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The specialized competency framework for community pharmacists (SCF-CP) in Lebanon: validation and evaluation of the revised version

Journal of Pharmaceutical Policy and Practice volume 16, Article number: 77 (2023) Cite this article

Abstract

Background

In the absence of similar studies in Lebanon, this study aimed at upgrading and validating the Lebanese specialized competencies framework for community pharmacists (SCF-CP) as a tool to transform community practice and support the professional development and career progression of community pharmacists.

Methods

Content validity was assessed and improved through a team of experts. After a thorough literature review and utilizing the Delphi technique, six domains were defined in the framework, with their respective competencies and behaviors. A cross-sectional study was then carried out from March to October 2022 using an online questionnaire created on Google Forms. The snowball technique was applied to reach community pharmacists across all the Lebanese governorates.

Results

The final sample included 512 community pharmacists. The construct validity of the framework was confirmed by factor analysis. The Kaiser–Meyer–Olkin measures of sampling adequacy were satisfactory for all models ranging from 0.500 to 0.956 with a significant Bartlett’s test of sphericity (P < 0.001). The internal consistency of all competency domains was confirmed by Cronbach’s alpha, with values ranging from 0.803 to 0.953. All competencies were significantly correlated with their respective domains (P < 0.001), and all domains were significantly correlated with each other and with the framework (P < 0.001). The participants declared being competent in all domains relating to fundamental skills, safe and rational use of medicines, pharmacy management, professional skills, public health fundamentals, and emergency preparedness and response, with some exceptions, such as compounding, management, and emergency preparedness. A higher declared competency level was associated with having more experience and receiving more than 50 patients per day.

Conclusion

Our findings could demonstrate that the Lebanese specialized competency framework is a valid and reliable tool. This framework could help assess the minimum competencies that community pharmacists should possess or acquire and direct initial and continuing education for better practice. Hence, it could be adopted by the authorities and implemented in the Lebanese community pharmacy setting.

Background

The roles of healthcare professionals are rapidly changing worldwide, placing additional demands on the healthcare professions, including pharmacy. In many countries, the expanded patient-centered roles for pharmacists have been recognized through a wide range of national healthcare system reforms [1]. As new technologies are added to therapeutic care, pharmacists must acquire new knowledge, skills, and behaviors to be able to apply new modalities to patient care [2]. Furthermore, pharmacists are no longer solely responsible for drug dispensing; they now play an essential role in community health and wellness through expanded services, such as educational counseling [3], medication safety [4], and medication reconciliation and management [5, 6].

Community pharmacists are the most accessible healthcare professionals, with capabilities in different therapeutic areas such as drug information and health promotion. They are in a unique position to bring drug knowledge to the community [7]. With this responsibility, the competencies of community pharmacists should consistently be assessed according to a specific framework where the development of an adaptable and accessible healthcare workforce is imperative to build and maintain resilient health systems and improve the healthcare services delivered [8, 9]. In this perspective, regulatory bodies such as the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) designed a pharmacy education action plan that focused on identifying local needs and adapting educational programs [10,11,12]. This plan pertains to a subset of outcomes, including knowledge, skills, and attitudes, which relate to professional performance and focus on improvement through training and development [13].

At the global level, a profession-wide competency framework for foundation-level pharmacists was developed based on the FIP Global Competency Framework, but it was not specific to community pharmacists in particular [14, 15]. Many developed countries have established a competency framework intended for the practice of community pharmacists and recognized it as a means to facilitate their continuing professional development (CPD) and performance review [16]. However, developing countries do not yet have such a framework. In Malaysia, a survey exploring patient-oriented services provided by community pharmacists beyond processing prescriptions and dispensing medications revealed a trend toward the allocation of such activities, but this practice was not widely implemented [17]. Thus, given the fundamental role of pharmacy education and CPD in preparing and producing competent pharmacists in Arab countries, a national competency framework for pharmacists is necessary to bridge the gap between traditional pharmacy education and the challenging demands of modern health systems.

Following a similar approach, the Order of Pharmacists of Lebanon (OPL, the official national pharmacy association) suggested assessment projects related to developing a validated core competency framework for both pharmacy graduates and practicing pharmacists in Lebanon based on international frameworks [18, 19]. The OPL also suggested specialized frameworks for various pharmacy practice fields, including community pharmacy [20]. However, to date, this framework has not been validated nor implemented, and it remains unknown whether community pharmacists have the minimum competencies required to be held accountable in their practice field. Thus, it was deemed necessary to review and update the specialized competency framework that was designed specifically for community pharmacy practitioners.

Therefore, this study aimed to revise and validate the Lebanese specialized competency framework for community pharmacists (SCF-CP), which could serve to assess the competencies of community pharmacists in Lebanon and support their professional development and career progression.

Methods

Tool update and content validity

A team of experts gathered and reviewed the content of the previously suggested and validated community pharmacy framework, which included five domains [20]. The team of experts comprised four academics (two of whom are preceptors in community settings and two in clinical settings) and two community pharmacists.

After a thorough literature review, domains, competencies, and behaviors (items) were reviewed and adapted to the Lebanese setting. Additional behaviors were added, and the existing ones were adjusted based on several international studies and available frameworks [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. A sixth domain describing “Preparedness and Response to Emergencies”, with behaviors taken from other frameworks [37,38,39,40], was added further to the pandemic and the multiple crises that hit Lebanon. Using a Delphi technique, the framework was circulated to the experts on more than 5 rounds until a consensus of more than 90% on all items was reached. Afterwards, the questionnaire was sent to a group of 11 community pharmacists from the OPL for a final review. Questions and minor inconsistencies were resolved by a final discussion.

The finalized framework was subsequently adapted to be administered to pharmacists through standardized online questionnaires.

Study design

A cross-sectional study was carried out from March to October 2022 through an online questionnaire created on Google Forms for ease of distribution on social platforms (Facebook, Instagram, LinkedIn, and WhatsApp groups). The snowball technique was applied to reach pharmacists working in community settings across the five Lebanese governorates (Beirut, Beqaa, Mount Lebanon, South Lebanon, and North Lebanon). All community pharmacists living in Lebanon were eligible to participate.

Ethical aspect

The Lebanese International University (LIU) School of Pharmacy Research and Ethics Committee approved the study protocol (2022RC-041-LIUSOP). This study was conducted following the ethical principles outlined in the Declaration of Helsinki. Explanations about the topic and the different aspects of the study were available in the introductory section of the questionnaire. Respondents gave written consent before proceeding to the survey. Anonymity and confidentiality were ensured across the entire data collection process.

Sample size calculation

Two different methods were used to determine the minimum sample size required for the study. The first involved using the CDC Epi-info software to calculate the minimum sample needed to achieve a 3% error rate, with a 95% confidence interval, 5% alpha error, and 80% power. Based on the assumption that 90% of working pharmacists in the community setting would meet the specialized competencies and domains, a minimum of 350 participants was necessary. The second method used the G-Power software, version 3.0.10, to calculate the minimum sample size based on an effect size of 0.0526 and squared multiple correlations of 0.05 (R2 deviation from 0) related to the Omnibus test of multiple regression. The study allowed for 20 predictors to be included in the model with a 5% alpha error and 80% power, resulting in a minimum sample size of n = 415.

The targeted sample size was increased to 500 participants to account for potential missing data.

Questionnaire and variables

The questionnaire was in English, as this language is commonly spoken by healthcare professionals in Lebanon, and comprised two sections. The first section collected information related to sociodemographic features and professional status. The second section consisted of the scale-based framework, which covered six domains, each comprising a set of competencies with their related behaviors (Additional file 1).

Sociodemographic data

In this part, participants were asked about their general sociodemographic data, including age, gender, area of work, university of graduation, highest educational level, years of experience, the number of working hours per day, and the number of working days per week.

Domains, competencies, and behaviors

The final framework comprised six domains related to 25 competencies. Domain 0 included one set of competencies related to fundamental skills and comprised five competencies: Legal considerations, Product procurement and management, Compounding, Pharmacy Operation, Quality Improvement, and Pharmacy Automation. Domain 1 (Safe and Rational use of medicines) comprised six competencies, i.e., Clinical skills, Medication Therapy Management, Compliance and Adherence, Problem-Solving/Referrals, Over-the-Counter Medications, and Pharmacovigilance. Domain 2 (Pharmacy Management) covered two competencies, i.e., Functions and Managed care/Drug Coverage Policies. Domain 3 (Professional Skills) encompassed seven competencies, i.e., Health Literacy, Patient Communication, Health professional Communication, Team Communication, Leadership Abilities and Personal Skills, Drug Information Skills, and Ethical Consideration. Domain 4 (Public Health Fundamentals) included the competency of Clinical application of Public Health. Domain 5 (Preparedness and Response to Emergency) included four competencies, all related to the emergency setting: emergency preparedness and response, operation management, patient care and population health interventions, and evaluation, research, and dissemination for impact and outcomes. Based on every competency, behaviors were suggested, and answers were adapted using a Likert scale (1 = Not confident at all to 5 = Very confident).

Statistical analysis

The data were analyzed using SPSS software version 25. Firstly, a factor analysis using the principal component analysis (PCA) technique was conducted for the self-assessment of behaviors based on competencies and domains. The Kaiser–Meyer–Olkin (KMO) coefficient, Bartlett’s test for sphericity, and the total percentage of variance explained were reported for every analysis. For structural validity measures, Pearson correlation coefficients were calculated to assess the correlation of the domains within their respective competencies and their association with the other domains and the whole framework. Cronbach’s alpha values were also calculated for every competency to assess internal consistency (reliability).

Secondly, a descriptive analysis was performed using counts and percentages for categorical variables and means and standard deviations for continuous measures. For competencies and domains, standardized means over 100 were used for ease of comparison. The normality of continuous variables was checked using a visual inspection. In the bivariate analysis, the mean grade of each competency domain was then analyzed with the sociodemographic characteristics and working experiences of pharmacists using independent sample T-test (two groups comparison), one-way ANOVA (multiple groups comparison), and Pearson correlation (association between continuous variables).

Afterward, six multivariable linear regression models were performed, taking the mean of each competency domain as the dependent variable and the sociodemographic characteristics and working experiences with P values lower than 0.2 in the bivariate analysis as independent variables. The results were reported as an unadjusted beta with a 95% confidence interval. In all cases, the level of significance was set at P < 0.05.

Results

Description of the sociodemographic characteristics and work experience

A total of 512 community pharmacists were included in the study; their mean age was 35.35 years (± 10.77). The majority (91.6%) had a bachelor's degree in pharmacy, 54.3% were females, and 69.9% were English educated. The average number of years of experience was 10.10 (± 8.56), the majority (78.3%) of pharmacists practiced in a community setting only, the average number of working days per week was 5.93 (± 0.84), and the average number of working hours per day was 8.91 (± 3.09). Table 1 displays the complete sociodemographic characteristics and work experience of the participants.

Table 1 Sociodemographic characteristics and work experience of community pharmacists
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Validation of the framework

Content validity

The final validated framework included six domains, 25 competencies, and 135 behaviors. The first domain (Domain 0: Fundamental Skills) comprised 27 behaviors categorized into legal considerations; product procurement and management; compounding; pharmacy operation; quality improvement; and pharmacy automation. The second domain (Domain 1: Safe and Rational Use of Medicines) involved 28 behaviors divided into clinical skills; medication therapy management; compliance and adherence; problem-solving and referrals; over-the-counter medicines; and pharmacovigilance. The third domain (Domain 2: Pharmacy Management) covered 16 behaviors grouped under managed care/drug coverage policies. The fourth domain (Domain 3: Professional Skills) included 30 behaviors categorized into health literacy; patient communication; health professional communication; team communication; leadership abilities and personal skills; drug information skills; and ethical considerations. The fifth domain (Domain 4: Public Health Fundamentals) comprised 8 behaviors grouped under clinical applications of public health. Finally, the sixth domain (Domain 5 Emergency Preparedness and Response) included 26 behaviors categorized into emergency preparedness and response; operations management; patient care and population health interventions; and evaluation, research, and dissemination for impact and outcomes.

Factor analysis

Factor analysis was run to confirm the construct validity of the framework domains. All competencies could be extracted with Promax rotation and loaded appropriately on their domain. All competencies were loaded on one factor, and no variables had low factor loading (< 0.3), low communality (< 0.3), or over-correlation with each other (r > 0.9). The KMO measures of sampling adequacy were satisfactory for all models ranging from 0.500 to 0.956 with a significant Bartlett’s test of sphericity (P < 0.001). The percentage of explained variance ranged from 64.30 to 87.7%. Table 2 presents the Promax rotated matrix of factor analysis of the Lebanese community pharmacists’ competencies.

Table 2 Factor analysis (Promax rotated component matrix) and internal consistency of the framework
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Validity measures

The internal consistency of all competencies and domains was confirmed by measuring Cronbach’s alpha values, which ranged from very good (0.803) to excellent (0.953).

The values varied as follows: Domain 0 from 0.803 to 0.953, Domain 1 from 0.849 to 0.948, Domain 2 from 0.930 to 0.936, Domain 3 from 0.850 to 0.927, Domain 4 from 0.939, and Domain 5 from 0.893 to 0.933 (Table 2). Furthermore, all competencies were significantly correlated with their respective domains, with all values of P < 0.001, and there was a significant correlation between all domains and between each domain and the total framework (P < 0.001). The Pearson correlation analysis is shown in Table 3.

Table 3 Structural validity through Pearson correlation analysis of the framework domains
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Assessment of competencies

Figure 1 presents the assessment of the 6 domains of the framework among community pharmacists. Participants declared being competent in all domains, with a percentage of mean grade ranging from 90.67% for public health fundamentals to 91.90% for professional skills. Two domains had slightly lower grades, i.e., 89.75% for pharmacy management and 89.72% for emergency preparedness and response.

Fig. 1
figure 1

Assessment of the 6 domains of the framework among community pharmacists

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The assessment of each competency within the domains showed that the competencies with the lowest means were compounding (82.3%; fundamental skills), medication therapy management (90.1%; safe and rational use of medicines), functions (89.5%; pharmacy management), drug information skills (90.6%; professional skills), and emergency preparedness and response (88.7%). Table 4 presents a detailed assessment of the domains and competencies.

Table 4 Assessment of the framework domains and competencies
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Bivariate analysis

In the bivariate analysis, higher means of the fundamental skills domain were significantly associated with being a pharmacy owner (P = 0.020), not having another field (non-community) of work (P = 0.017), older age (P < 0.001), a higher number of working days per week (P = 0.018), and more years of experience as a community pharmacist (P < 0.001). Fundamental skills were also significantly different, according to work locations (P = 0.001) and the number of patients received per day (P < 0.001).

Higher means of safe and rational use of medicines were significantly associated with being a pharmacy owner (P = 0.009), not having another field (non-community) of work (P = 0.005), older age (P < 0.001), a higher number of working days per week (P = 0.011), and more years of experience as a community pharmacist (P < 0.001). Safe and rational use of medicines were also significantly different, according to the language of education (P = 0.020), work location (P < 0.020), and the number of patients received per day (P = 0.001).

Higher means of pharmacy management were significantly associated with being a male pharmacist (P = 0.015), a pharmacy owner (P = 0.002), not having another field (non-community) of work (P = 0.036), older age (P = 0.002), a higher number of working days per week (P = 0.001), and more years of experience as a community pharmacist (P = 0.001). Pharmacy management was also significantly different, according to work location (P = 0.004) and the number of patients received per day (P = 0.026).

Higher means of professional skills domain were significantly associated with older age (P < 0.001), a higher number of working days per week (P = 0.008), not with having another field (non-community) of work (P = 0.011), and more years of experience as a community pharmacist (P < 0.001). Professional skills were also significantly different according to work location (P = 0.001), and the number of patients received per day (P = 0.004).

Higher means of public health fundamentals were significantly associated with older age (P = 0.006), a higher number of working days per week (P = 0.009), and more years of experience as a community pharmacist (P = 0.007). Public health fundamentals were also significantly different according to the number of patients received per day (P = 0.003).

Higher means of emergency preparedness and response were significantly associated with being a male pharmacist (P = 0.005), a pharmacy owner (P = 0.026), not having another field (non-community) of work (P = 0.038), older age (P = 0.006), a higher number of working days per week (P = 0.040), and more years of experience as a community pharmacist (P = 0.003). Emergency preparedness and response were also significantly different, according to work location (P = 0.038) and the number of patients received per day (P = 0.008).

The bivariate analysis taking the community pharmacists' competency domains as the dependent variables is shown in Table 5.

Table 5 Bivariate analysis taking the framework domains as the dependent variables
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Multivariable analysis

Six models of multivariable linear regression, taking the framework domains as the dependent variables, were performed.

Better fundamental skills were significantly associated with more years of experience as a community pharmacist (Beta = 0.281, P = 0.001) and receiving more than 50 patients per day (Beta = 3.389, P = 0.004) compared to receiving less than 50 patients per day. However, lower fundamental skills were significantly associated with having another field (non-community) of work (Beta = -3.022, P = 0.032).

Safer and more rational use of medicines was significantly associated with more years of practice experience as a community pharmacist (Beta = 0.184, P = 0.046) and receiving more than 50 patients per day (Beta = 3.508, P = 0.006) compared to receiving less than 50 patients per day. Lesser safe and rational use of medicines was significantly associated with having another field (non-community) of work (Beta = − 4.124, P = 0.006).

The pharmacy management competency domain was also significantly associated with receiving more than 50 patients per day (Beta = 1.699, P = 0.042) compared to receiving less than 50 patients per day, while it was significantly lower with having another field (non-community) of work (Beta = − 2.053, P = 0.038).

Better professional skills were significantly associated with more years of experience as a community pharmacist (Beta = 0.253, P = 0.010) and receiving more than 50 patients per day (Beta = 2.763, P = 0.041) compared to receiving less than 50 patients per day. Lower professional skills were significantly associated with having another field (non-community) of work (Beta = − 4.145, P = 0.010).

Better public health fundamentals were significantly associated with other languages of pharmacy education vs. the French language (Beta = 2.397, P = 0.034) and receiving more than 50 patients per day (Beta = 1.237, P = 0.005) compared to receiving less than 50 patients per day.

Finally, better emergency preparedness and response were significantly associated with receiving more than 50 patients per day (Beta = 3.188, P = 0.012) compared to receiving less than 50 patients per day.

The six models of multivariable linear regressions, taking the framework domains as the dependent variables, are shown in Table 6.

Table 6 Multivariable linear regressions taking the framework domains as the dependent variables
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Discussion

This study could update and validate the first version of the Lebanese specialized competency framework for community pharmacy practitioners in conformity with the published literature. The six domains described comprised fundamental skills, safe and rational use of medicines, pharmacy management, professional skills, public health fundamentals, and emergency preparedness and response. The total number of competencies was 25, while the total number of behaviors was 135.

The necessity of a country-specific framework to assess pharmacists’ performance and considerations on how to enhance this framework was recognized by several countries around the world, although mainly applied to core competencies. Several studies from Australia [41], Croatia [42, 43], Ireland [44], Kuwait [14], Japan [45], New Zealand [21], Serbia [46], Thailand [47, 48], and 14 African countries, including Ghana, Kenya, Nigeria, and South Africa [49] were conducted to develop or translate and cross-culturally adapt a national competency framework to assess essential standardized recommendations implementation to advance local practice.

The notable feature of this framework consists of adapting it to the multifaceted crisis context of Lebanon [50] by including the emergency preparedness and response domain, which was not in the previously suggested framework. Emergency preparedness and response have become an emerging role of pharmacists, a rising area of pharmacy practice [51], and a significant concern given the recent global spread of COVID-19 [52]. According to the FIP, pharmacists have roles and responsibilities at all levels of emergency preparedness linked to functioning at individual and community levels [53]. Adapting the roles of the pharmacist in response to the needs of the public requires continuing development of pharmacists’ competencies to adequately participate in areas such as emergency response and disasters.

To the best of our knowledge, no previous studies have evaluated the construct validity and reliability of specialized competencies required by community pharmacists. Our findings demonstrated the construct validity of the Lebanese specialized competency framework for community pharmacists, showing that all competencies have high factor loading and thus confirming the adequacy of all the domains of the framework. The structural validity of the current framework was also confirmed by the highly significant correlation of each competency with its domain and the highly significant correlation of all domains with each other and with the entire framework. Analysis of additional psychometric properties of the framework verified its reliability, as indicated by the Cronbach alpha values for all competencies [54]. Thus, this framework is recommended for assessment in practice and research settings. Nevertheless, further validation measures such as criterion validity and test–retest reliability are still required, in addition to comparative studies with the competencies of other practice settings such as hospital and ambulatory care.

The present study also assessed the grade of each competency and domain among participants and evaluated the role of sociodemographic characteristics and work experience in predicting the competencies of community pharmacists. Our findings showed that community pharmacists appeared to be competent in all six domains. Yet, participants were found to be slightly less skilled in pharmacy management and emergency preparedness and response compared to other areas. The reason for the lower declared competence in pharmacy management could be attributed to the pharmacy education in Lebanon and the knowledge and skills acquired through the curricula. Indeed, pharmacy management is usually introduced in one or more didactic courses throughout the pharmacy programs, although it is not adequately enforced in practical experiences and entrustable professional activities [55, 56]. Worse grades in pharmacy management and other domains are expected soon due to the large number of fresh graduates who have undertaken their didactic courses remotely and practical experiences virtually over a considerable period during the COVID-19 lockdowns [57]. On the other hand, the low grades in emergency preparedness and readiness were not surprising as this is a new emerging role of pharmacists, and this domain is still relatively recent among the internationally recommended competencies [53]. Meanwhile, Lebanese pharmacists reportedly demonstrated high professional skills and expertise in providing community services and patient care amid the COVID-19 pandemic [58].

The present findings showed that better competencies are significantly associated with more years of practice experience, receiving more patients per day, and being a non-French educated pharmacist. However, lower competencies were significantly associated with having additional work outside the community setting. The domains of fundamental skills, safe and rational use of medicines, pharmacy management, professional skills, public health fundamentals, and emergency preparedness and response were declared to be significantly better among pharmacists who receive more than 50 patients per day. Further, the domains of fundamental skills, safe and rational use of medicines, and professional skills were significantly better among pharmacists with more years of work experience. Receiving a higher number of patients and having more years of practice correlated with better competence in several areas of community service provision and patient care. Although this association was not comprehensively explored previously, the literature reported that more work experience was associated with better knowledge and skills [59]. Of note, the degree of education was not linked to better-declared competencies, which reveals the gap between education and practice.

Public health fundamental skills were significantly higher among community pharmacists who received their education in languages other than French. The reason for this finding is not fully understood, but it could be due to the rating scheme that is consistently higher in the American versus the French system to which pharmacists have been exposed as students; the same was also found for core competencies assessment [18, 19]. It could also be that universities with French curricula do not focus on public health aspects of pharmacy. Further studies in this context are suggested to elucidate this association.

Moreover, pharmacists who got an additional non-community pharmacy work reported significantly lower competencies in the domains of fundamental skills, safe and rational use of medicines, pharmacy management, and professional skills. This result could be attributed to fatigue and less attentive practice in each work setting [60]. Lately, many Lebanese pharmacists have been obliged to secure multiple jobs to improve their financial situation during the current severe socioeconomic crisis affecting Lebanon. This reality was associated with longer working hours and lower proficiency [61].

Implications for practice

The Lebanese specialized competency framework for community pharmacists carries significant implications for policy and practice globally and locally. Firstly, the framework serves to confirm the existing competencies that community pharmacists should possess while also identifying new emerging roles and areas for professional development. Thus, it provides a clear roadmap for pharmacists to enhance the quality of community services and patient care. This competency-based approach is crucial in an ever-evolving healthcare landscape where pharmacists play a vital role in ensuring safe and effective medication use. Moreover, this framework would potentially transform pharmacy practice, education, and continuing professional development by providing a structured approach to guide the education and training of future pharmacists and ensuring that they acquire the necessary skills and knowledge aligned with the evolving needs of the profession. It would also support ongoing professional development, enabling practicing pharmacists to continuously update their competencies and stay abreast of advancements in their field.

Another notable implication of this framework is its potential to establish standardized community pharmacy practice. Indeed, it creates a benchmark for professional practice and encourages consistency in service delivery across different pharmacy settings by defining the competencies expected from community pharmacists. This standardization promotes quality assurance and fosters public trust in the pharmacy profession. Furthermore, the framework has the potential to bridge the gap between different generations of pharmacists. Younger pharmacists may possess more updated theoretical knowledge, while older pharmacists bring valuable practical experiences. Both generations can benefit from a shared understanding of the necessary competencies by embracing this competency framework, thus facilitating collaboration and knowledge exchange for the benefit of patient care.

While the framework presents promising opportunities, it is essential to acknowledge the potential challenges its implementation might encounter. The unstable political situation in Lebanon might hinder the adoption of new policies and legislation, making it crucial for relevant authorities and academia to exert additional efforts. Continuous advocacy, engagement, and collaboration between policymakers, academia, and relevant stakeholders are necessary to overcome these obstacles and ensure the integration of these competencies into community pharmacy practice.

Limitations and strengths

This study has several strengths. It is the first study to upgrade a specialized competency framework in a developing country and evaluate its construct and structural validity and reliability in the community setting. The sample size was sufficient for adequate statistical analysis for validation and assessment. The sample was also representative as it included pharmacists from all universities in Lebanon and pharmacists who graduated from outside Lebanon.

Nevertheless, a few limitations should be acknowledged. The snowball sampling technique could have led to selection bias. However, this risk is believed to be minimized since the sample included community pharmacists from all districts across Lebanon. Additionally, most participants were middle-aged pharmacists with an average of ten years of practice experience. Therefore, the competencies were not well-assessed among fresh graduates and older pharmacists. The length of the questionnaire may have been associated with exhaustion, ensuing in a possible risk of information bias, although it is believed that this risk is reduced as pharmacists were able to autosave their responses at any time and continue filling out the survey at their convenience. Finally, although a multivariable analysis was conducted to decrease confounding, residual confounding is still possible. Further studies are suggested to confirm the validity of the framework and expand its application to assessment situations.

Conclusion

Our findings could demonstrate that the Lebanese specialized competency framework is a valid and reliable tool. The Lebanese community pharmacists reported being competent in all domains, with lower confidence in areas related to compounding, management, and emergency preparedness. Overall, higher competencies were positively associated with longer work experience and the number of received patients but not with the degree of education. This framework could be adopted by the authorities and implemented in the Lebanese community pharmacy setting. It could help assess the minimum competencies that community pharmacists should possess or acquire and direct initial and continuing education for better practice.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

FIP:

International Pharmaceutical Federation

CPD:

Continuing professional development

OPL:

Order of Pharmacists of Lebanon

LIU:

Lebanese International University

PCA:

Principal component analysis

KMO:

Kaiser–Meyer–Olkin

COVID-19:

Coronavirus diseases 2019

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Authors and Affiliations

  1. School of Pharmacy, Lebanese International University, Beirut, Lebanon

    Fouad Sakr, Marwan Akel, Jihan Safwan & Katia Iskandar

  2. INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique Et de Toxicologie-Liban), Beirut, Lebanon

    Fouad Sakr, Marwan Akel, Hala Sacre, Chadia Haddad, Samah Tawil, Jihan Safwan, Aline Hajj, Rony M. Zeenny, Katia Iskandar & Pascale Salameh

  3. School of Education, Lebanese International University, Beirut, Lebanon

    Marwan Akel

  4. Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon

    Chadia Haddad, Samah Tawil & Pascale Salameh

  5. School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon

    Chadia Haddad

  6. Research Department, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon

    Chadia Haddad

  7. Laboratoire de Pharmacologie, Faculty of Pharmacy, Pharmacie Clinique et Contrôle de Qualité Des Médicament (LPCQM), Saint Joseph University of Beirut, Beirut, Lebanon

    Aline Hajj

  8. Faculté de Pharmacie, Université Laval, Québec, Canada

    Aline Hajj

  9. Oncology Division, CHU de Québec Université Laval Research Center, Québec, Canada

    Aline Hajj

  10. Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon

    Rony M. Zeenny

  11. Faculty of Pharmacy, Lebanese University, Hadat, Lebanon

    Katia Iskandar & Pascale Salameh

  12. University of Nicosia Medical School, Nicosia, Cyprus

    Pascale Salameh

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  1. Fouad Sakr
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Correspondence to Fouad Sakr.

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The Lebanese International University (LIU) School of Pharmacy Research and Ethics Committee approved the study protocol (2022RC-041-LIUSOP). This study was conducted following the ethical principles outlined in the Declaration of Helsinki. Explanations about the topic and the different aspects of the study were available in the introductory section of the questionnaire. Respondents gave written consent before proceeding to the survey. Anonymity and confidentiality were ensured across the entire data collection process.

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Supplementary Information

Additional file 1. 

The specialized competency framework for community pharmacists' questionnaire.

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Sakr, F., Akel, M., Sacre, H. et al. The specialized competency framework for community pharmacists (SCF-CP) in Lebanon: validation and evaluation of the revised version. J of Pharm Policy and Pract 16, 77 (2023). https://doi.org/10.1186/s40545-023-00585-6

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Keywords

Journal of Pharmaceutical Policy and Practice

ISSN: 2052-3211

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