**4. Discussion**

A review of job postings for pharmacy technicians provided a rich description of the different roles and skills currently needed across pharmacy settings. Technicians remain in many traditional settings, such as retail/community pharmacy. This is consistent with other descriptions that place technicians in supportive roles at community pharmacies and health-system pharmacies [1]. In these settings, technicians often assist with technical pharmacy functions and interact with patients. However, this can expand to other roles, such as providing support for medication therapy managemen<sup>t</sup> (MTM) services and other clinical services [1]. Interestingly, there are emerging areas that are hiring technicians, such as managed care. As pharmacists in managed care continue to expand their opportunities to provide clinical services and chronic care management, technicians may have increasing roles to support data collection and documentation [15].

The data show that 12.3% (N = 2583) of pharmacy technicians are required to have standard certifications in pharmacy technician work such as PTCB and exCPT. Many states have a requirement that pharmacy technicians ge<sup>t</sup> certified either through these routes or through a standardized exam with similar content within a year of hiring, but there is little standardization across the board for these exams [17,18]. On multiple occasions, calls for standard national training and certification processes have been made, and it is clear that multiple organizations find it crucial to have this kind of a standard for certified pharmacy technicians [19,20]. While 81.5% (N = 17,114) did prefer a certified technician, it is surprising that more employers do not share the same national desire.

To fill these roles in a variety of settings, pharmacy technicians appear to need a variety of skills—many of which lie in the affective domain, i.e., professionalism and communication. Given the customer/patient service role many technicians provide, it is essential that they exhibit professionalism and can communicate appropriately in both written and verbal formats [2]. Further, analysis of the ads underscored the importance of technicians in quality assurance. Given their role in the dispensing process, inventory management, and other aspects of the pharmacy, technicians play a vital role in fostering an environment that promotes safe and effective medication use. For example, Odukoya, Schleiden, and Chui (2015), found that pharmacy technicians play a vital role in preventing e-prescribing errors by catching errors before the prescription is sent to the pharmacist to verify [16].

Expanding the roles of certified pharmacy technicians continues to be a discussion in the literature and the profession of pharmacy. States continue to explore tech-check-tech programs to free up pharmacist time to focus on clinical activities [9]. Some recent research also has explored the use of pharmacy technicians to extend medication managemen<sup>t</sup> to the home setting, performing medication reconciliation and reiterating key counseling points from the pharmacist using motivational interviewing and the teach-back method [14]. Others have explored creating a clinical pharmacy technician to expand patient medication education [17]. While the job postings do not necessarily reflect these expansions, it would be important to continue to monitor ads to determine if the roles of pharmacists, and particularly, certified pharmacy technicians, are altering and expanding to allow pharmacists to focus on clinical activities.

As noted in the results, a small portion of the data included advertisements that required the technicians to be knowledgeable in HIV-related patient care. While this was not a substantial portion of the data, it is interesting to note that it is an area of potential growth for pharmacy technicians in the US. An article from 2013 found that a pharmacy technician-centered medication reconciliation for ART therapy of patients in the hospital was successful in assisting with the prevention of drug-drug interactions, as well as other medication errors. The program showed that ART and OI prophylaxis in HIV/AIDS patients was improved by the utilization of pharmacy technicians [21]. Similar data were collected related to a pharmacy technician-centered medication reconciliation unit at a mental health location in 2014 [22]. These articles and pieces of literature show that there is potential for pharmacy technician-led integration of prevention of med errors even in disease-specific areas of healthcare.

In order to continue integrating pharmacy technicians into the practice of pharmacy, it is important for those pharmacy technicians to be highly skilled to enhance the clinical reach of the pharmacist. Projected pharmacy technician skills that could potentially be sought out by progressive employers include skills such as managing certain aspects of clinical tasks such as medication managemen<sup>t</sup> and medication reconciliation, reiterating counseling points to reinforce statements made by the pharmacist, exceptional skills in communication and professionalism, as well as being able to quickly and accurately review information regarding patients' prescriptions during data collection and order entry. One systematic review found that pharmacy technicians are often utilized to support MTM through medication reconciliation and that adherence and medication utility can be improved. However, standardization for administration utilization and educational training in this setting is necessary [23].

Another study found that the implementation of pharmacy technicians into a nursing team in an acute admissions unit in a hospital setting allowed for the prevention of omitted doses and helped all members of the team make better use of their time [24]. Another similar study showed that pharmacy technicians working in hospital wards in order to improve medication managemen<sup>t</sup> and to prevent the utilization of expired or misplaced medications caused significant cost savings, as well as per-patient time savings for the nurses also working in the wards [25]. These and other studies like it allow us to see the benefit of utilizing pharmacy technicians in expanded definitions of the traditional pharmacy tech role. These articles and trials of expanding the role of pharmacy technicians have given insight into ways to continue utilizing pharmacy technicians well. Due to the vast amount of pharmacy technician positions in the US, and the variety in settings that pharmacy technicians can explore, it is expected that these potentially beneficial positions will continue to develop in the United States as pharmacy practice continues to move forward.

In addition to defining potential expansion of the role for technicians, the literature also emphasizes the importance of education and training in order to standardize patient care and to ensure best practice is being followed. Pharmacy technicians must be competent, able to communicate, and behave in a professional manner. Given their integral role in the profession of pharmacy, providing opportunities for pharmacy technicians to develop professionally is vital. Multiple professional organizations have provided outlines of competencies and training/education to assist pharmacy settings in providing these opportunities [1,13]. Opportunities also remain for technicians to become certified, and some jobs preferred or required this additional training [1,13]. However, the benefits of completing additional training for technicians may not ye<sup>t</sup> be balanced with the costs of obtaining it [18].
