Global overview of pharmacy support personnel training programmes: a scoping review protocol

IntroductionBackground

Pharmacy support personnel is the most crucial cadre that supports pharmacists in the delivery of pharmaceutical services. The supervision approach of this cadre should be competency based and dependent on the availability of professional staff. Global disparities ranging from education and training requirements, regulatory oversight, supervision and practice have been observed.1 This has then necessitated a need to improve pharmacy support personnel’s scope of practice, education programmes and legal framework with the International Pharmaceutical Federation working towards uniting global efforts. The global training programme characteristics vary from on-the-job training, through certificate-level vocational courses, to a diploma in some other parts of the world.2 3 Furthermore, a variety of names referring to pharmacy support personnel exist with pharmacy assistants and pharmacy technicians predominantly used.2 4

Disparities also exist with high-income countries’ (HICs) pharmacy support personnel working closely with pharmacists, while in low/middle-income countries (LMICs), a shortage of pharmacists still exists resulting in heavy reliance on pharmacy support personnel.2 In both LMICs and HICs, there are circumstances where the pharmacy support personnel are expected to provide pharmaceutical services independently but within regulated environment and supervision guidelines that ensure quality of service delivered.5–7 This then necessitates the strengthening of pharmacy support personnel training programmes adjusting to local needs. HICs normally have an adequate number of pharmacists; however, a need to shift the practice paradigm by delegating the repetitive task that does not require pharmacists’ cognitive skills to pharmacy support personnel has been identified.7–10 HICs have commenced with robust debates on the approaches to pharmacy support personnel education and training, while challenges still exist in LMICs with limited action taken. Focus has been on pharmacy education and little attention to pharmacy support personnel.11 HICs have also started advocating for the role of a pharmacist in clinical patient management as opposed to just being dispensers. This practice paradigm shift needs to be accompanied by the pharmacy support personnel training that is fit for purpose.4

Overview in HICs

In the USA, there is no standardisation of pharmacy technician workforce regulations, scope of practice and training approaches.9 12 Each member state has its own regulations including definition of pharmacy technician, varying minimum entry requirements from no formalised training or certification to graduation from an accredited training programme and national certification.13 Two categories exist, that is, entry and advanced pharmacy technician level with clearly defined roles and responsibilities.3 Career pathing includes being a pharmacy technician, senior or lead technician with limited opportunity for management positions although some are performing leadership functions.7 Various approaches to the education and training of pharmacy technicians have been noted with accreditation standards only published in 2018.8 14 These standards require pharmacy technicians to be graduates of a Pharmacy Technician Certification Board from a recognised pharmacy technician training programme or have minimum hours of work experience to sit for the pharmacy technician certification examination.11 The teaching and learning approaches include didactic, simulation and experiential education for entry and advanced-level education options. Pharmacy technician training is currently offered by a wide range of organisations including community colleges, pharmacy chains, health systems, the US military, and select colleges and universities.7 15 Currently, practising pharmacy technicians are not required to pass a licensing examination in order to practise, and there are no clear minimum entry requirements for enrolling into pharmacy technician training programmes.3 11 13 The duration of pharmacy training varies from 18 hours to 24 months with an average of 32 weeks with some programme curriculum covering pharmacology and pharmacy law, some not including experiential learning.11 The teaching staff include pharmacists, pharmacy technicians, nurses, physicians and lawyers.

In Canada, a pharmacy assistant’s role started with no formal regulation, professional responsibility and unstandardised training, but it has evolved into formal regulated education programme including name transition to pharmacy technicians in around 1990s.16 This change left some confusion between the role of pharmacy technicians and pharmacy assistants not only in the public but also within the profession. Pharmacy technicians are now expected to complete a nationally accredited training programme with minimum of 940 hours and pass a board examination.7 Pharmacy technicians work independently and, in some instances, supervise pharmacy assistants. Canada has further implemented continuous professional development programmes for pharmacy technicians.

In the UK, pharmacy technicians are registered with the General Pharmaceutical Council (GPhC) after meeting criteria and standards for training with 2 years experiential learning, while registration for pharmacy assistants is not a requirement.4 The pharmacy technician GPhC registration requirement became mandatory in 2011 and little is known about pharmacy assistant practice and training. The pharmacy assistant training is through National Vocational Qualification provided by Further Education Colleges with 12 months of apprenticeship and evidence of successfully completing knowledge and competency qualification requirements.17 The training of pharmacy technicians is in a form of apprenticeship-type model consisting of knowledge and competency-based learning outcomes offered by providers face-to-face and through private distance learning.17 18 The knowledge base covers human physiology and pharmacy law assessed through assignments and sitting for examination, while competency based requires candidates to demonstrate their ability to undertake a task as observed by an assessor.

In addition to that, a need has been identified to advance the curriculum content of the pharmacy technician training programme to include law, compounding, pharmacy calculations and management.7 However, a concern has also been raised that pharmacy colleges are not participating in offering the pharmacy technician training programmes and few pharmacists are taking part in teaching and learning. This leaves the teaching and learning responsibility to non-pharmaceutical staff similar to the USA. The UK has further implemented an accuracy checking pharmacy technician (ACPT) cadre as part of career pathing.7 In order to qualify as an ACPT, the candidate is expected to have a minimum of 6 months of experience as part of GPhC registration requirement. In addition, candidates must complete online learning and practice-based activities, to further demonstrate their ability to dispense accurately through submission of dispensing logs and maintaining a portfolio. In Denmark, pharmacy support personnel are referred to as pharmaconomists and their scope of practice is close to that one of pharmacists in other countries. The Danish College of Pharmacy Practice offers a 3-year programme for pharmaconomists, equivalent to 180 European Credit Transfer System points.19

Overview in LMICs

Little is found in the literature about the pharmacy support personnel training, registration and practice in LMICs. This could be as a result of the fact that LMICs are usually faced with health systems challenges. These countries experience inadequate funding, resulting in a shortage of professional health workers. Ultimately, pharmacy support cadres find themselves providing pharmaceutical services unsupervised especially in remote, rural areas and in some instances, in urban areas.2 This practice may or may not be governed by legislation and/or special government policies. In Malawi, a cadre of pharmacy support personnel consist of pharmacy technicians and pharmacy assistants with a 3-year diploma and 2-year certificate qualifications, respectively, obtained through Malawi College of Health Sciences.20 The pharmacy technicians are working independently in district hospitals, while the pharmacy assistants are also working independently in health centres. Pharmacy assistant training is more competency based with experiential learning as part of the curriculum focusing on supply chain management.21 The pharmacy assistant curriculum is approved by the Malawi Pharmacy Medicines and Poisons Board as a regulatory requirement and the pharmacy assistants are also expected to register with this board in order to practise, after meeting all the registration requirements.

In South Africa, a cadre of pharmacy support personnel consist of pharmacy assistants (basic and post-basic) and recently introduced pharmacy technicians.22 The South African Pharmacy Council developed Good Pharmacy Education (GPE) standards, which outline minimum standards in pharmacy education and training.23 24 In the GPE standards, the minimum standards for pharmacy support personnel training, which includes work-based learning, programme delivery, exit-level outcomes and programme quality, are unpacked. South Africa has further put in place a national accreditation system for pharmacy support personnel training with well-defined competencies linked to the scope of practice. However, the standard of training by various service providers and assessors is still a concern.6 The current South African education and training programme offered has varying consistencies in the quality of training material and assessment standards.25 The competencies gained during the current training programme have limitations in preparing this cadre to work under indirect supervision on the tasks that do not require pharmacists’ cognitive skills.26 The introduction of a cadre of pharmacy technicians is hoped to breach this gap.22

Purpose of conducting a scoping review

Global discrepancies in the quality of pharmacy support personnel training programmes have been noted with various modalities that require standardisation.8 The training programmes’ global discrepancies include qualification options, skills, knowledge, competencies, accreditation, admission criteria, content and duration. The interface between knowledge, practice and regulatory requirements remains unclear. The pharmacy support personnel training programmes vary from country to country but are developed considering the expected competencies required to render the services and scope of practice.2 The purpose of this scoping review is to map out global evidence available on the pharmacy support personnel training programmes. It is anticipated that this scoping review will highlight the global pharmacy support personnel training programme characteristics, and interface between knowledge, practice and regulatory requirements while also identifying gaps for future research.

Methods and analysisDesign of the protocol

Arksey and O’Malley’s framework and Levac et al’s recommendations will be adopted to guide this scoping review.27 28 The development of this scoping review methodology is aligned with the following six stages as outlined in the guiding framework:

Identifying a research question.

Identifying relevant studies.

Study selection.

Charting the data.

Collating, summarising and reporting the result.

Consultation exercise (optional step).

We also followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols: 2015 elaboration and explanation29 guidelines to develop this protocol (online supplemental file 1). However, we will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA): extension for scoping reviews checklist to report this study’s results.

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Identifying a research question

Global need for competent, well-trained pharmacy support personnel has been identified; however, variations in the training programmes have also been noted.1 2 This scoping review is aiming at systematically mapping global evidence available on pharmacy support personnel training programmes, as well as identifying any existing knowledge gap for future research. The following research question was formulated: What is known from the existing literature about pharmacy support personnel training programmes globally?

Research subquestions

What are the characteristics of the pharmacy support personnel training programmes (skills, knowledge, competencies, admission criteria, delivery models, approaches, content and duration)?

How is the interface between knowledge, practice and regulatory requirements incorporated into the training programmes?

What qualification options exist for pharmacy support personnel?

Table 1 below presents the Population, Concept and Context used to inform the eligibility of this proposed review.30

Table 1

Population, Concept and Context framework for defining the eligibility of the studies for the research question

Identification of relevant studiesInformation sources

To identify potentially relevant documents, the following databases will be searched: MEDLINE (EBSCOhost), PubMed, CINAHL (EBSCOhost), Web of Science, Academic Search Complete, (EBSCOhost) and Dissertation and Thesis (ProQuest), ProQuest Dissertation and Thesis Global, and Google Scholar. We will perform citation search by manually searching reference lists of included studies. The systematic approaches for the grey literature will be conducted by using keywords used to search the electronic databases and specific steps will be adjusted based on the search engines’ results. We will also search contents of specific regulatory professional bodies’ websites and general internet search engines to locate unpublished data. Experts of relevant organisations working in the field of pharmacy support personnel training, including international professional regulatory bodies, will be contacted via emails to obtain additional information.

Search strategy

The search strategy was developed in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis.30 The first step included searching MEDLINE and PubMed using broad search terms covering all areas related to pharmacy support personnel training and practice. The text words in the title, abstracts, keywords and Medical Subject Headings (MeSH) terms were identified and analysed for the second step of the search strategy development. We will then perform the second step using identified keywords and MeSH terms and perform search across all other databases identified for this scoping review. Search strategy will be tailored to the specifications of each of databases searched. Finally, we will look at the reference lists from articles selected for the review. A subject librarian has provided suggestions and verifications regarding the appropriate syntax and the adaptation of search strategies across databases. A complete search strategy from all major databases used is outlined in online supplemental file 2.

The search strategy will be iterative with researchers engaging with each stage in a reflexive way, and where necessary, repeat steps to ensure that literature is covered comprehensively and in order to refine search terms as familiarity with literature increases. Search will continue until the saturation point is reached where no new relevant articles are identified. EndNote will be used as reference manager to manage records and keep track of articles. In addition, a search summary table will be used to ensure transparency, reliability and reproducibility of the search. A rerun of the search will be done on the databases that yielded the most articles in order to ensure that no relevant articles are missed in the initial search.

Keywords

The following keywords will be used: “pharmacy support workforce” OR “pharmacy support personnel” OR “pharmacy technician” OR “pharmacy technologist” OR “pharmacy assistant” OR “pharmaconomists” AND “training program” OR “education and training” OR “certification” OR “apprenticeship” OR “entry-level requirement”.

Inclusion and exclusion criteria

Table 2 below outlines the inclusion and exclusion criteria that will be used to conduct the literature review.

Table 2

Inclusion and exclusion criteria for the scoping review

Study selection

All studies that meet the inclusion criteria will be imported into a reference management package (EndNote V.20 library program) that facilitates study selection, screening and de-duplication. The total number of relevant studies retrieved from each information source will be recorded, as well as the number of duplicates removed. The number of studies excluded after screening of titles, abstracts and full texts will also be recorded, as will the reasons for exclusion. This information will be presented in a PRISMA flow diagram, a schematic draft of which is presented as figure 1 below as recommended in the PRISMA extension for scoping reviews checklist.31 32

Figure 1Figure 1Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for updated systematic reviews, which included searches of databases, registers and other sources. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. From: Page et al.32 For more information, visit: http://www.prisma-statement.org/.

The articles will be screened in three stages, that is, title, abstract and full article screening. The principal investigator will screen the title and abstract in parallel with the co-reviewer for relevance to the topic. The independent reviewers will be required to read the abstract and make decision if the study can be selected or not based on the inclusion and exclusion criteria. The discrepancies from the outcome of abstract screening will be discussed by the independent reviewers until final agreement is reached. If it is unclear whether or not to include an article based on the first stage of the reviewing process, at title and abstract, then the study will be included for full-text review to ensure it is not being excluded without full consideration. If the study qualifies to be included, the next step will be to read the full article as it is acknowledged that an abstract does not always represent the full article. Where a full-text article cannot be retrieved or not accessible from the online databases, we will seek assistance from the University of KwaZulu-Natal library or write to the authors to request the full text. Any discrepancies arising from the abstract and full article screening will be resolved by the third reviewer.

Data charting

A data charting form was jointly developed by two reviewers to determine which variables to extract, adapted from the JBI manual guidance and Gilfoyle et al’s scoping review protocol, to include the items specific to this scoping review with associated questions guiding the charting elements (table 3).30 33 The two reviewers will independently chart the data, discuss the results and continuously update the data charting form in an iterative process. The data charting form will be piloted as recommended by the JBI manual.30 The two independent reviewers will extract data from first 5–10 studies using the data charting form and then meet to determine whether the approach is consistent with the research question and purpose.

Table 3

Charting elements and associated questions for data charting elements

Collating, summarising and reporting results

Data extracted from the included studies will be collated, and quantitative results presented using descriptive statistics such as percentages, tables, charts and flow diagrams as appropriate. As suggested by the JBI Reviewer’s Manual, a narrative summary will be included to complement the quantitative results and discussion on how the findings relate to the scoping review purpose and objectives.30 A narrative account of findings from the literature will be presented following qualitative content analysis of the extracted information using NVivo V.12. The PRISMA extension designed for the scoping reviews checklist will be used to guide the reporting of the results of this scoping review. Knowledge gaps identified will be used to inform future primary studies. Quality appraisal of included studies will not be assessed as the purpose of the scoping review is to give a descriptive global overview of the pharmacy support personnel training programme and evidence will also be sourced from grey literature.

Consultation exercise (optional step)

This scoping review will not include the sixth optional stage as it is believed that the information found from the literature will be sufficient to address the research question.

Ethics and dissemination

No ethical approval is needed for this study as it does not include animals or human participants. The study findings will be disseminated electronically and in print with presentations done at relevant platforms, that is, in peer-reviewed journals, in print and in conferences.

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