**3. Results**

#### *3.1. Response Rate and Respondent Characteristics*

Of the 1800 survey links disseminated, 110 were returned with undeliverable email addresses. There were valid responses from 326 respondents, resulting in a response rate of 19.3%. Response rates by U.S. state (assuming an equal proportion of undeliverable surveys for each) ranged from a low of 14.6% for Florida to a high of 21.3% for Tennessee. Just over 2/3 of respondents were White/Caucasian (see Table 1), and just over 1/8 indicated a preference not to answer. Nearly 3/4 of respondents worked the equivalent of full-time hours (i.e., greater than 39 h). Over half of the responding pharmacists came from the community pharmacy setting, with an approximately equal share among those from independent and chain settings, respectively. Just under 1/4 came from hospital/health-system settings. There were a considerable number (nearly 7%) who came from a compounding or other specialty practice, and several apiece representing various other practice settings. Sta ff pharmacists represented nearly 1/3 of respondents, while several respondents were in some sort of administrative or ownership position. Clinical pharmacists could have come from any of various settings, but many of the pharmacy managers likely came from community settings with administrative responsibilities in addition to sta ffing those pharmacies.

In comparison to the general population of pharmacists in the U.S., the Bureau of Labor Statistics only categorizes pharmacists into much broader work settings, with 26% working in hospital (compared with the current study's 23%) and 57% working in retail (compared with the current study's 54%), which is commensurate given that some of the current study respondents likely work in a hospital or retail setting but have a job title/responsibilities that might be more clinical or administrative [34]. A 2014 study of a national random sample of pharmacists also responding to a survey showed responses in their sample from 56% who were female and 44% male, compared with the current study of just over 52% female and just under 48% male [35].

## *3.2. Survey Results*

Cronbach's alpha calculations for all subsets of items ranged from a low of 0.83 to a high of 0.97. Respondents' perceptions of the impact of certification on technician competence alone, or in combination with other types of education/training and with previous work experiences are described in Table 2. Certification alone was not deemed to have a very substantial impact on many of the general skills under question that generally transcend most, if not all practice settings. Some of the skills/items where certification alone was rated as having the least impact were billing/administrative functions, time managemen<sup>t</sup> skills, leadership, and problem-solving. Although still under the median scale value ("3"), the areas in which certification alone was deemed to have greater impact were basic pharmacology/drug knowledge, math computation, medication order/prescription entry, and non-sterile compounding. Respondents were more positive about the impact of certification in combination with other types of education/training, with nearly all response means calculated to be at or above the median scale value (except for time management). In addition to time management, those items/areas where the impact of certification in combination with additional education/training was rated lowest included interpersonal communication, ethical decision making and managing organizational change. Those areas rated highest included mathematical computation and medication/prescription order entry, but also sterile compounding. Some of the larger incremental evaluations from combination of certification with education/training versus certification alone included medication/prescription preparation, sterile compounding, problem-solving, and billing/inventory management. Likewise, certification in combination with previous work experience as a technician was viewed to have a more positive impact, with positive mean values (above scale median) for all items except for ethical decision-making. Many of the mean values were similar to but in some cases perhaps somewhat greater than those of certification combined with other education/training. Higher mean values were seen with regard

to tech-check-tech, emerging responsibilities (e.g., administering immunizations and assistance with medication therapy management), and a few others; however, these were not compared statistically.


**Table 1.** Demographic and work-setting characteristics of responding pharmacists (*n* = 326).

\* Percentages for each category may not summarily equal 100.0% due to rounding.

Table 3 provides mean ratings of items/factors contributing to making certification more impactful. Most items were evaluated quite highly on a three-point scale of importance, with all but one of them at or above the median scale value of "2". The factor rated below "2" was "more di fficult examination". Items the respondents rated rather high on importance included better integration of the certification process with vocational training, more content on technical pharmacy knowledge/skills, more content on "soft skills", and more support for certification from employing organizations.

Emerging/new

Basic Math

Managing

responsibilities

computational

organizational

assistance with MTM)

pharmacology/knowledge

 (e.g.,

> of drug names/OTCs

> > skills

> > > change

immunizations,


**Table 2.** Perceptions of the impact of certification on technician competence alone, in combination with other types of education/training, and in combination with previous work experience.

> \* Mean ± Standard deviation on a scale ranging from 1 = Not at all to 5 = Very much.

2.19 ± 1.28

2.69 ± 1.34

 2.65 ± 1.20

 2.08 ± 1.27  3.48 ± 1.36

 3.58 ± 1.36

 3.65 ± 1.34

 3.08 ± 1.28  3.52 ± 1.33

 3.65 ± 1.31

 3.58 ± 1.28

 3.12 ± 1.19

**Table 3.** Items/factors contributing to making certification more impactful.


\* Mean ± Standard Deviation on a three-point scale ranging from 1 = Not important to 3 = Very important.

Respondents' beliefs about various facets of the value of certification are shown in Table 4. Respondents slightly disagreed with the notion that certification is equally beneficial across different practice settings. There was also slight disagreement with mean scores toward neutral for items suggesting certified technicians make fewer mistakes, are more innovative in customer service, are better prepared to deal with organizational change, and are more committed to their employer. There was agreemen<sup>t</sup> with the idea that technicians with experience are able to leverage certification, are more committed to their occupation/profession, help to promote a stronger organizational culture, and are better prepared to accept new roles, as well as that hiring decisions are made at least in part on whether the technician is certified. There was strongest agreemen<sup>t</sup> with the idea that technician certification should be a requirement for advanced status and/or roles.


**Table 4.** Respondents' beliefs about various facets of the value of certification.

\* Mean ± standard deviation on a scale ranging from 1 = Strongly disagree to 6 = Strongly agree.

Table 5 provides the mean ranking of various factors responding pharmacists actually use or would use in hiring pharmacy technicians. Ranked highest (lowest mean) was the technician's demonstrated or anticipated job abilities. This was followed by their previous work history as a technician, their communication skills and moral integrity, whether or not they are certified, their ability to adapt to practice change, their emotional intelligence, and finally their acquisition of vocational school training.


**Table 5.** Mean ranking of factors in respondents' hiring or potential hiring decisions regarding pharmacy technicians.

> \* Mean ± standard deviation based on a ranking of each item/factor from 1 to 8.
