**4. Discussion**

In this study, pharmacy technicians were identified as having varying assignments in Med Sync programs in community pharmacies who had 50% or more prescriptions in the program. Our results demonstrate that technicians can support Med Sync programs by marketing and enrolling patients, reviewing patient prescriptions, selecting medication synchronization dates, and assisting in the delivery or pick up of medications. These results help to close the gap on the conversation as to whether Med Sync services fall on pharmacists and initiate the capturing of non-pharmacist staff participation in the Med Sync process [13]. This study demonstrates that technicians can be engaged in all tasks of the Med Sync process.

The APhA white paper establishes the steps to improve consumers' adherence to medication and the systematic review conducted by Patti and colleagues summarizes the white paper to help standardize Med Sync within community pharmacies. [13,16]. The white paper and the systematic review demonstrate key roles that must take place to perform Med Sync services, ye<sup>t</sup> neither document mentions which pharmacy staff members should perform these services. The five activities that technicians participated in that emerged from our data are reflective of the Patti and colleagues 5 core components. Participant responses alluded to technicians' practicality in performing most, if not all tasks. This suggests that technicians are and can be integral components for effective Med Sync implementation.

According to the results, technicians have constant engagemen<sup>t</sup> with patients and are in a grea<sup>t</sup> position for involvement in all steps of a Med Sync program from initiation to pick up and/or delivery. In fact, one of the pharmacies mentioned technician involvement in all 5 core components of the

Med Sync process, and the technician was the primary lead on the service. This demonstrates that technicians are capable of participating in all steps of the Med Sync process, and technicians are also in a grea<sup>t</sup> position to take the lead of the service. Recent studies have shown having a dedicated Med Sync technician assists in supporting clinicians [17,18]. In the current study, one participant, a pharmacist, deferred their question regarding patient synchronization and enrollment responding, "*That's probably a better question for the techs.*" This suggests the pharmacist trusted the technician to be the leader of the Med Sync program.

Not only are technicians in a grea<sup>t</sup> position to lead the program, they are also able to assume increased responsibility. Two recent workforce surveys sugges<sup>t</sup> technician responsiveness and eagerness in assuming increased responsibility [1,19]. When the lone pharmacy technician was asked how they became involved in the program they responded, "*I have an eye for organization, and I just started taking it over, little by little*." This represents the increased responsibility the technician was willing to take on to lead the program. In addition, to leading the Med Sync program, the technician also attended a national meeting to learn more about the service. This further solidified the technician's commitment as a leader and their continued involvement in Med Sync.

In other observations of pharmacies struggling to implement new services, underutilization of pharmacy technicians is a common theme. Given the challenging practice environment that community pharmacists are faced with, e fficiently involving all sta ff members in Med Sync operation is key. Participant responses were consistent in leveraging the technician workforce in support of Med Sync success. Though this study focused on the role of technicians, future research needs to investigate the roles of additional non-pharmacist sta ff. Clerks and cashiers were mentioned in multiple steps in the Med Sync process. One participant acknowledged the importance of the cashiers in their Med Sync enrollment process stating "*cashiers... would get a lot more [enroll more patients] because they were talking face to face with people*".

Finally, this study expands the literature regarding advancing the roles for pharmacy technicians in community pharmacies. By allowing technicians to have more advanced technical roles, it provides community pharmacist opportunities to become more involved in direct patient care. This transition allows pharmacists to participate in activities that use their expertise in medication optimization services and improves medication outcomes. Inevitably, advancing pharmacy practice depends on elevating the roles and responsibilities of pharmacy technicians.
