“Who is going to do what?”: the reallocation of pharmacy activities for the French pharmacy technicians?
Résumé
Title: “Who is going to do what?”: the reallocation of pharmacy activities for the French pharmacy technicians. Background information: In France, pharmacy technicians (PTs) are authorized to dispense under the supervision of community pharmacists (CPs). The initial training of PTs has been integrated into the schools of pharmacy for 3 years now. Moreover, the implementation of the pharmacy services, the increase of the activities related to the triage of patients, and the lack of CPs require to review the activities as well as “who is doing what” within the community pharmacies. Purpose: The main objective of the survey is to determine the preferences of the CPs (owners (OCPs) and employed CPs (ECPs)) and PTs on the evolution of the PTs’ professional activities in the community setting. Method: The study is based on a MaxDiff type questionnaire. Thirteen activities of the daily pharmacy practice were identified, related both to the clinical and the management aspects. Each participant was asked to think about a reallocation of the activities in the pharmacy where they practice. A total of 13 different choice tests were submitted to the participants. For each choice test, they had to choose among 4 activities which one would suit the PTs the best and the worst. A multinomial logistic regression was performed to estimate the weight of preferences. Results: A total of 97 OCPs, 48 ECPs and 36 PTs responded and 2353 choice tests could be analysed. The OCPs and the ECPs preferentially assign to PTs the daily order management (OCPs: b = 1.31, 95%CI [1.37 – 1.48] ; ECPs: b = 1.62, 95%CI [1.35 – 1.90]), screening interventions (OCPs: b = 1.09, 95%CI [0.93 – 1.25] ; ECPs: b = 0.96, 95CI% [0.74 – 1.19]) and the supply chain management of the nursing homes (OCPs: b = 0.93, 95%CI [0.77 – 1.09] ; ECPs: b = 0.81, 95%CI [0.60 – 1.03]). The PTs preferentially assign to themselves the daily order management (b = 1.37, 95%CI [1.09 – 1.67]), the supply chain management of the nursing homes (b = 0.75, 95%CI [0.51 – 1.00]) and the drug dispensation in autonomy (b = 0.51, 95%CI [0.27 – 0.75]). The activities related to pharmacy services fall under the competence of pharmacists for the 3 types of respondents. The weight of the preferences are significantly different for the prescription for minor ailments (OCPs: b = -0.16, 95%CI [-0.30 – -0.01] ; ECPs: b = -0.41, 95CI% [-0.61 – -0.21] ; PTs: b = 0.32, 95%CI [0.08 – 0.57]) and quality management (OCPs: b = -0.02, 95%CI [-0.17 – 0.11] ; ECPs: b = 0.11 , 95%CI [-0.08 – 0;32] ; PTs: b = -0.50, 95%CI [-0.73 – -0.26]). Conclusion: The top 3 and the worst 3 in the preferences to reallocate the activities in the community pharmacies are substantially identical for the OCPs, ECPs and PTs. We can assume that the activities in the top 3 correspond to activities that are already in the process of being assigned to PTs. Identifying them allows us to support professional changes and to ensure that the PTs initial training is adapted to the current professional practice changes. It is interesting to note that pharmacists do not wish that the PTs could dispense drugs in autonomy. These results may appear to contradict what is observed in the community settings and reflect the pharmacists’ concern that their pharmacist's diploma may be threatened. These results echo that the PTs’ weight preference about the prescription for minor ailments is higher than the pharmacists’. Finally, activities whose preferences are intermediate should attract our attention: they could be reassigned in the near future.