Pharmacy Technician Fatigue

Exploring Occupational Fatigue in Illinois Pharmacy Technicians

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Authors: Sodam Kim, PharmD, PhDc; Johnson Osei, BPharm, MPH, PhDc; Grace Fick, PharmDc; Tara Hensle, BS; Taylor L Watterson, PharmD, PhD

Research Objective:

Patient safety has been nationally prioritized in the United States healthcare system. However, while the quality of care received by patients has improved, the well-being of the health workforce has declined. Although pharmacy technicians play a critical role in community pharmacies, their well-being is often overlooked. In pharmacy settings, pharmacy technicians are responsible for assisting the pharmacist in dispensing medication to patients and completing other tasks. The goal of this study is to explore one aspect of well-being, occupational fatigue, in Illinois (IL) community pharmacy technicians.

Study Design:

This qualitative study leverages deductive thematic analysis. The Conceptual Framework of Occupational Fatigue and the Systems Engineering Initiative for Patient Safety (SEIPS) framework were used as the theoretical frameworks underpinning this study. Community pharmacy technicians participated in a 60-minute virtual interview that explored factors related to occupational fatigue. Interviews were transcribed verbatim. The research team used the theoretical frameworks to create an a priori codebook. The researchers coded the interview transcripts using pre-specified codes in NVivo (Version 14; Lumivero) and summarized by major themes. To ensure coding consistency, inter-rater reliability was examined using Cohen’s Kappa and discrepancies discussed until consensus was reached.

Population Studied:

We recruited technicians who work in IL community pharmacies including retail, commercial, or independent settings. The eligibility criteria included 18+ years of age and fluency in English. flyers were mailed to 400 randomly selected pharmacies in IL. Additionally, flyers were hand-delivered to 61 community pharmacies in randomly selected ZIP code areas near four major metropolitan cities in IL—Chicago, Rockford, Springfield, and Edwardsville/Belleville. A total of 17 individuals participated in the interviews. A majority were female (82.4%) and reported working in a National Chain Pharmacy (70.6%). On average, individuals were 30 years old, received 6.8 hours of sleep most nights, and worked 5 years in their community pharmacy.

Principal Findings:

Using the SEIPS framework, we identified themes related to personal and work system components that help pharmacy technicians cope with occupational fatigue, as well as those that contribute to occupational fatigue. Availability of breaks and supportive team members were frequently stated as key factors in reducing fatigue, whereas lack of workforce and heavy task burdens were commonly cited as contributors to fatigue. Technology was found to have an ambivalent role, either alleviating fatigue or exacerbating it, depending on its implementation. We also explored outcomes related to occupational fatigue, categorized as proximal outcome and distal outcomes. Proximal outcomes focused mental and physical aspects of fatigue, while distal outcomes encompassed a broader scope of fatigue including prolonged responses to stressors on the jobs, patient safety resulting from the pharmacy technician’s fatigue and the deteriorated quality of care provided to patients.

Conclusions:

Study findings provide insights to the factors that promote or mitigate occupational fatigue among community pharmacy technicians.

Implications for Policy or Practice:

The study findings can inform the development of targeted interventions to reduce pharmacy technician fatigue. Internally, these findings will support future research aimed at implementing a Fatigue Risk Management System (FRMS) intervention in community pharmacies, with the goal of enhancing both employee’s well-being and quality of patient care.

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Subjective Measures of Occupational Fatigue in Community Pharmacy Technicians

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Authors: Johnson Osei, BPharm, MPH, PhDc; Sodam Kim, PharmD, PhDc; Grace Fick, PharmDc; Tara Hensle, BS; Taylor L Watterson, PharmD, PhD

Research Objective:

Community pharmacists and pharmacy technicians are experiencing unsafe levels of stress and excessive demands in the workplace. Pharmacy technicians are vital to the provision of quality patient care by supporting pharmacists and assisting with the preparation and dispensing of prescriptions, yet are historically overlooked in research studies or initiatives examining workload. This project examines Illinois (IL) community pharmacy technician occupational fatigue via subjective surveys. Occupational fatigue is the body’s need for recuperative rest that occurs during, after, or in relation to work.

Study Design:

This study employs a quantitative, observational, cross-sectional study design to describe the subjective perceptions and prevalence of occupational fatigue domains. Pharmacy technicians working in IL community pharmacies were invited to participate in a web based survey that included the Pharmacy Fatigue Instrument (PFI), the Occupational Fatigue, Exhaustion, and Recovery Scale (OFER) and a brief demographic survey. The PFI is validated to assess frequency of two occupational fatigue dimensions, mental fatigue and physical fatigue. The OFER is a validated instrument that captures acute fatigue, chronic fatigue, and inter-shift recovery.

Population Studied:

The study population included IL community pharmacy technicians. Inclusion criteria included individuals 18+ years of age and fluent in English. A total of 27 pharmacy technicians completed the 3 surveys. The average age of the respondents was 28 years, with 5 years being the average number of years each had worked at their respective pharmacies. Majority of the respondents, 61.5% worked in national chain pharmacies and 3.8% worked in independent pharmacies.

Principal Findings:

The findings from the PFI, which asked respondents to report the frequency of events during the last two weeks (14 days), showed that more than half of them experienced decreased energy (55%), felt more tired later in the day (73.1%) and generally fatigued (59.2%) more than half or all the days they worked.

The findings from the OFER scale, which asked respondents to report their agreement with statements related to fatigue over the last few months, showed mean scores of chronic fatigue (OFER-CF) = 59.6, acute fatigue (OFER-AF) = 70.2, and inter-shift recovery (OFER-IR) = 44.3. Higher scores, indicate higher fatigue/inter-shift recovery. Approximately 30% of respondents experienced “high” levels of chronic fatigue i.e. OFER score > 75, 48% acute fatigue, and only 18% reported high levels of inter-shift recovery.

Conclusions:

The results of the PFI and OFER indicate that pharmacy technicians are experiencing occupational fatigue.

Implications for Policy or Practice:

Pharmacy technician occupational fatigue is a complex and multi-dimensional problem that has potential negative implications on the quality of patient care and safety. System-mitigation strategies must address the work contributors of occupational fatigue such as increasing workload with the expanding role of pharmacy technicians.

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Mapping Inequity: The Evolution of Pharmacy Deserts in Chicago and the Legacy of Structural Racism

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Authors: Grace Fick, PharmDc; Sodam Kim, PharmD, PhDc; Victoria Kulbokas, PharmD, PhDc; Johnson Osei, BPharm, MPH, PhDc; Tara Hensle, BS; Taylor L Watterson, PharmD, PhD

Research Objective:

Pharmacists and pharmacy services are critical to public health, yet systemic inequities have long shaped their unfair distribution in many different parts of the country. Specifically in Chicago, Illinois, redlining—a discriminatory practice of grading neighborhoods based on racial composition—has left lasting impacts on healthcare access in neighborhoods across the city. These inequities persist as “pharmacy deserts,” a term first used in 2014 to describe low-income communities with low access to pharmacies. This study explores how access to community pharmacies in Chicago changed post-World War II, from 1950 to 2000. This study aims to highlight geospatial disparities across neighborhoods by visualizing independent and chain community pharmacies over time.

Study Design:

This study uses quasi-experimental archival observation; collecting historical pharmacy addresses sourced from telephone directories and library archives. ArcGIS is used to visualize pharmacy locations and changes over time. Pharmacy addresses are mapped at five-to-ten-year intervals to assess patterns of distribution by neighborhood. Data is enriched with Home Owners’ Loan Corporation (HOLC) grading maps.

Population Studied:

The study includes all 6,917 registered community pharmacies within Cook County, Illinois, USA, emphasizing pharmacies located in Chicago. Pharmacy addresses are obtained from 1950, 1955, 1960, 1983, 1991, 1996, and 2000 Cook County Yellow Pages. These data contain both independently owned and retail chain pharmacies.

Principal Findings:

The findings reveal significant shifts in the geographical distribution of community pharmacies in Chicago, marked by a significant decline in independent pharmacies, a rise in chain pharmacies, and an overall reduction of more than 70% in the total number of pharmacies over the past five decades. Northern and Downtown Chicago areas have seen an increase in pharmacy locations, reflecting the concentration of economic activity and relative infrastructure. In contrast, Southern and Western neighborhoods, many of which are historically marginalized and redlined, have witnessed a sharp decline in pharmacy access over time.

Conclusions:

This historical analysis underscores a persistent disparity in pharmacy accessibility, primarily affecting marginalized communities. The trend of reduced independent pharmacies in these areas highlights the effects of structural policies, such as redlining, that have long-term impacts on healthcare access in heavily segregated cities. These areas also experience compounded challenges, as residents face limited transportation options, increased risk of complications from chronic conditions and poor medication adherence, amplifying barriers to healthcare access. The study’s insights suggest a critical need for policy interventions that prioritize support for community pharmacies in underserved neighborhoods.

Implications for Policy or Practice:

The findings emphasize the importance of enacting policies to counteract historical inequities in healthcare access. By supporting community pharmacies and incentivizing pharmacy establishment in underserved areas, policymakers can mitigate the impacts of pharmacy deserts and promote equitable healthcare access. Targeted strategies that address historical inequities, such as subsidies or tax incentives for pharmacies in redlined neighborhoods, could play a crucial role in improving health outcomes for marginalized communities in Chicago.

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