within that smaller family owned chain want to have their other independent pharmacies take on the model as well. So in both term safety and efficacy, we're seeing amazing results with, with this this TPB model.

Jessica Langley-Loep:

That's great to hear, and we love being able to have the data and the research behind it, you know, to support the concept. Especially as more States, start to look at that and adopt it, you know, within their own rules and regulations. The next one we want to talk about is medication therapy management. And I'll let you kind of describe what that is and what role the technicians play within it.

Dr. Kenneth Hohmeier:

Sure. So MTM is just a broad term, really for what a pharmacist can do in a direct patient care setting where, you know, you go to a dentist and they can inspect and clean your teeth. He goes to an optometrist and they're gonna check your eyes, maybe give you glasses. MTM is what a pharmacist can do with their skillset. And it's really about making sure the right medications are getting to the right patients in a proactive way, rather than just waiting for a drug utilization, drug interaction screen, to pop up or stumbling on something in counseling. They're usually 15 to 20 to 30 minute appointments. But there's a lot of work that goes into those appointments before and after. And so what the pharmacy technician can do here really is to support the services before and after the appointments that's scheduling. Those are followup phone calls, maybe faxing information to their physician recommendations from the pharmacist, things like that.

Dr. Kenneth Hohmeier:

All those kinds of supportive services are really important. We also see the technician being utilized in a medication reconciliation space. So this is interviewing the patient, talking to that patient and gathering the medication list prior to the pharmacist, stepping in the room. Again, I work in analogies a lot. And so the analogy I would share here is last time you went and you saw your family physician or your primary care physician, you did not do that position until you maybe touched two or three other professionals who took some vital signs from you did some interviewing filled out some forms with you. And then you saw the physician. That's what we're really seeing the technician stepping up to do in MTM.

Jessica Langley-Loep:

Great. So getting good histories, getting a complete medical list and then passing it on for the clinical judgment piece to be provided by the pharmacist who ultimately has the education requirement to do that, right. The background to do that, let's switch to vaccinations, which is obviously top of mine you know, across the nation right now, and our technicians available and capable of doing this. And are they being allowed to do this in some States? And what does it take in terms of training to get them to a point where they're competent to help perform vaccinations or immunizations within a pharmacy setting?

Dr. Kenneth Hohmeier:

Yeah, so this is a really exciting area. Obviously, pharmaceutic missions have been crucial vital to the quick, rapid growth of pharmacy delivered vaccines across the country. I mean, this has really been a phenomenon over the past 10 and 15 years where the professionalist stepped up to take on this public health need. And, and so the screening, the recommendations even his stapling flyers to bags to let patients know they're eligible. All of those things have been really crucial, but the exciting new thing that's coming out of this, this segment of pharmacy is the ability for pharmaceutical patients to actually administer the vaccine itself. And this is maybe only two or three years old at this point, but we're seeing well over a thousand vaccines already administered safely and effectively in a handful of States. And really what's known as is sort of the federal pharmacy system and its includes the Indian health services and some other systems that are really outside of the purview of state regulations, because that's where this whole thing lives. That's where the, the rights and privileges of an individual to give them vaccine that's where that comes from. And then when we're talking on the state level, the States allow this, this thing to happen. These pharmacy technician delivered vaccines. And at this point we only know Idaho and Rhode Island have allowed those, those those things to happen. But I think with a lot of these new tasks and roles this is just the beginning. We'll see this sort of expand in the coming years.

Jessica Langley-Loep:

Awesome. I know we oftentimes, you know, as an allied health organization, we support additional roles like medical assistance. And we often compare that to, in terms of equivalency and training, you know, they're both frontline you know, health professionals and why you know, with the, with the amount of training that a medical assistant have and equivalency, you know, with the pharmacy technicians, they should be able to perform a similar role than that, of a medical assistance. They both work underneath, you know, the delegation of a, of a healthcare professional you know, a provider. And so hopefully we will see that kind of bleed over into that, that profession and have them take on kind of similar ideas and training requirements and things like that, that we see on the medical side of things and adopt that into the pharmacy world. Lastly, we talked a little bit about this before, when you talked about MTM, but share a little bit more about the importance of medication history collection. So what type of information a technician may acquire or gain from an interview type process with a patient. And I think more importantly, what value does this bring to the patient themselves and what we can do to help elevate their, you know, their health and wellbeing?

Dr. Kenneth Hohmeier:

Absolutely. So a medication history collection really involves gathering and compiling the entire medication list. All of the things that patients taking from prescription products to over the counters, herbal supplements this include vaccinations by the way, and then corresponding information like those strength, directions, quantity like the treatment. What we find a lot is that what's collected if done appropriately does not match either the pharmacy or the medical record. And I think that that's true for a lot of things in life, but what's on paper. Doesn't always match with some practice where we think isn't always what happens in, in reality. And so this, this is essential because what's actually going to impact the patient for safety or for effectiveness is what the patient's taking and not what's on a computer screen. The problem is that most providers, pharmacists included are really crunched for time and that, that can't be overemphasized and it's been more recently than ever before.

Dr. Kenneth Hohmeier:

And so what can happen is, is rushing through this very important piece of the patient care process. So what we're doing in the community now is borrowing from what the health systems and hospitals have done for a long time. And that's to empower well trained, qualified, and credentialed pharmacy technicians to actually do that data collection with dedicated time and the appropriate training. And we're getting much more robust information from the patient because of those interviews, from which we can make really sound clinical decisions. And and that gets right back into that medication therapy management program and in a lot of other clinical services as well,

Jessica Langley-Loep:

Right? It's the circle of life, right? We need to have all the information in order to make the best treatment plan for individuals. And just having that time to collect all that information is, is really key. Well, so we talked about four different types of kind of advanced skills that technicians are doing, and we so appreciate you breaking those down for us. We invite you all to check out Ken's article in access 2020, and to just kind of round this out, dr. Homeier, if there are technicians listening or pharmacist or pharmacy employers or pharmacy managers just end with like, where do you think the future of pharmacy technicians is heading and how can people, you know, engage to help adopt these new models so that we really do deliver the best quality of care and medication safety to our patients?

Dr. Kenneth Hohmeier:

Yeah. If I could leave everybody with just sort of one, one big nugget, it would be that this is just the start. I would expect more responsibilities, but in, in bits since spurts once they doing this and other doing that, and I think you can look at how vaccines have grown over the past 10 to 15 years as a, is a good example of what that will look like, where it's sort of this uneven growth in expanded duties and roles, but at some point there's a leveling out and then we've sort of got a status quo of, of all of these new, great advanced roles. So for our technicians out there who are listening just really stayed tuned to new training and credentialing opportunities. Employers want these new roles to happen, but foremost, they want to ensure that the rules are being held by the highest trained and qualified individuals.

Jessica Langley-Loep:

Perfect. And of course, you know, NHA ourselves are always looking to support research to support the training and advancement of pharmacy technicians and also just to advocate for them anywhere that we can. So if you all have questions or want to outreach, or just have things to share with NHA, obviously you can do that through our website, NHA now.com or just reaching out even to myself and my email. And we can also share questions with dr. Homer and human share would be happy to get back with you. So, dr. Hamada thank you so much. You've done so much great work. Not only for the pharmacy technician profession, but we enjoy all the collaboration that you have done with NHA. And we look forward to continuing to work with you in the future,

Dr. Kenneth Hohmeier:

Same here. And so appreciative of the team there at NHA for all you've done to advance the profession and help us all take care of patients in a in a better way. And please, I do extend that that offer if anybody wants to reach out hopefully my contact information will be made available, do not hesitate to reach out the best research questions comes from the folks on the front lines. And I would hope to hear from, from all of you at some point,

Jessica Langley-Loep:

Great, thanks so much.

 

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