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  • Research
  • Open Access
  • Open Peer Review

A survey of pharmacists’ perception of foundation level competencies in African countries

Human Resources for Health201816:16

https://doi.org/10.1186/s12960-018-0280-1

  • Received: 26 January 2017
  • Accepted: 16 March 2018
  • Published:
Open Peer Review reports

Abstract

Background

Evidence from published literature in pharmacy practice research demonstrate that the use of competency frameworks alongside standards of practice facilitate improvement in professional performance and aid expertise development. The aim of this study was to evaluate pharmacists’ perception of relevance to practice of the competencies and behaviours contained in the FIP Global Competency Framework (GbCF v1). The overall objective of the study was to assess the validity of the GbCF v1 framework in selected countries in Africa.

Methods

A cross-sectional survey of pharmacists practicing in 14 countries in Africa was conducted between November 2012 and December 2014. A combination of purposive and snowball sampling method was used. Data was analysed using SPSS v22.

Results

A total of 469 pharmacists completed the survey questionnaire. The majority (91%) of the respondents were from four countries: Ghana, Kenya, Nigeria and South Africa. The study results showed broad agreement on relevance to practice for 90% of the behaviours contained in the GbCF v1 framework. Observed disagreement was associated with area of pharmacy practice and the corresponding patient facing involvement (p ≤ 0.05). In general, the competencies within the ‘pharmaceutical care’ and ‘pharmaceutical public health’ clusters received higher weighting on relevance compared to the research-related competencies which had the lowest. Specific inter-country variability on weighting of relevance was observed in five behaviours in the framework although, this was due to disparity in ‘degree of relevance’ that was related to sample composition in the respective countries.

Conclusion

The competencies contained in the GbCF v1 are relevant to pharmacy practice in the study population; however, there are some emergent differences between the African countries surveyed. Overall, the findings provide preliminary evidence that was previously lacking on the relevance of the GbCF v1 competencies to pharmacy practice in the countries surveyed.

Keywords

  • Competencies
  • Professional development
  • Pharmacy practice
  • Pharmacy workforce

Background

Competent pharmacists improve therapeutic outcomes, minimise the risk associated with medicines use and assure patient safety through the provision of medicine expertise [15]. The central role pharmacists play within the health system underpins the demand for a competent and highly skilled workforce that is equipped with the requisite knowledge and skills relevant to population health needs [68]. This is of particular importance in resource-limited settings such as in sub-Saharan Africa where severe workforce shortages hamper access to health services including medicines expertise [9, 10].

The International Pharmaceutical Federation (FIP) is the global leadership body representing 3 million pharmacists and pharmaceutical scientists worldwide [11]. FIPEd, which is the pharmacy education and workforce development arm of the FIP, advocates the need to define and articulate the competencies that pharmacists require to consistently perform safely, effectively, and efficiently [12]. The overall objective is to provide an infrastructure for global guidance on the practice-based expectations of the pharmacy workforce [13].

Published research demonstrate that when competency frameworks are used alongside standards of practice: it facilitates improvement of pharmacists’ performance [1417], promotes the attainment and maintenance of fitness to practice [17, 18], aids identification of knowledge gaps and learning needs [19], and fosters continuing professional development [20]. The findings of longitudinal studies show that using competency frameworks to identify knowledge gaps and tailor learning activities significantly improve pharmacists’ performance (p ≤ 0.05) at 6 months [14, 15, 17], 9 months [16], and 12 months [18, 20]. Similar findings from comparative studies conducted in United Kingdom [14, 20] indicate that competency frameworks facilitate a more sustained improvement in pharmacists’ performance (p < 0.001) in the intervention group at 12 months when compared to a control group that had no access to a framework. These findings have also been corroborated by other studies in Australia [15], Croatia [18], Serbia [17], and Singapore [16].

In 2012, FIPEd developed the FIP Global Competency Framework (GbCF v1) using evidence-based methodologies [21]. This framework was specifically designed to serve as a source document containing the core competencies expected of foundation level pharmacy practitioners (this means, pharmacists with less than 5 years practice experience) [13]. Since its development, the GbCF v1 has been successfully used to design pre-service education and training curriculum in a number of countries [22, 23]. It has also been used to develop country-specific frameworks for in-service practitioners in Ireland [24], the Pacific Island countries [25], Croatia, Singapore and Serbia [21]. A previous survey that validated the GbCF v1 using evidence from 64 countries [26] showed that 70% of respondents ranked all the behaviours in the questionnaire as relevant to practice. However, respondents from countries in Africa comprised only 12.3% of the total sample in the survey [26]. The aim of this present study was therefore to evaluate pharmacists’ perception of the relevance to practice of the competencies and behaviours contained in the GbCF v1, focusing on selected African countries.

Methods

Data collection and sampling

A cross-sectional survey of pharmacists practicing in selected countries in Africa was conducted between November 2012 and December 2014. A combination of purposive and snow-ball sampling method was used. Due to a lack of access to the pharmacy membership list of the respective countries in Africa, the URL link to the online survey was circulated centrally via email to the 35 FIP member organisations in Africa for onward distribution to their respective individual members. The FIP member organisations contacted were the leadership bodies representing practicing pharmacists in 24 countries in Africa (list provided in the Appendix). These organisations were selected based on availability of contact persons, expression of interest to participate when contacted and willingness to gather data. The survey invite was also disseminated through the FIP United Nations Education Scientific and Cultural Organisation (UNESCO) University Twining Network (FIP UNESCO UNITWIN) in Africa. The survey URL link was further customised and distributed via social media and short message service platforms including Facebook®, Twitter®, WhatsApp® and Blackberry Messenger®. Respondents were encouraged to assist by forwarding the survey URL link to their colleagues and contacts. Email reminders were thereafter forwarded monthly through the aforementioned media until the end of the study. Due to the non-availability of reliable estimates on the number of pharmacists per country organisation represented in FIP, a sampling frame was not feasible and survey respondents were therefore recruited consecutively until the end of the study period.

Survey questionnaire

An anonymous online questionnaire developed and validated in a previous study [26] was used. The questionnaire was fully reproduced from the GbCF v1 and comprised of 105 questions. Five questions related to demographic information while the remaining questions referred to the 100 GbCF v1 behavioural statements (labelled B1 through B100, and hereafter referred to as ‘behaviours’). These behaviours are grouped under the 20 competency domains and four broad competency clusters in the framework (Table 1).
Table 1

Components of the GbCF v1 framework

Cluster

Composition and description

Pharmaceutical public health

Four behaviours labelled B1–B4 grouped under two competencies: ‘health promotion’ and ‘medicines information and advice’

Pharmaceutical care

25 behaviours labelled B5–B29 grouped under six competencies: ‘assessment of medicines’, ‘dispensing’, ‘medicines’, ‘monitor medicines therapy’, ‘patient consultation and diagnosis’

Organisation and management

32 behaviours labelled B30–B61 grouped under six competencies: ‘budget and reimbursement’, ‘human resource management’, ‘improvement of service’, ‘procurement’, ‘supply chain and management’, and ‘work place management’

Professional and personal

39 behaviours labelled B62–B100 grouped under six competencies: ‘communication skills’, ‘continuing professional education’, ‘legal and regulatory practice’, ‘professional and ethical practice’, ‘quality assurance and research in the workplace’, ‘self-management’

Data analysis

Survey data was collected electronically, without transformation and analysed using the Statistical Package for the Social Sciences (SPSS) version 22. To ensure data quality, a random 10% of the total survey sample was reviewed for coding errors with missing values replaced with code 999. Respondents’ perception of relevance to practice of each of the behaviours was evaluated using a 4-point Likert scale. Respondents were required to rank each of the 100 GbCF v1 behaviours as ‘not relevant’, of ‘low relevance’, ‘relevant’ or ‘highly relevant’ to their practice. For the purpose of analysis and to ensure the results produced could be meaningfully interpreted, the response categories in the Likert scale were further aggregated. The ‘highly relevant’ and ‘relevant’ ratings were condensed into one category: ‘relevant’, while the ‘low relevance’ and ‘not relevant’ ratings remained distinct categories. Agreement was evaluated by comparing the proportion (frequency and percentage) of the total ratings in the three categories. Consensus on relevance to practice was attained when not more than 10% of the respondents ranked a given behaviour as ‘not relevant’. This threshold was defined empirically based on previous research involving pharmacists from 64 countries [26].

Pearson’s chi-square (χ2) test was used to assess homogeneity in the survey sample. The test of homogeneity was undertaken to ascertain whether the sample could be treated as a group irrespective of the number of replies received per country. The χ2 test was also used to evaluate the relationship between weighting of relevance and area of practice for behaviours that showed a lack of consensus. In order to assess inter-country variability in responses, multivariate analysis of variance (MANOVA) via Pillia’s trace test (V) was used to evaluate weighting of relevance per country per competency with confirmatory post hoc analysis conducted using Bonferroni correction.

Ethical consideration

Formal ethical approval from the research ethics committee was not required for this study as it did not involve the use of identifiable patient information or data, rather the study recruited pharmacists and sought their views by virtue of their professional roles. However, consent to participate was sought from the respondents prior to completing the survey questionnaire. Participation was voluntary, and confidentiality was maintained at all times with responses remaining anonymous. All data collected in the research were stored in an encrypted database with hard copies kept in locked filling cabinets at the Department of Practice and Policy, UCL School of Pharmacy, United Kingdom. Access to study data was restricted to the three researchers directly involved with the study.

Results

Demography

Four hundred and sixty-nine pharmacists from 14 countries in Africa responded to the survey. Over half of the survey respondents were female (54%). The mean length of practice was 7.7 years (SD ± 8.1 years; min–max 1–43 years). Respondents with less than 5 years practice experience made up 47% of the sample while pre-registration candidates/pharmacy students in their last year (internship) comprised 5.5%. The majority of the respondents were in hospital practice (56.7%). Table 2 shows the summary of the distribution of survey replies per country and area of pharmacy practice.
Table 2

Survey replies per country per area of pharmacy practice

Area of practice

Country N (%)

Kenya

Ghana

Nigeria

South Africa

Others a

Academic pharmacy

1 (1.0)

4 (4.3)

11 (6.6)

21 (32.8)

6 (14.0)

Administrative pharmacy

6 (5.8)

13 (14.0)

4 (2.4)

2 (3.1)

4 (9.3)

Community pharmacy

2 (1.9)

10 (10.8)

41 (24.7)

10 (15.6)

10 (23.3)

Hospital pharmacy

89 (86.4)

60 (64.5)

80 (48.2)

23 (35.9)

14 (32.6)

Industrial pharmacy

1 (1.0)

3 (3.2)

26 (15.7)

6 (9.4)

5 (11.6)

Othersb

4 (3.9)

3 (3.2)

4 (2.4)

2 (3.1)

4 (9.3)

Total sample

103 (22)

93 (19.8)

166 (35.4)

64 (13.6)

43 (9.2)

aCountries with fewer than 50 replies each [includes Zambia [15], Egypt [8], Zimbabwe [5], Uganda [3], Lesotho [3], Tunisia [5], Namibia, Ethiopia Sudan and Tanzania (1 each)]

bAreas of pharmacy practice with fewer than 20 replies [includes pharmacy information [11], military and emergency [2] and laboratory and medicines control pharmacy [4]]

Sample homogeneity

Four countries—Kenya, Nigeria, South Africa and Ghana—each had more than 50 replies and made up 91% of the sample. Ten countries—Ethiopia, Egypt, Lesotho, Uganda, Tunisia, Namibia, Sudan, Tanzania, Zambia and Zimbabwe—had fewer than 20 survey replies each. The observed disparity in number of replies indicated two cluster groups: a ‘high response group’ made up of countries with more than 50 replies each, and a ‘low response group’ made up of countries with fewer than 20 replies each. The number of replies also varied for the four competency clusters in the framework. Table 3 shows a summary of the distribution of replies for each competency cluster per country group.
Table 3

Distribution of survey replies per competency cluster per country response group

Competency cluster

Behaviour label

Country response group (N)a

Countries with high responseb

Countries with low responsec

Pharmaceutical public health

B1–B4

426

43

Pharmaceutical care

B5–B29

350

36

Organisation and management

B30–B61

295

33

Professional and personal

B62–B100

273

32

aCountries with more than 50 replies each were regrouped as the high response group while countries with fewer than this were the low response group

bIncludes Ghana, Kenya, Nigeria and South Africa

cIncludes Zambia, Egypt, Zimbabwe, Uganda, Lesotho, Tunisia, Namibia, Ethiopia Sudan and Tanzania

The test for homogeneity in the survey sample showed that distribution of the ratings in the response categories (that is, in the ‘relevant’, ‘low relevance’ and ‘not relevant’ categories) was strongly associated with the country group for 11 behaviours [(p < 0.01); Table 4]. These 11 behaviours were distributed across the four competency clusters in no observable pattern. The outcome of the χ2 test implied homogeneity in responses between the country groups for 89% of the GbCF v1 behaviours. The low counts (frequency of less than 5) observed in the table cells within the group with low number of replies (N < 20 per country; Table 4) suggested an absence of data in this group rather than disparity in responses between countries. Given the χ2 test known property of being imprecise in ‘small’ samples [2729], it is likely that the test overestimated the relationship between the responses and the country group. Based on this, sample homogeneity was assumed and the survey replies were subsequently analysed as a group. Figure 1 shows the percentage of ratings in the ‘relevant’ category for the low response, high response, and combined group of countries, respectively. The total ratings in the combined country groups indicate that at least 70% of survey respondents ranked all the behaviours in the framework as ‘relevant’. This was not inclusive of the ‘not relevant’ and ‘low relevant’ ratings.
Table 4

Behaviours showing association with country response group

Cluster

Competency

Behaviour

High response countries (N)

Low response countries (N)

χ2 value

p

Not relevant

Low relevance

Relevant

Not relevant

Low relevance

Relevant

Pharmaceutical public health

Health promotion

[B1] Assess primary healthcare needs

10

20

396

1*

7

35

9.67

0.01

Medicines information and advice

[B4] Identify sources, retrieve, evaluate, assess and disseminate relevant medicines information according to patients needs

2*

22

402

1*

8

34

1.12

0.01

Pharmaceutical care

Assessment of medicines

[B6] Identify and act upon medicines interactions

40

68

242

3*

15

18

9.56

0.01

Dispensing

[B12] Dispense devices (e.g. inhalers)

11

18

321

0*

9

27

20.54

< 0.001

Medicines

[B19] Ensure appropriate medicine route, dose, time, form and response for individual patients

22

21

307

5

7

24

12.52

0.002

Organisation and management

Human resource management

[B37] Participate and collaborate, advice in therapeutic decision-making and use appropriate decision referral in a multi-disciplinary team

11

23

261

4*

6

23

9.4

0.01

Improvement of service

[B42] Resolve, follow-up and prevent medicines related problems

10

23

262

1*

9

23

12.8

< 0.001

Procurement

[B44] Develop and implement a contingency plan for shortages

11

27

257

5

2*

26

8.5

0.01

Supply chain management

[B54] Implement system for documentation and record keeping

11

13

271

3*

8

22

22.35

0.001

Work place management

[B61] Recognise and manage pharmacy resources (e.g. financial, infrastructure)

9

26

260

5

3*

25

10.71

0.01

Professional and personal

Quality assurance and research in the workplace

[B94] Implement, conduct and maintain a report system of pharmacovigilance (e.g. report adverse drug reactions)

16

11

246

2*

6

24

11.88

0.003

*Counts of less than 5

Fig. 1
Fig. 1

Percentage of total ratings in the ‘relevant’ category per behaviour (not inclusive of ratings in the ‘low relevance’ and ‘not relevant’ categories). Numbers on the circumference refer to behaviour labels (1 through 100) while numbers on the vertical axis refer to percentage of total ratings

Overall perception of relevance

Consensus on relevance to practice (N ‘not relevant’ < 10%) was obtained for 90 behaviours in the questionnaire. This included all the behaviours in the ‘pharmaceutical public health’ cluster, 84% in the ‘pharmaceutical care’, 90% in ‘organisation and management’ and 92% in the ‘professional and personal’ cluster, respectively (please see Tables 5, 6, 7 and 8). The 10 behaviours with more than 10% of the total ratings in the ‘not relevant’ category, suggested disagreement on relevance to practice (Table 9). This observed disagreement was associated with area of pharmacy practice for six of the ‘disagreed’ behaviours (Table 9; P < 0.05).
Table 9

Distribution of the ‘not relevant’ ratings in relation to area of pharmacy practice for the 10 behaviours showing disagreement

Cluster

Competencies

Behaviours

Area of practice (%N ‘not relevant’)

χ2 value

p

Acad.

Admin.

Comm.

Hosp.

Indus.

Othersa

Pharmaceutical care

Assessment of medicines

[B6] Identify, prioritise and act upon medicine-medicine interactions; medicine-disease interactions; medicine-patient interactions; medicines-food interactions (n = 43)

20

9.5

0

11.6

21.9

7.1

23.5

0.01

Dispensing

[B13] Document and act upon dispensing errors (n = 50)

14.3

19

20

7.6

21.9

35.7

36.9

< 0.001

[B14] Implement and maintain a dispensing error report system and a ‘near misses’ report system (n = 43)

17.1

14.3

20.3

7.1

12.5

14.3

15.9

0.1

Medicines

[B20] Package medicines to optimise safety [ensuring appropriate re-packaging and labelling of the medicines] (n = 39)

20

9.5

16.9

4.4

25

14.3

31.9

< 0.001

Organisation and management

Budget and reimbursement

[B32] Ensure appropriate claim for reimbursement (n = 40)

24

5

10.9

8.8

24

27.3

20.1

0.03

[B34] Ensure proper reference sources for service reimbursement (n = 34)

18.2

5

10.9

7.8

16

27.3

16.8

0.08

Workplace management

[B58] Ensure production schedules are appropriately planned and managed (n = 35)

15.2

5

19.6

6.7

20

18.2

17.4

0.08

Professional and personal

Quality assurance and research in the workplace

[B87] Apply research findings and understand the benefit risk [e.g. pre-clinical, clinical trials, experimental clinical-pharmacological research and risk management] (n = 34)

12.5

5

20.9

10.2

9.1

0

20.4

0.03

[B90] Ensure appropriate quality control tests are performed and managed appropriately (n = 39)

12.5

0

25.6

11.9

9.1

9.1

22.8

0.01

[B95] Initiate and implement audit and research activities (n = 33)

12.5

5

20.9

9

9.1

0

15.78

0.11

Acad. academic pharmacy, Admin. administrative pharmacy, Comm. community pharmacy, Hosp. hospital pharmacy, Indus. industrial pharmacy

aIncludes areas of pharmacy practice with fewer than 20 replies (these were pharmacy information [11], military and emergency pharmacy [2] and laboratory and medicines control pharmacy [4])

The disagreement was also associated with ‘patient-facing role’ in practice area [(P < 0.05); Table 10]. A higher percentage of the respondents in the ‘non-patient’ facing areas of practice (this means area of pharmacy practice with little or no daily patient interactions such as industrial and academic pharmacy) ranked the behaviours that showed disagreement in the ‘pharmaceutical care’ (B6, B13, B14, B20) and ‘organisation and management’ cluster (B32, B34, B58) as ‘not relevant’ compared to respondents in the ‘patient-facing’ practice areas (such as hospital and community pharmacy) (Table 10). The converse was true for the research-related (B87 and B95) and quality control (B90) behaviours (Table 10).
Table 10

Distribution of the ‘not relevant’ ratings in relation to patient-facing component in area of pharmacy practice for the 10 behaviours showing disagreement

Cluster

Competency

Behaviour

Patient-facing sectors* (N%)

Non patient-facing sectors (N%)

χ2 value

p

Not relevant

Low relevance

Relevant

Not relevant

Low relevance

Relevant

  

Pharmaceutical care

Assessment of medicines

[B6] Identify, prioritise and act upon medicine-medicine interactions; medicine-disease interactions; medicine-patient interactions; medicine-food interactions (n = 43)

9.1

21.1

69.8

18.2

22.7

59.1

6.3

0.04

Dispensing

[B13] Document and act upon dispensing errors (n = 50)

11.4

11.4

77.2

18.2

11.4

70.5

2.8

0.25

[B14] Implement and maintain a dispensing error report system and a ‘near misses’ report system (n = 43)

10.1

13.4

76.5

14.8

6.8

78.4

3.87

0.15

Medicines

[B20] Package medicines to optimise safety [ensuring appropriate re-packaging and labelling of the medicines] (n = 39)

7.4

11.7

80.9

19.3

13.6

67

11.45

0.003

Organisation and management

Budget and reimbursement

[B32] Ensure appropriate claim for the reimbursement (n = 40)

10

18.4

71.6

19.2

10.3

70.5

6.56

0.04

[B34] Ensure proper reference sources for service reimbursement (n = 34)

9.2

16.8

74

14.1

17.9

67.9

1.72

0.44

Work place management

[58] Ensure the production schedules are appropriately plan and manage (n = 35)

9.6

18.4

72

14.1

7.7

78.2

5.74

0.06

Professional and personal

Quality assurance and research in the workplace

[B87] Apply research findings and understand the benefit risk [e.g. pre-clinical, clinical trials, experimental clinical-pharmacological research and risk management] (n = 34)

11.7

18.2

82.4

9.5

8.1

70.1

5.02

0.08

[B90] Ensure appropriate quality control tests are performed and managed appropriately (n = 39)

14.3

21.2

64.5

8.1

6.8

85.1

11.72

0.003

[B95] Initiate and implement audit and research activities (n = 33)

11.3

19.9

68.8

9.5

8.1

82.4

6.19

0.05

*Pharmacy areas involving daily patient interactions including hospital and community pharmacy

Pharmacy areas not involving daily patient interactions including industrial, academic, administrative, laboratory and medicine control, and pharmacy information

Table 5

Overall rating of behaviours within the pharmaceutical public health cluster

Pharmaceutical public health competencies (n = 469)

Not relevant

Low relevance

Relevant

Group

Count

Row (N%)

Count

Row (N%)

Count

Row (N%)

Health promotion

 B1. HP | Assess the primary healthcare needs (taking into account the cultural and social setting of the patient)

11

2.30

27

5.8

431

91.9

1

 B2. HP | Advise on health promotion, disease prevention and control, and healthy lifestyle

2

0.4

26

5.5

441

94

1

Medicines information and advice

 B3. MIA | Counsel patients on the appropriate use of medicines and devices (including the selection, use, contraindications, storage, and side effects of non-prescription and prescription medicines) taking into account patients preferences

3

0.60

23

4.90

443

94.4

1

 B4. MIA | Identify sources, retrieve, evaluate, organise, assess and disseminate relevant medicines information according to the needs of patients and clients and provide appropriate information

3

0.60

30

6.40

436

92.9

1

Behaviours that showed agreement (this means, N ‘not relevant’ ≤ 10%) were categorised as group 1; group 2 behaviours showed disagreement on relevance (N ‘not relevant’ > 10%)

Table 6

Overall rating of behaviours in the pharmaceutical care cluster

Pharmaceutical care competencies (n = 386)

Not relevant

Low relevance

Relevant

Group

Count

Row (N%)

Count

Row (N%)

Count

Row (N%)

Assessment of medicines

 B5. AM | Appropriately select medicines (e.g. according to the patient, hospital, government policy, etc.)

18

4.7

40

10.4

328

85

1

 B6. AM | Identify, prioritise and act upon medicine-medicine interactions; medicine-disease interactions; medicine-patient interactions; medicines-food interactions

43

11.1

83

21.5

260

67.4

2

Compounding medicines

 B7. CM | Prepare pharmaceutical medicines (e.g. extemporaneous, cytotoxic medicines), determine the requirements for preparation (calculations, appropriate formulation, procedures, raw materials, equipment etc.)

25

6.5

61

15.8

300

77.7

1

 B8. CM | Compound under the good manufacturing practice for pharmaceutical (GMP) medicines

35

9.1

61

15.8

290

75.1

1

Dispensing

 B9. D | Accurately dispense medicines for prescribed and/or minor ailments and monitor the dispense (re-checking the medicines)

19

4.9

43

11.2

324

83.9

1

 B10. D | Accurately report defective or substandard medicines to the appropriate authorities

26

6.7

53

13.7

307

79.5

1

 B11. D | Appropriately validate prescriptions, ensuring that prescriptions are correctly interpreted and legal

16

4.1

41

10.6

329

85.2

1

 B12. D | Dispense devices (e.g. Inhaler or a blood glucose meter)

11

2.8

27

7

348

90.2

1

 B13. D | Document and act upon dispensing errors

50

13

44

11.4

292

75.6

2

 B14. D | Implement and maintain a dispensing error report system and a ‘near misses’ report system

43

11.1

46

11.9

297

76.9

2

 B15. D | Label the medicines (with the required and appropriate information)

14

5.2

20

3.6

352

91.2

1

 B16. D | Learn from and act upon previous ‘near misses’ and ‘dispensing errors

19

4.9

27

7

340

88.1

1

Medicines

 B17. M | Advise patients on proper storage conditions of the medicines and ensure that medicines are stored appropriately (e.g. humidity, temperature, expiry date, etc.)

17

4.9

19

4.4

350

90.7

1

 B18. M | Appropriately select medicines formulation and concentration for minor ailments (e.g. diarrhoea, constipation, cough, hay fever, insect bites, etc.)

33

8.5

42

10.9

311

80.6

1

 B19. M | Ensure appropriate medicines, route, time, dose, documentation, action, form and response for individual patients

27

7

28

7.3

331

85.8

1

 B20. M | Package medicines to optimise safety (ensuring appropriate re-packaging and labelling of the medicines)

39

10.1

47

12.2

300

77.7

2

Monitor medicines therapy

 B21. MMT | Apply guidelines, medicines formulary system, protocols and treatment pathways

11

4.9

19

2.9

356

92.2

1

 B22. MMT | Ensure therapeutic medicines monitoring, impact and outcomes (including objective and subjective measures)

22

5.7

26

6.7

338

87.6

1

 B23. MMT | Identify, prioritise and resolve medicines management problems (including errors)

12

3.1

19

4.9

355

92

1

Patient consultation and diagnosis

 B24. PCD | Apply first aid and act upon arranging follow-up care

18

4.7

29

7.5

339

87.8

1

 B25. PCD | Appropriately refer

14

3.6

18

4.7

354

91.7

1

 B26. PCD | l Assess and diagnose based on objective and subjective measures

12

3.1

21

5.4

353

91.5

1

 B27. PCD | Discuss and agree with the patients the appropriate use of medicines, taking into account patients  preferences

14

3.6

30

7.8

342

88.6

1

 B28. PCD | Document any intervention (e.g. document allergies, medicines and food, in patient medicines history)

21

5.4

43

11.1

322

83.4

1

 B29. PCD | Obtain, reconcile, review, maintain and update relevant patient medication and diseases history

18

4.7

28

7.3

340

88.1

1

Group: 1 = agreement, 2 = disagreement

Table 7

Overall rating of behaviours in the organisation and management cluster

Organisation and management competencies (n = 328)

Not relevant

Low relevance

Relevant

Group

Count

Row (N%)

Count

Row (N%)

Count

Row (N%)

Budget and reimbursement

 B30. BR | Acknowledge the organisational structure

16

4.9

45

13.7

267

81.4

1

 B31. BR | Effectively set and apply budgets

20

6.1

53

16.2

255

77.7

1

 B32. BR | Ensure appropriate claim for the reimbursement

40

12.2

54

16.5

234

71.4

2

 B33. BR | Ensure financial transparency

21

6.4

45

13.7

262

79.9

1

 B34. BR | Ensure proper reference sources for service reimbursement

34

10.4

56

17.1

238

72.5

2

Human resources management

 B35. HRM | Demonstrate organisational and management skills (e.g. Know, understand and lead on medicines management; risk management; self-management; time management; people management; project management; policy management.)

8

2.4

23

7

297

90.6

1

 B36. HRM | Identity and manage human resources and staffing issues

13

4

37

11.3

278

84.8

1

 B37. HRM | Participate, collaborate, advice in therapeutic decision-making and use appropriate referral in a multi-disciplinary team

15

4.6

29

8.8

284

86.6

1

 B38. HRM | Recognise and manage the potential of each member of the staff and utilise systems for performance management (e.g. carry out staff appraisals)

12

3.7

33

10.1

283

86.3

1

 B39. HRM | Recognise the value of the pharmacy team and of a multidisciplinary team

7

2.1

25

7.6

296

90.2

1

 B40. HRM | Support and facilitate staff training and professional development

9

2.7

23

7

296

90.2

1

Improvement of service

 B41. IS | Identify and implement new services (according to local needs)

7

2.1

35

10.7

286

87.2

1

 B42. IS | Resolve, follow up and prevent medicines related problems

11

3.4

32

9.8

285

86.9

1

Procurement

 B43. P | Access reliable information and ensure the most cost-effective medicines in the right quantities with the appropriate quality

12

3.7

20

6.1

296

90.2

1

 B44. P | Develop and implement contingency plan for shortages

16

4.9

29

8.8

283

86.3

1

 B45. P | Efficiently link procurement to formulary, to push/pull system (supply chain management) and payment mechanisms

18

5.5

44

13.4

266

81.1

1

 B46. P | Ensure there is no conflict of interest

19

5.8

43

13.1

266

81.1

1

 B47. P | Select reliable suppliers of high-quality products (including appropriate selection process, cost effectiveness, timely delivery)

16

4.9

32

9.8

280

85.4

1

 B48. P | Supervise procurement activities

23

7.0

34

10.4

271

82.6

1

 B49. P | Understand the tendering methods and evaluation of tender bids

25

7.6

50

15.2

253

77.1

1

Supply chain and management

 B50. SCM | Demonstrate knowledge in store medicines to minimise errors and maximise accuracy

15

4.6

20

6.1

293

89.3

1

 B51. SCM | Ensure accurately verification of rolling stocks

16

4.9

30

9.1

282

86

1

 B52. SCM | Ensure effective stock management and running of service with the dispensary

17

5.5

18

5.2

293

89.3

1

 B53. SCM | Ensure logistics of delivery and storage

16

4.9

23

7

289

88.1

1

 B54. SCM | Implement a system for documentation and record keeping

14

4.3

21

6.4

293

89.3

1

 B55. SCM | Take responsibility for quantification of forecasting

22

7.0

23

6.7

283

86.3

1

Work place management

 B56. WPM | Address and manage day to day management issues

8

2.4

20

6.1

300

91.5

1

 B57. WPM | Demonstrate the ability to take accurate and timely decisions and make appropriate judgments

8

2.4

15

4.6

305

93

1

 B58. WPM | Ensure the production schedules are appropriately plan and manage

35

10.7

52

15.9

241

73.5

2

 B59. WPM | Ensure the work time is appropriately plan and manage

10

3

23

7

295

89.9

1

 B60. WPM | Improve and manage the provision of pharmaceutical services

8

2.4

20

6.1

300

91.5

1

 B61. WPM | Recognise and manage pharmacy resources (e.g. financial, infrastructure)

14

4.3

29

8.8

285

86.9

1

Group: 1 = agreement, 2 = disagreement

Table 8

Overall rating of behaviours in the professional and personal cluster

Professional and personal competencies (n = 305)

Not relevant

Low relevance

Relevant

Group

Count

Row (N%)

Count

Row (N%)

Count

Row (N%)

Communication skills

 B62. CS | Communicate clearly, precisely and appropriately while being a mentor or tutor

4

1.3

6

2

295

96.7

1

 B63. CS | Communicate effectively with health and social care staff, support staff, patients, carer, family relatives and clients/customers, using lay terms and checking understanding

4

1.3

9

3

292

95.7

1

 B64. CS | Demonstrate cultural awareness and sensitivity

6

2.0

17

5.6

282

92.5

1

 B65. CS | Tailor communications to patient needs

5

1.6

15

4.9

285

93.4

1

 B66. CS | Use appropriate communication skills to build, report and engage with patients, health and social care staff and voluntary services (e.g. verbal and non-verbal)

3

< 0.1

10

3.3

292

95.7

1

Continuing professional development (CPD)

 B67. CPD | Document CPD activities

10

3.3

36

11.8

259

84.9

1

 B68. CPD | Engage with students/interns/residents

12

3.9

28

9.2

265

86.9

1

 B69. CPD | Evaluate currency of knowledge and skills

8

2.6

25

8.2

272

89.2

1

 B70. CPD | Evaluate learning

8

2.6

25

8.2

272

89.2

1

 B71. CPD | Identify if expertise needed outside the scope of knowledge

9

3.0

31

10.2

265

86.9

1

 B72. CPD | Identify learning needs

7

2.3

28

9.2

270

88.5

1

 B73. CPD | Recognise own limitations and act upon them

5

1.6

20

6.6

280

91.8

1

 B74. CPD | Reflect on performance

4

1.3

14

4.6

287

94.1

1

Legal and regulatory practice

 B75. LRP | Apply and understands regulatory affairs and the key aspects of pharmaceutical registration and legislation

7

2.3

23

7.5

275

90.2

1

 B76. LRP | Apply knowledge in relation to the principals of business economics and intellectual property rights including the basics of patent interpretation

16

5.2

54

17.7

235

77.1

1

 B77. LRP | Be aware of and identify the new medicines coming to the market

4

1.3

25

8.2

276

90.5

1

 B78. LRP | Comply with legislation for drugs with the potential for abuse

5

1.6

11

3.6

289

94.8

1

 B79. LRP | Demonstrate knowledge in Marketing and Sale

24

7.9

75

24.6

206

67.5

1

 B80. LRP | Engage with health and medicines policies

3

< 0.1

31

10.2

271

88.9

1

 B81. LRP | Understand the steps needed to bring a medicinal product to the market including the safety, quality, efficacy and pharmacoeconomic assessments of the product

18

5.9

41

13.4

246

80.7

1

Professional and ethical practice

 B82. PEP | Demonstrate awareness of local/national codes of ethics

5

1.6

14

4.6

286

93.8

1

 B83. PEP | Ensure confidentiality (with the patient and other healthcare professionals)

4

1.3

10

3.3

291

95.4

1

 B84. PEP | Obtain patient consent (it can be implicit in occasions)

10

3.3

21

6.9

274

89.8

1

 B85. PEP | Recognise own limitations

5

1.6

14

4.6

286

93.8

1

 B86. PEP | Take responsibility for own action and for patient care

5

1.6

11

3.6

289

94.8

1

Quality assurance and research in the work place

 B87. QARWP | Apply research findings and understand the benefit risk (e.g. pre-clinical, clinical trials, experimental clinical-pharmacological research and risk management)

34

11.1

48

15.7

223

73.1

2

 B88. QARWP | Audit quality of service (ensure that they meet local and national standards and specifications)

26

8.5

34

11.1

245

80.3

1

 B89. QARWP | Developed and implement Standing Operating Procedures (SOP’s)

17

5.6

17

5.6

271

88.9

1

 B90. QARWP | Ensure appropriate quality control tests are performed and managed appropriately

39

12.8

54

17.7

212

69.5

2

 B91. QARWP | Ensure medicines are not counterfeit and quality standards

16

5.2

24

7.9

265

86.9

1

 B92. QARWP | Identify and evaluate evidence-base to improve the use of medicines and services

16

5.2

32

10.5

257

84.3

1

 B93. QARWP | Identify, investigate, conduct, supervise and support research at the workplace (enquiry-driven practice)

29

9.5

48

15.7

228

74.8

1

 B94. QARWP | Implement, conduct and maintain a report system of pharmacovigilance (e.g. report adverse drug reactions)

17

5.9

18

5.6

270

88.5

1

 B95. QARWP | Initiate and implement audit and research activities

33

10.8

52

17.5

220

72.1

2

Self-management

 B96. SM | Apply assertiveness skills (inspire confidence)

5

1.6

9

3

291

95.4

1

 B97. SM | Demonstrate leadership and practice management skills, initiative and efficiency

4

1.3

12

3.9

289

94.8

1

 B98. SM | Document risk management (e.g. critical incidents)

14

4.6

28

9.2

263

86.2

1

 B99. SM | Ensure punctuality

1

< 0.1

10

3.3

294

96.4

1

 B100. SM | Prioritise work and implement innovative ideas

4

1.3

12

3.9

289

94.8

1

Group: 1 = agreement, 2 = disagreement

Perception of relevance per competency per country

Inter-country variability in responses was assessed for each of the 20 competencies in the questionnaire. For ease of interpretation, the analysis included 426 replies from four countries: Kenya, Nigeria, South Africa and Ghana with the 10 countries that had fewer than 20 survey replies each excluded. The result showed similarity in weighting of relevance for the competencies in the ‘pharmaceutical public health’ (Pillia’s trace V = 0.025, F = 1.809, df = 6, p = 0.094), and ‘professional and personal’ (Pillia’s trace V = 0.084, F = 1.270, df = 18, p = 0.2) clusters, respectively. Specific inter-country variability was observed in the ‘pharmaceutical care’ (Pillia’s trace V = 0.083, F = 1.624, df = 18, p = 0.045), and ‘organisation and management’ (Pillia’s trace V = 0.136, F = 2.279, df = 18, p = 0.002) clusters.

Confirmatory post hoc analysis using Bonferroni correction showed the inter-country variability in responses observed within the ‘pharmaceutical care’ cluster was in three behaviours: B6 [‘assessment of medicine (AM)]’ and B25 and B27 [‘patient consultation and diagnosis (PCD)’] competencies. This was between South Africa and Ghana [in B6: N ‘relevant’ = 47% vs 71%)], Nigeria and Kenya [in B25: N ‘relevant’ = 98 vs 89%], and Nigeria and Ghana [in B27: N ‘relevant’ = 98 vs 85%)]. In spite of the observed disparity in weighting of relevance, only South Africa showed a lack of consensus on relevance (N ‘not relevant’ = 15%) for this cluster and this was in the B6 behaviour.

The disparity in the organisation and management cluster was in B32 [‘budget and reimbursement (BR)’], B45 [‘procurement (P)’] and B55 [‘supply chain and management (SCM)’] competencies. More of the respondents from Ghana rated the B32, B45 and B55 behaviours ‘relevant’ compared to Nigeria (75%, 92%, 94% vs 70%, 70%, 79%, respectively). A lack of consensus on relevance was observed in the South Africa and Nigeria group for the B32 (N ‘not relevant’ = 11%) and B49 (N ‘not relevant’ = 11%) behaviours, respectively. Since only Nigeria and South Africa showed a lack of consensus (N ‘not relevant’ > 10%) on relevance to practice for three behaviours in the framework, it suggests that the inter-country variability in weighting of relevance observed in this study indicated differences in perception of ‘degree of relevance’ between countries. This variability is likely due to the disparity in sample composition in the respective countries given that Kenya had a higher percentage of the respondents in hospital practice (86%) while Nigeria and South Africa on the other hand had less than 50% respectively. Also, more than a third of the respondents from South Africa were in academic pharmacy compared to Nigeria, Kenya and Ghana with less than 7% each.

Discussion

The disagreement observed in 10 behaviours in the GbCF v1 framework was mainly related to respondents’ area of pharmacy practice and the corresponding patient-facing involvement, a finding that is consistent with evidence from previous research [26]. The disagreement in the four behaviours under the ‘pharmaceutical care’ cluster observed in academic and industrial pharmacy is also in line with the scope of practice of pharmacists in these areas given that they are not routinely involved in activities related to medicine assessment and medicines use. This also explains the disagreement observed in the three behaviours under the ‘organisation and management’ cluster.

On the other hand, the disagreement in the research-related behaviours (B87 and B95) under the ‘professional and personal’ cluster was not fully explained by area of pharmacy practice or ‘patient-facing’ involvement. A high percentage (N > 10%) of the respondents in academic and community pharmacy rated these same behaviours ‘not relevant’, thereby adding to the increasing body of evidence from other studies that suggest that pharmacists are not routinely involved in research [3033] and perceive their research-related roles to be of low importance [3437]. It also corroborates the findings of published studies from Australia [38], United Kingdom [39] and Thailand [40] that show that pharmacists generally perceive research-related behaviours and competencies included in developmental frameworks to be relatively low in relevance and rank them accordingly. Time constraints due to workload and a lack of supporting environment for pharmacy research are some of the barriers to participation in research-related activities in the workplace reported in existing literature [38, 41, 42]. Given that the survey respondents in our study included international pharmacists from different areas of pharmacy practice and with varying length of practice experience, this finding highlights the need to scale up efforts to build research capacity in this region.

Of particular interest is the finding that a high percentage (N > 15%) of community pharmacists from the countries represented in this survey ranked two dispensing-related behaviours: B13 (document and act upon dispensing errors) and B14 (implement and maintain a dispensing error report system and a near miss report system) ‘not relevant’ to practice. This suggests community pharmacy respondents from these countries do not routinely carry out these activities although this may have been due to the response rate and/or that the pharmacists were self-selecting. However, available evidence suggests this may also be related to the peculiarities of community pharmacy practice in countries with severe health workforce shortages such as Nigeria [43] and Zambia [44]. Studies show that dispensing activities in community pharmacies in Nigeria are mainly carried out by pharmacy assistants and in some instances, by sales personnel or clerks [43].

Furthermore, the finding may also be related to evidence that suggest that many countries including those in Africa either lack a defined medication error reporting system [45, 46] or where available such systems are primarily independent and/or based within a specific healthcare facility [45, 47]. Given the broad similarities in pharmacy practice reported in countries within the African region [48] and published reports of high incidence of patient harm due to medication errors in some of the countries represented in this survey [49, 50]. This finding underscores the need to review current practice and incorporate robust dispensing and medication error reporting processes in community practice with oversight functions by pharmacists in order to assure patient safety.

Homogeneity in sample responses and the overall survey results indicate minimal disparity between countries in perception of relevance to practice for majority of the behaviours in the GbCF v1. This finding corroborates evidence from previous research [26] and provides evidence that was previously lacking on the relevance of the GbCF v1 competencies in these countries. The finding is in consonance with similar evidence from the field of medicine that demonstrates the relevance of the Canadian CanMEDS Physician Competency Framework to medical practice in the Netherlands [51], Denmark [52, 53] and Australia [54]. It is also in line with evidence from studies that show consensus between countries in Europe on the relevance of a core set of competencies for pharmacy education and practice [42, 55].

Although evidence from global studies have shown that continuous professional development (CPD) is mandatory in many countries in Africa, none of the countries represented in this survey have reported the availability of a validated competency framework for early career pharmacy practice [7, 56]. Studies conducted in Ghana, Ethiopia and Sudan suggest that the lack of a structured post-registration pathway for skills development contribute to the comparatively lower levels of job satisfaction shown by early career pharmacists in these countries [5759]. Our findings therefore provide preliminary evidence on the validity of a core set of competencies that can be further adapted to country context and used to design skill development and learning activities for pre- and in-service early career pharmacy practitioners in these countries. Our findings also suggests the feasibility of adapting the GbCF v1 to develop country-specific frameworks for use in facilitating performance improvement and identifying learning needs particularly in the four countries with comparatively high number of replies in this study.

This study has some limitations. The length of the survey questionnaire (105 questions presented over six pages) may have negatively impacted on the number of replies received. Findings from a meta-analysis of randomised controlled trials show that the odds of a response decreases by more than half as the number of pages of a survey questionnaire increases [OR 0.39, 95% CI 0.34 to 0.45] [60]. This was particularly obvious with the consistent decrease in number of replies per additional competency cluster in the survey questionnaire (Additional file 1). Nonetheless, research also demonstrates that the variation in response rates per page of a questionnaire does not affect the quality of the overall responses received [61].

Online surveys are generally associated with low response rates particularly because it restricts the target populations to individuals with internet access [62, 63]. This implies that potential respondents without Internet access were excluded from this survey, a feature that is significant given that our study was conducted in countries that have been shown to have comparatively higher cost and lower Internet accessibility [64, 65]. However, the geographical location of the survey population, limited resources and time available for this research precluded the use of a telephone or postal survey. Participant self-selection and the non-probabilistic sample obtained via the purposive and snowball sampling technique in our study likely limits the generalisability of our findings. Studies show that self-selected participants are likely to be more intrinsically motivated than the general population [66]. This non-random sampling method was undertaken due to challenges with obtaining a sampling frame for the respective countries. For this same reason, it was difficult to estimate an optimal sample size a priori and to calculate a response rate. In spite of these limitations, the methods used in our study are established and pragmatic evidence-based approaches in pharmacy practice research [26, 3840]. Furthermore, given that our study was an exploratory survey, our findings provide useful information on pharmacists’ perception of relevance to practice of the competencies and behaviours contained in the GbCF v1 framework in the countries represented.

Further work is necessary to qualitatively explore expert opinion and obtain insight from other stakeholders including policy-makers and pharmacy leaders on the validity of these competencies in the respective countries. Also, a larger scale validation study is needed to obtain further inputs from practitioners in non-patient-facing roles such as industrial, administrative and academic pharmacy in this region. This will provide an opportunity for further review of the GbCF v1 competencies in relation to these specific areas of practice.

Conclusion

The majority (90%) of the competencies in the framework as relevant to practice for the respondents in this survey, although there are some emergent differences in weighting of relevance between the countries represented. Overall, the findings provide preliminary evidence that was previously lacking on the relevance of the GbCF v1 competencies to pharmacy practice in these countries.

Abbreviations

AM: 

Assessment of medicine competency

BR: 

Budget and reimbursement competency

D: 

Dispensing competency

FIP: 

The International Pharmaceutical Federation

FIPEd: 

The International Pharmaceutical Federation Education Initiative

GbCF v1: 

Global Competency Framework version 1

M: 

Medicines competency

OR: 

Odds ratio

P: 

Procurement competency

PCD: 

Patient consultation and diagnosis competency

SCM: 

Supply chain and management competency

SPSS v22: 

Statistical Package for the Social Sciences version 22

Declarations

Acknowledgements

The authors thank Charles Ofei-Palm (Ghana), Onyimbo Kerama (Kenya), Prof. Sabiha Essack, Susan Buekes and GT Mahlatsi (South Africa), and Unoma Onugbolu and Kamilu Labaran (Nigeria) for their assistance with disseminating survey invite to pharmacists in their respective countries. We also thank the pharmacy leadership bodies in the countries represented in the survey for their interest in participating in our study.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Availability of data and materials

All authors had complete access to the data that supported the research.

Authors’ contributions

IB conceived the study with inputs from AB and AU. AU designed the study, IB and AB provided input on methodology and reviewed interpretation of the outcome of the data analysis. All three authors read the draft manuscript for intellectual content and approved the final version.

Ethics approval and consent to participate

This study was exempted from formal ethical approval by the research ethics committee as it did not involve the use of identifiable patient information or data, rather the study recruited pharmacists and sought their views by virtue of their professional roles.

Participants completed a consent page prior to participating in the survey.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
University College London School of Pharmacy, London, United Kingdom
(2)
Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), Melbourne, Australia

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