Developing a competency assessment framework for pharmacists in primary health care settings in India

doi:10.21203/rs.3.rs-3096716/v1

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Research Article

Developing a competency assessment framework for pharmacists in primary health care settings in India

https://doi.org/10.21203/rs.3.rs-3096716/v1

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Background

Pharmacists play a significant role in primary health Care. The competence assessment of pharmacists is a critical driver for enhancing primary healthcare performance. While several countries have developed competency frameworks for pharmacists in primary care, such frameworks are lacking in the Indian context.

Methods

This study aimed to develop a competency assessment framework for in-service pharmacists in Indian public primary healthcare settings. A five-stage consultative process was followed. In the first stage, a systematic literature review was conducted to identify pharmacist competencies in the primary healthcare setting. Expert consultations were then organized to build consensus on competencies and behaviours. Competency assessment tools were developed based on the literature and experts' agreements. Another round of expert consultation was conducted to achieve consensus on the competency assessment tools. Finally, the tools were tested in a public primary healthcare facility.

Results

The systematic literature review identified 20 competencies and 175 associated behaviors distributed across four domains: Pharmaceutical Health, Pharmaceutical Care, Organization and Management, and Professional/Personal. Expert consultations resulted in the consensus on 11 roles of pharmacists in primary healthcare settings. Competencies and associated behaviors were discussed and agreed upon for each role.

Conclusions

This study successfully developed a competency assessment framework for in-service pharmacists in Indian public primary healthcare settings. The framework encompasses 20 competencies and associated behaviors, covering various domains and roles of pharmacists. It provides a comprehensive tool for assessing pharmacist competencies and identifying competency gaps. The framework can be used to capacitate pharmacists, improve the performance of pharmacists in primary healthcare settings, and enhance the delivery of healthcare services in India. It fills a critical gap in the existing literature and can serve as a valuable resource for policymakers, educators, and healthcare professionals involved in pharmacy practice in primary care settings.

Pharmacist

Primary health care

Competency

Competency Assessment

Competency Assessment Tool

Skills

Knowledge

Behaviours

Competency Based Training

Importance of Pharmacist competency in Primary health Care Setting:

Pharmacists play an important role in primary health care(1). In primary health care settings, Pharmacists as a team member engage in direct patient care and medication management services (MMS) for ambulatory patients, development of long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management(2). Globally, including in low and middle-income countries (LMICs), the role of pharmacists in primary health care is becoming vital because it supports primary health care to meet the elevated burden of chronic care (1). The Primary Health Care Performance Initiative (PHCPI) framework has identified provider's competence as a critical driver to improve PHC performance(4). In economic terms, an Australian study on the economic impact of increased clinical intervention rates in community pharmacies found that adequately trained and remunerated pharmacists generated savings (on health care, medicines, and pharmacy practice costs) six times greater than those of a control group with no access to the same education or remuneration. It was estimated that adequately trained and remunerated pharmacists would save the health care system 15 million Australian dollars (approx. US$100 million) a year(5). Similar findings are reported from the USA(6). Hence, the role of competent pharmacists in PHC performance is crucial.

Pharmacists

The World Health Organization (WHO) defines pharmacists as "healthcare professionals whose professional responsibilities and accountabilities include seeking to ensure that people derive maximum therapeutic benefit from their treatments with medicines" (7). A pharmacist usually works in one of the three settings, i) Pharmaceutical Industry, ii) Practice Setting, and iii) Others. Other settings include academics, regulators (government), and clinical research. In a practice setting, there are three areas: Community Pharmacy, Hospital Pharmacy, and Clinical Pharmacy(8). The Community pharmacist is defined as "an individual currently registered and who works according to legal and ethical guidelines to ensure the correct and safe supply of medical products to the public" (10). While, hospital pharmacists are defined as a "individual currently registered and who works in a hospital pharmacy service, primarily within the public / private sector and responsible for ensuring the safe, appropriate and cost-effective use of medicines" (10). In India,Primary health care is being delivered through the Primary health centres, where the hospital pharmacists are in place and contributing in maintaining and improve people's health by advising and information and supplying prescription medicines. Pharmacists are well established in providing primary health care services in facilities. However, their role and contribution to primary health care teams, including roles in community pharmacy practice, are health care reforms in many countries(3).

In the growth of pharmacy practice in India, the health system is encountering multi-pronged challenges, including a shortage of trained teachers, limited skills demonstration facilities for teaching institutions, poor networking among the teaching institutions, limited pharmacist involvement with the community, limited interaction between clinician and pharmacist in patient management(11). These challenges hinder pharmacists from acquiring competency and further developing competence in pharmacy practice.

Competence and Competency Definition

Competence is one of the critical determinants of improving health outcomes and Client Satisfaction(12). Provider's competence is the state of proficiency to perform the required practice activities to the defined standard, which includes the requisite competencies (13) to successfully and effectively deliver high-quality services(12). Providers or individuals develop competence through education, training, and work experience (14). However, competency is the ability of a person to integrate knowledge, skills, and attitudes in their performance of the tasks in a given context(13). Competence is dynamic and multidimensional, changing with time, experience, and context/ setting, while competencies are durable, trainable, and measurable through the expression of behaviors.

Status of Existing Pharmacist competency assessment in Primary Health Care Setting

In Australia, professional bodies such as the royal pharmaceutical society (RPS) and the Pharmaceutical Society of Australia (PSA) have developed role descriptions and mapped the competencies for General Practice pharmacists(15). In Canada, the Association of Faculties of Pharmacy (AFPC) educational outcomes for Canadian pharmacists have illustrated the competencies expected of pharmacists in the primary health care setting, either in the community or the primary health care team(3). Similarly, In the United States of America, the role and competencies of pharmacist working in Primary Care has also been listed(2). The United Kingdom has also invested in integrating the clinical pharmacist into general practice since 2019, primarily to meet the workforce shortage(16). Similarly, In the Netherlands, the Clinical Pharmacist has already been part of General practice(17). Saudi Arabia has identified the competencies of Primary Care pharmacists for adults and paediatrics (18).

Many countries, primarily the global North and a few from the global South, have defined the roles and competencies of Pharmacists in Primary Health Care settings (19). Apart from that, In 2010, The International Pharmaceutical Federation (FIP) also developed the comprehensive Global Competency Framework for the services provided by Pharmacy Workforce, which is widely used globally(14).

Rationale- Why do we need a Pharmacist Competency Assessment Framework for India

The workload of the Primary Health Care workforce is increasing because of rising Chronic Conditions globally. It has forced the health system to extend primary Care Services to make it more comprehensive(20). Understanding the critical role of pharmacists, the UK, Canada, The Netherlands, and other countries have invested in pharmacists to build competencies to meet primary care needs. However, in LMICs, it is yet to begin, including India. In India, the situation is further complicated by the double burden of infectious and non-communicable diseases(21) and increasing anti-microbial resistance(22). Due to this, under a comprehensive primary health care package, twelve services have been provisioned in public primary health care institutions. It has significantly increased the pharmacist challenges in delivering health services, which were already facing challenges in competencies due to pre-service education and in-Service training(23).

Identifying the pharmacist's competency gap is critical for its capacitation in which the Competency Assessment Framework plays a significant role in competency assessment. Currently, no pharmacist's competency assessment framework for Indian settings exists that can be used for assessing competency for in-service pharmacists in primary health care settings. Hence, developing a competency assessment framework will bridge this gap, which will further help capacitate Pharmacists in the Primary Health Care setting.

Study Objective

The objective of this study was "to develop the competency assessment framework to assess the In-Service Pharmacist competency in public Primary health Care setting." The specific objective of this study was to identify the Pharmacist's competencies and to develop Competency Assessment Tools for in-service pharmacists in public primary healthcare settings.

Study Design

We followed a five-stage (Refer to Fig-1) consultative process to develop the Pharmacist competency assessment framework. The stage-wise details are as below.

Stage 1 Competency Identification:

In this phase, we did a systematic literature review (Refer to Fig. 2) to identify the Pharmacists' competencies in the primary health care setting to identify the scientific and grey literature between 2000 to 2020 on PubMed and SSRN. For PubMed, we used the search strategy as; ((( "Primary Health Care/education" [Mesh] OR "Primary Health Care/standards"[Mesh] )) AND "Pharmacists"[Mesh]) AND ( "Professional Competence"[Mesh] OR "Clinical Competence"[Mesh] OR "Cultural Competency"[Mesh] OR "Social Skills"[Mesh] ). Two extra filters were used, English and Humans. This strategy retrieved four papers. Similarly, for SSRN, "Pharmacist" as a title was searched, and then "Competence." This search retrieved only one paper. Google Scholar was also used to retrieve papers using two search strategies; "Primary Care Pharmacist Competency" and "Community Pharmacist Competency." Through this, 14 and seven papers were retrieved, respectively. Because the competencies have been minimally explored scientifically and are primarily available as guiding documents, Google has been used to search such literature (Piasecki, 2018). Through this, 11 papers were retrieved. 38 papers were found from all the sources, of which five were duplicates. The rest 33 articles were studied in detail, and later twenty-five articles were removed. Finally, thirteen articles were selected that illustrated at least one domain of Pharmacist Competencies.

Stage-2 Expert Consultation to build consensus on Competencies: In the second stage, we organized expert consultation to build consensus on Competencies and behaviours. This consultation was held virtually on 10th March 2022.

Stage 3 Competency Assessment Tool Development

In this stage, based on the literature, we developed the Instruments to assess the Competencies and their associated behaviors in terms of knowledge, attitude, and skills.

Stage 4 Expert Consultation to build consensus on CAT: In this phase, we organized expert consultation on 14th November 2022 in Bhubaneswar, Odisha, to achieve consensus on Competency Assessment Tool instruments.

Stage-5 Pretesting of Competency Assessment Tool–After converting the English version of the Competency Assessment Tool into a Bilingual language, i.e., English and Odia (Vernacular Language), we pretested it in One of the public primary health care setting facilities in Odisha, on 13th January 2023.

Experts

During two rounds of expert consultations, twenty experts participated. All the experts were trained Pharmacists and have been involved in delivering Pharmacy services in Primary Health Care Settings or as academia in Pharmacy education or involved in the process of policy making as a multi-lateral organization representative or professional body representative or policy maker with over 20 Years of experience.

Stage − 1 Competencies Identification

Through literature, we found 175 behaviours under 20 competencies, distributed among four domains like: Pharmaceutical Health, Pharmaceutical Care, Organization and Management, and Professional/personal. Under the pharmaceutical health domain, health promotion is one of the competencies. There are three behaviours; to assess primary healthcare needs; to advise on health promotion, disease prevention, and control, and a healthy lifestyle; and to provide training programs for community staff and leaders on knowledge and skills for promoting health. Please refer to Table 1 for domains and their associated competencies and refer to Additional file 1 for the detailed list of behaviours.

Table 1

Domains and Competencies
Domains	Competencies	References
Pharmaceutical Health	Health Promotion	(14,24–29)
Pharmaceutical Health	Medicine Information and advice	(14,24,26–28,30)
Pharmaceutical Care	Assessment of Medicines	(14,25,26,28)
	Compounding Medicines	(14,24,27,28,30)
	Dispensing	(14,25,26,28)
	Medicines	(14,25,30)
	Monitor Medicines Therapy	(14,25,27,30)
	Patient Consultation and diagnostics	(14,25,26,28,30)
Organisation and Management	Budget and reimbursement	(14,28,31)
	Human Resource Management	(14,28,31)
	Service Improvement	(14,24,26,28)
	Procurement	(14,24)
	Supply Chain and management	(14,24,26,28)
	Workplace Management	(14,24–34)
Professional / Personal	Communications Skills	(14,24–29,32–34)
	Continuing Professional Development	(14,26,28,29,32,34)
	Legal and Regulatory Practice	(14,24–26,31)
	Professional and ethical practice	(14,24–27,33)
	Quality Assurance and Research	(14,24,26,27,33)
	Self-Management	(14,24–27,33,34)

Stage-2 Expert Consultation

Expert consultation was organized to build consensus among experts on pharmacist competencies and their associated behaviours. However, it emerged during the consultation that role plays a significant role in defining in-service competencies for any cadre of professionals. The consensus was made for eleven roles of Pharmacists in primary health care settings (Table 2). After that, competencies and their associated behaviours were discussed, and consensus was achieved.

Table 2

Pharmacist Role
Pharmacist Role in Indian Primary health care setting
1. Pharmacy Management 2. Dispensing Medical Products 3. Ensure compliance with regulations on Medical Products 4. Assistance to Medical Officers in the preparation and implementation of different projects and programs 5. Outreach to the Community 6. Professional Practice 7. Ethical Practice 8. Communication 9. Workplace Management 10. Emergency Role 11. Continuing Professional Development:

Role-1. Pharmacy Management

In this role, during the consultation, we arrived at the Consensus on nine competencies (Refer Table 3) and fifty-five behaviours (Refer Additional file − 2). In managing a Pharmacy, one of the critical Competencies is Knowledge about the Pharmacy, infrastructure, layout, and how to adapt it to optimize pharmacy services, including inventory management. Equally, knowing the drugs, consumables, and materials to be kept in store, their nature, use, and required storage conditions are important in managing pharmacy. Other competencies for Pharmacists in pharmacy management are maintenance of storage conditions, planning and procurement, inventory management, store verification, condemnation, and maintenance of registers and records. Knowledge about the Not of Standard Quality (NSQ) Medical Products and how to act appropriately is another vital competency for pharmacists in managing pharmacy. In this digital age, it is difficult for pharmacists to avoid the Competency around digital literacy, which helps maintain IT Based Supply chain systems like Drugs and Vaccine Distribution Management System (DVDMS) and e-Niramaya. Considering the limited expertise about medical products at the primary health centre level, Pharmacists should have the Competency to attend different committees' meetings like Pharmacy (drug) and therapeutic committee, Annual Indent committee, Purchase committee, Condemnation committee, and Prescription audit committee.

Table 3

Pharmacy Management Competencies
1. Knowledgeable about the Pharmacy layout, pharmacy infrastructure, and how to adapt it to optimize pharmacy services, including inventory management. 2. Knowledgeable about drugs, consumables, and materials to be kept in store, their nature, use, and storage conditions required. 3. Be able to maintain and ensure the required storage conditions. 4. Knowledgeable about the procedure for all types of planning and procurement (Pool Procurement) 5. Able to manage the inventory correctly. 6. Able to perform and fulfil the duties as a member of different committees in the institution or representing it. 7. Able to manage drugs and vaccine Distribution Management system (DVDMS)/ eNiramaya, and other existing IT systems (Adequate digital literacy ) 8. Able to conduct institutional store verification, condemnation, and maintenance of all registers and records relevant to the Pharmacy and pharmacy store. 9. Knowledgeable about the information and directions from authorities relating to banned and Not of Standard Quality (NSQ) medicines and acting appropriately

Role 2: Dispensing Medical Products: During the consultation regarding this pharmacist's role in dispensing medical products, the consensus arrived at five competencies (Refer to Table 4) and sixteen behaviours (Refer to Additional file 2). One of the critical competencies is knowledge about drug details for dispensing, including generic/brand names, usage (Indication), dosage (Quantity and frequency), route of administration, how to use, and drug interaction/compatibility. However, Pharmacists also need to monitor the medical products' use and patient adherence, as appropriate, to ensure positive clinical outcomes. To improve patient adherence to medical products, Pharmacists need to encourage and facilitate. Hence, it is also identified as a competency. Another competency for pharmacists is recognizing the adverse drug reaction and supporting the primary health care team in managing the adverse reaction event.

Table 4

Dispensing Medical Products Competencies
1. Knowledgeable about medical products details for dispensing, including generic/brand names, usage (Indication), dosage (Quantity and frequency), route of administration, how to use and drug interaction/compatibility, 2. Able to monitor medical product use and patient adherence, as appropriate, to ensure positive clinical outcomes. 3. Encourage and facilitate the patient for medication adherence. 4. Able to encourage optimal use of medical products. 5. Able to recognize and support the Primary Health Care team in managing adverse drug reactions

Role-3 Ensure compliance with regulations on Medical Products

Medical products are a highly regulated commodity hence, dealing with them requires compliance with the applied regulations. Towards that, the consensus among the experts made during the consultation is that the Pharmacists in the primary health care setting should be able to guide the primary health care team of the health facility to ensure compliance with laws and regulations as applicable to the medical products. Under this, the consensus was also made on five behaviours (Refer to Additional file − 2).

Role 4. Assistance to Medical Officer in preparation and implementation of different projects and Programs

As a Pharmacist in a Primary Health Care setting, one role is to assist Medical Officer in preparing and implementing various health projects and programs, particularly in medical products management and its documentation.

Role 5. Outreach to the Community

In this role, the consensus among the experts was made on two competencies (Refer to Table 5) and five behaviours (Refer to Additional file-2). One of them is to assist the primary health care team in organizing community outreach camps. During a disaster, pharmacists' roles become vital; another competency for Pharmacists is supporting the primary healthcare team in disaster management preparedness.

Table 5

Outreach to Community Competency
1. Able to assist the primary health care team in organizing community outreach camps 2. Able to support disaster management preparedness

Role-6 Professional Practice: Among the experts during the consultation, the consensus was made that Pharmacists should necessarily be knowledgeable about roles and responsibilities. Under which Consensus was made on one behaviour (Refer to Additional file-2).

Role-7 Ethical Practice: Ethical practice is central to delivering health services. Towards that, the consensus among the experts made that the Pharmacist should be able to comply with ethical practices as a competency. The agreement was also made on three behaviours (Refer to Additional file − 2).

Role-8 Communication: The Consensus among the experts during the consultation was that the Pharmacist should be able to communicate effectively in routine and emergencies. The Consensus among the experts was also made on the seven behaviours (Refer to Additional file − 2).

Role-9 Workplace Management

Workplace management is one of the typical roles that a pharmacist must play in a Primary Health Care Setting. For that, Consensus arrived during the consultation that one competency which every pharmacist should be able to manage the workplace. There were five behaviours on which the expert agreed (Refer to Additional file − 2).

Role-10 Emergency Role: Under the emergency role, the Consensus among the experts during the consultation is made on three competencies. Pharmacists should essentially have the Competency to perform basic diagnostic tests/ Checks, support other health professionals, and handle medical devices/equipment. The government of Odisha, India, has permitted Pharmacists to provide treatment services for minor ailments without doctors(35). Considering this state government initiative and the need, the experts arrived at the Consensus that pharmacists should also have the competencies to manage minor ailments by recommending medical products for diseases like `Fever, Malaria, Upper Respiratory Tract Infection, Skin diseases (Scabies, Ring worms), Helminthiasis, Acid Peptic Disease (APD), Diarrhoea, Minor Injury without Medico-Legal Cases, Superficial burns without Medico-Legal Cases (MLC), Drainage of abscess, etc. On six behaviours in this role, experts arrived at Consensus during the consultation (Refer to Additional file − 2).

Table 6

Emergency Role Competencies
1. Able to Carry out basic diagnostic tests/ Checks to support other health professionals. 2. Able to handle medical devices/equipment. 3. Able to manage minor ailments by recommending medicines (Odisha State Guidelines)

Role 11. Continuing Professional Development: Health Services updates procedures and medical products based on global scientific advancements. Accordingly, the government and other stakeholders keep revising the guidelines. Understanding the volatility of different competencies, experts agreed that the Pharmacist should be willing to participate in Continuing Professional Education/ Development programs to update knowledge and practice. Experts also agreed on two behaviours for the said competency (Refer to Additional file − 2).

Stage − 3. Competency Assessment Tool (CAT) Development

In this stage, to assess Pharmacist Competency in terms of knowledge, attitude, and skills, based on literature, we developed Competency Assessment Tool. We developed the questionnaire to assess the Pharmacist's knowledge and attitude; under this, 256 questions were constructed (Refer to Table 7). The 143 questions were for knowledge, and the rest 113 were for attitude. Further, to assess the Pharmacist's skills, we used three assessment instruments (Refer to Annex 3), Observational Checklists, Mini Clinical Evaluations for Specific Conditions, and Simulation exercises(13, 36). Under Observation, we identified twenty-four skills; under mini-clinical evaluation exercises, we identified thirty skills and four skills under simulation exercises. For the Observation and Mini Clinical Evaluation of selected conditions, we identified the tracer elements for the skills and listed them as means of verification. To standardize the score based on means of verification, we developed the standard score definitions (Refer to Table 8 for Score Definition) for observations and mini-clinical evaluation of selected conditions.

Table 7

Competency Assessment Tool- Instrument details
Competency Elements	Instruments	Number of Questions/ Skills
Competency Elements	Instruments	Pre-Consultation	Post Consultation
Knowledge	Questionnaire	143	48
Attitude	Questionnaire	113	48
Skills	Observational Checklist	24	20
	Mini Clinical Exercises for Specific Conditions	30	30
	Simulation Exercises	4	4

Table 8

Score Definition
Score Definition A. None—No demonstrated skills at all/does not perform the task(s) completely. B. Limited Demonstrated very limited strengths/skills in this area. C. Some—Demonstrated some ability/skills in this area. D. Strong—Demonstrated strong skills/strength in this area. E. Excellent—Demonstrated excellent skills/strength in this area. F. Not applicable G. Don't know- not even heard about that skill. H. Skill limitation is related to resource limitations

Stage-4 Expert Consultation

In this stage, to develop a consensus among the experts on the Competency Assessment Tool, we organized an expert consultation on Nov 14, 2022, in Bhubaneswar. Consensus arrived on the Ninety-Six Questions during this consultation to assess knowledge and attitude. Out of ninety-six, forty-eight were for knowledge, while the rest were for attitude. On Observational skills, Consensus arrived at 20 skills, while it was thirty for Mini Clinical evaluation for specific conditions. For Simulation exercises, experts were in a consensus for all four skills (Please Refer to Table 7).

Stage-5 CAT Pre-testing:

In this stage, the English version of CAT was converted into the bilingual format in English and Odia (Please see Additional file-3). After that, we pre-tested in one of the public primary health care settings facilities in Khorda district, Odisha, India. We found that technical words like inventory management, not of Standard Quality, Supply Chain, prescription error, and prescription validation were comparatively more understandable in English than in Odia. We also understood that in place of the Drugs and Vaccines Distribution Management System (DVDMS), E-Niramaya, an IT-based supply chain system, is being used at the facility level. Accommodating these learnings, we developed the final version of bilingual CAT.

We developed the competency assessment framework for In-Service pharmacists in primary healthcare settings. Under this, we identified the role-based competencies and their associated behaviours. Along with the competencies and their related behaviours, we developed the competency assessment tool that can determine the degree of competency among in-Service pharmacists. In this way, this assessment framework will be helpful for policymakers and implementers in designing, monitoring, and evaluating pharmacist competencies. It will further lead to improved pharmacist performance in the primary health care setting.

Factors Influencing Pharmacist Competency

One of the factors that influence pharmacist competency the most is pre-service education. Teaching Institutions engaged in Pharmacist Production face challenges in ensuring trained teachers' availability. Qualified teachers who have exposure to be in the practice domain are very limited. Acquiring skills is not possible unless the teaching institutions have skills demonstration facilities. Shortage of Skill demonstration facilities is also becoming a hindrance in developing skills during pre-service education and further prevents the Pharmacist from entering into the pharmacy practice(11). Another challenge of Pre-service education is the outdated curriculum and education regulations(37).

For the public health system, the Union and State governments have attempted to capacitate in-Service Pharmacists except under the Revised National Tuberculosis Training Program(38). Some States have made specific efforts to capacitate pharmacists; even those efforts were limited to Store Management and Rational use of Drugs(39).

Importance of Competency Assessment framework in developing Competency-based Training for Pharmacists

It is evident that the Competency framework for training helps improve pharmacist performance irrespective of the setting (40). In India, there are lacunae in providing training to the in-service pharmacist(41). Competency-Based Training (CBT), a structured training and assessment system that allows individuals to acquire skills and knowledge to perform work activities to a specified standard, is a globally accepted solution to capacitate the in-Service professional(42). For which the role-based competencies and their behaviour, along with the competency assessment tool, will play a foundational role in developing the Competency-based training manual and other resource materials for Pharmacists in primary health Care Settings.

Strengths and Limitations

The strength of this study is the consultative approach through which the Competency assessment framework has been developed. In this process, twenty experts in community pharmacy took part. These experts have over 20 Years of experience in teaching, policymaking, and practice from Teaching Institutions, Union, and State Governments, professional bodies, and Private retail pharmacy and Public Primary Health Care facilities. In both consultations, twenty experts participated; hence, we recognize that the experts who participated in this study cannot be considered the complete representation of all the stakeholders for the In-Service Pharmacist Competency development initiative.

In method, In the first stage of methods to identify literature-based competencies, we searched the literature from 2000 to 2020. We likely missed some of the relevant old and recent pieces of literature. Attitude assessment of a professional is a complex process; however, we developed the questionnaire to assess Pharmacists' attitudes. It is possible that the questionnaire to assess attitude cannot capture the responses entirely and accurately.

Apart from it, we did not use any tool to check the validity of the score definition for Skills assessment (Observation and Mini Clinical Exercises). We also understand that we pre-tested CAT in only one public facility in Odisha, India, and did not use any quantitative tool to check its validity.

The developed competency assessment framework is comprehensive. Hence, administering CAT to assess in-service pharmacist competency is time-consuming. As the role of professionals evolves overtime based on service requirements, this Competency Assessment framework will need periodic review and updating.

For the first time, this study has developed role-based competencies and competency assessment tools for in-service pharmacists in the Indian context; hence, if any new addition happens with the Pharmacist role, based on the extended role, the competencies and their associated behaviours must be included accordingly.

The competency Assessment framework will help to identify the Competency-based training needs for in-service pharmacists in primary health care settings. It would further help the primary health care apparatus design Competency-based training. Competency-based training will undoubtedly help upskill the Pharmacist, which will help improve the quality of services in primary health care facilities.

Practice Implication

Using this Competency Assessment framework, the health system implementers can identify the gap in serving Pharmacists' competencies in primary health care settings. They can develop and design competency-based training to upskill them.

LMIC Low- and middle-Income Countries

PHC Primary health care

WHO World Health Organization

PSA Pharmaceutical Society of Australia

AFPC Association of Faculties of Pharmacy

CAT Competency Assessment Tool

CBT Competency based Training.

FIP International Pharmaceutical Federation

NSQ Not of Standard Quality

HSTP Health Systems Transformation Platform

CPD-IPA Community Pharmacy Division, Indian Pharmaceutical Association

Ethics approval and consent to participate
We did not collected data from human participants hence this study may be exempted from ethics committee approval.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was supported by the Health Systems Transformation Platform, New Delhi.

Authors' contributions:

SK has conceptualised and wrote the first draft of the paper. PB, MG, and GP contributed to cross-cutting discussions. All authors have reviewed the paper and added their inputs. SK is the guarantor of the paper. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. The views and contents of this paper is those of the author(s) and do not necessarily represent the official position of Health Systems Transformation Platform, New Delhi.

Acknowledgements

We would like to thank Mr. Rajeev Sadanandan, Dr. N. Devadasan, Mr. Sunil Nandraj, Dr. Kumaravel Ilangovan, Ms. Pallavi Gupta from HSTP for their useful suggestions on development of this paper. We also recognize the contributions of the experts who participated in the study consultations.

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AdditionalFile1DevelopingCompetencyAssessment.docx
Additional File 1 Literature based Competencies and its behaviours list
AdditionalFile3DevelopingCompetencyAssessment.docx
Additional File 2 Pharmacists Role based Competencies and behaviours List
AddtionalFile2DevelopingCompetencyAssessment.docx
Additional File-3 Competency Assessment Tool

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11 Oct, 2023
Editor assigned by journal
27 Jun, 2023
First submitted to journal
26 Jun, 2023

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Developing a competency assessment framework for pharmacists in primary health care settings in India

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Version 1

Abstract

Figures

Introduction

Methods

Study Design

Stage 1 Competency Identification:

Results

Stage − 1 Competencies Identification

Stage-2 Expert Consultation

Stage − 3. Competency Assessment Tool (CAT) Development

Stage-4 Expert Consultation

Stage-5 CAT Pre-testing:

Discussion

Strengths and Limitations

Conclusion

Abbreviations

Declarations

References

Supplementary Files

Status:

Version 1