*Commentary*

## **Using Real-Life Data to Strengthen the Education of Pharmacy Technician Students: From Student to Research Assistant**

#### **Bjarke Abrahamsen 1,\*, Rikke Nørgaard Hansen 1, Marianne Bjørn-Christensen 2, Tina Druskeit 2 and Charlotte Rossing 1**


Received: 5 March 2020; Accepted: 5 April 2020; Published: 8 April 2020

**Abstract:** This commentary is based on the experience of teaching and observations of how pharmacy technician students can expand their perspective on patient safety by using real-life student-gathered patient data collected from community pharmacies. Pharmacy technicians in Denmark work extensively with counselling on the safe and e fficient use of medications. Final-year pharmacy technician students can take the elective course in Clinical Pharmacy in Community Pharmacy, which targets the students who wish to work in depth with patient communication and quality assurance in counselling. One assignment that forms part of the course is for students to collect data about patients' beliefs about medications. Teachers' observations sugges<sup>t</sup> that when students gather and work with their own data, they change their perspective on patients' beliefs about medications. It also strengthens the students' awareness of their responsibility for ensuring patient safety and contributes valid data to research in pharmacy practice.

**Keywords:** social pharmacy; pharmacy technician student; education; pharmaceutical care; patient safety; pharmacy practice research; medication beliefs

#### **1. Pharmacy Technicians Contributing to Patient Safety and E** ffi**cient Use of Medications through Education and Practice**

Community pharmacies in Denmark contribute to the healthcare system by o ffering a variety of pharmacy services to support the patients' optimal use of medications [1]. In Denmark, the number of community pharmacies is lower than the European average, with 8.6 community pharmacies per 100,000 citizens compared to the European average of 32 community pharmacies per 100,000 citizens [2]. In Denmark, community pharmacies must be owned by a pharmacist holding a five-year MSc university degree in Pharmacy. Throughout the opening hours of a community pharmacy, a pharmacist must be available in person at the main pharmacy and in close contact for pharmacy branches related to the main pharmacy. The largest group of personnel at Danish community pharmacies is pharmacy technicians who hold a three-year degree, as outlined below. The allocation of responsibilities between pharmacists and pharmacy technicians is decided at each pharmacy according to the Danish Healthcare Quality Program [3] with the owner having the overall responsibility. However, some pharmacy services, such as the new medicine service and medication review, must be undertaken by a pharmacist. Pharmacy technicians have direct patient contact; they counsel patients at community pharmacies and deliver some pharmacy services, e.g., the inhaler technique assessment service. Representative mapping of pharmacy technicians counselling activities in Danish community pharmacies shows that 58.9% of

all patients served by a pharmacy technician received counselling [4]. Counselling was provided to all groups of patients; patients getting prescription drugs, over-the-counter drugs, presenting with a symptom, or requesting a non-medical product. Furthermore, pharmacy technicians identified drug-related problems (DRP) for 17.8% of all pharmacy customers and counselled them accordingly, solving or partly solving 70.4% of all identified DRP. The study investigated 17,682 customers served by 76 pharmacy technicians from 38 community pharmacies over a duration of five days [4]. According to the survey on the scope of practice for pharmacy technicians from 2017, pharmacy technicians from other European countries have similar work activities, such as receiving prescriptions, investigating the dose and type of drug, and counselling patients about their medicines. The survey shows that British and Portuguese pharmacy technicians are most comparable with Danish pharmacy technicians [5].

Another study based on answers to a questionnaire from 313 Danish community pharmacy technicians showed that they rank the task of providing customers with information as one of their top three task preferences [6]. Around 68% of pharmacy technician students, as well as qualified pharmacy technicians, hold a position within a community pharmacy [7]. Because most pharmacy technicians working in community pharmacies in Denmark have close communication with patients, they require strong communication competences. This commentary reports experiences with strengthening patient communication skills through an assignment for final-year pharmacy technician students complementing existing courses on safe and efficient use of medications. It reports how the students were prepared for the assignment, how they worked with real patient data, and how the teachers observed changes in the pharmacy technician students' perspective of patients' use of medications.

#### **2. Preparing Pharmacy Technicians in Terms of Patient Safety**

The Danish Pharmacy Technician program is a three-year education program equivalent to 180 ECTS (European Credit Transfer System) points. The academic part, which takes place at the Danish College of Pharmacy Practice, corresponds to 85 ECTS points. Students spend a total of 23 weeks taking eight courses at college. Each course lasts two or three weeks, and there are three courses in year one, two in year two, and three in the final year of the program. The practical part of the education program corresponds to 95 ECTS points and takes place at a community pharmacy, where students are employed full-time and are part of the pharmacy schedule except when taking courses at college.

The overall objective of the Danish Pharmacy Technician program is to educate and provide students with the tools and knowledge that enable them to assess and provide professional information and improve patient safety while working in a systematic, methodical, and quality-conscious way to meet needs of the society. The competences that Danish pharmacy technicians gain are professional knowledge, an ethical approach, and a sense of accountability, where consideration of medication user conditions is essential for their practice.

Pharmacy technician students in their final year can choose the elective course in Clinical Pharmacy in Community Pharmacy equivalent to 13 ECTS points. The course focuses on patient safety, patient counselling, rational pharmacotherapy, and awareness of the role of community pharmacies in the healthcare sector. The course particularly targets the pharmacy technician students who wish to work extensively with patient communication and quality assurance of the counselling related to medication safety and rational pharmacotherapy.

The course comprises a total of 16 learning objectives, with four learning objectives associated with the pharmacy technician students' responsibility for providing patient safety and supporting safe and efficient use of medications. The learning objectives relevant to the focus of this commentary are to:


The teaching approach is to establish a link between students' own practical experience and the acquired theory. This is achieved through students working alone, in groups, and at plenary sessions discussing the subjects based on their experience.

#### **3. Educational Intervention—Using Real-Life Data**

Part of the course on clinical pharmacy in community pharmacy is a specific assignment using student-gathered data. This is to target the teaching and augmen<sup>t</sup> students' perspectives on issues such as awareness of how different behaviors can affect adherence to medications and how pharmacy staff can support the patient's adherence. The assignment has the following learning objectives:


The assignment is centered around students' collection of data based on patient interviews uncovering patients' beliefs about their medications. In the assignment discussed in this commentary, the students were introduced to the theory of the Beliefs about Medicines Questionnaire [8]. The students discussed how a patients' view on necessity and concerns about their medicines could affect their initiation, continuation, and overall adherence to their treatment. The students were prepared for the task through an introduction to the questionnaire before their community pharmacy placement. The students were requested to collect and register data from patients, one questionnaire per patient, during their seventh community pharmacy placement. All data were initially recorded by the students on paper before being electronically registered, also by the students, using a web-based survey tool. In 2018, SelectSurvey was used, and in 2019, Microsoft Forms were used. During their community pharmacy placement, the students received e-mail reminders about data collection and could contact a teacher if they had any questions.

#### *3.1. Outline for the 2018 Approach*


#### *3.2. Outline for the 2019 Approach*


#### **4. Qualified Teaching Using Patient Data**

Following the data gathering, the results were discussed once students were back at college. Starting with a plenary session, a researcher presented the results and an analysis of the data. The students were encouraged to ask questions about the results and to share their immediate reflections. This session was followed by group discussions where students worked with the results and discussed how to use their new knowledge to generate questions which could be used in a counselling situation to identify patients' perspectives on their use of medications. In the final plenary session, the groups presented their work and received feedback from the teachers and other students.

During the students' subsequent eighth community pharmacy placements, they presented the results of the study to their pharmacy mentor together with suggestions of how to use the results in counselling situations to identify the patients' perspectives on their use of medications. The future use of the results and suggestions was left to the community pharmacy to decide as part of their ongoing quality improvement.

Listed in Table 1 is the summary of what the teachers observed during the teaching in relation to both learning objectives for the course and for the assignment.


**Table 1.** Summary of the teachers' observations regarding learning objectives.
