Table 3 Factor analysis of Lebanese clinical pharmacists’ competencies (Promax rotated component matrix)

Domain 0: Quality improvement

 0.1 Medication use management

  1

Understand the process for developing, implementing, and maintaining a formulary system

0.911

0.922

  2

Implement quality improvement changes to the institution medication-use system

0.879

  3

Draft and distribute information and recommendations related to the clinical use of drugs when appropriate

0.811

  4

Participate in the identification of need for, development of, implementation of, and evaluation of an evidence-based treatment guideline/protocol related to individual and population-based patient care

0.811

  5

Participate in opportunities for improvement in the institutions medication-use system by comparing the medication-use system to relevant best practices

0.796

  6

Make a medication-use policy recommendation based on a comparative review, e.g., drug class review, drug monograph, antimicrobial stewardship, etc.

0.759

  7

Understand the institutions medication-use system and its vulnerabilities to adverse drug events (ADEs)

0.733

  8

Understand the structure and process of the medication-use system

0.706

  9

Understand the impact of pharmacist involvement on medication safety and quality using appropriate literature

0.706

  10

Document appropriate therapeutic recommendations related to medication therapy

0.679

  11

Use clinical pharmacy metrics/indicators to show the impact of clinical pharmacy services

0.660

  12

Identify opportunities for improvement of the institutions medication-use system

0.613

  13

Participate in pilot interventions to change problematic or potentially problematic aspects of the medication-use system with the objective of improving quality

0.562

 0.2 Medication dispensing

  1

Prepare and dispense medications following existing standards of practice and the institutions policies and procedures

0.934

0.900

  2

Dispense medication products following the institutions policies and procedures

0.934

  3

Identify the appropriateness (rational and safe use) of a medication order before preparing or permitting the distribution of the first dose

0.868

  4

Prepare medication using appropriate techniques and following the institutions policies and procedures

0.868

  5

Follow the institutions policies and procedures to maintain the accuracy of the patients’ medication profile

0.694

 0.3 Workplace management

  1

Quality Improvement/Workplace Management [Understand the principles of financial management of a pharmacy department.]

0.961

0.890

  2

Quality Improvement/Workplace Management [Use knowledge of the principles of change management to achieve organizational, departmental, and/or team goals.]

0.946

  3

Quality Improvement/Workplace Management [Evaluate the workload, organize the workflow, and check the accuracy of the work of pharmacy staff or others.]

0.827

  4

Quality Improvement/Workplace Management [Understand the effect of accreditation, legal, regulatory, and safety requirements on practice.]

0.825

Domain 1: Clinical Knowledge and Skills

 1.0. Analytical Skills

  1

Provide concise, applicable, comprehensive, and timely responses to requests for drug information from patients and healthcare providers

0.949

0.909

  2

Evaluate the usefulness of biomedical literature gathered

0.949

  3

Assess the effectiveness of drug information recommendations

0.879

  4

Determine relevant information to evaluate from all retrieved biomedical literature

0.879

  5

Formulate a systematic, efficient, and thorough procedure for retrieving drug information

0.843

  6

Formulate responses to drug information requests based on analysis of the literature

0.635

  7

Provide appropriate responses to drug information questions that require pharmacists to draw upon their knowledge base

0.422

 1.1. Fundamentals of Clinical Knowledge

  1

Support the management of acute toxicity and advice on appropriate antidotes

0.940

0.845

  2

Apply knowledge of pathophysiology to specific therapeutic areas and to particular patient groups

0.929

  3

Discuss the importance of emerging technologies in pharmacology and pharmacotherapy

0.847

  4

Understand the scientific basis of different dosage formulations, and adjuvant compounds, their design and influence on the clinical efficacy of medicines

0.814

  5

Know the advantages and risks of the new formulations

0.801

  6

Understand how administration, drug distribution, drug elimination influences medicines outcomes

0.686

  7

Describe and discuss the pharmacology and pharmacotherapy of drugs in routine use

0.582

  8

Show knowledge of basic physical health examinations and laboratory tests and show ability to interpret and respond adequately to such data

0.458

  9

Understand normal organ anatomy and function, the effects of disease states that affect medicines use

0.457

  10

Demonstrate an appropriate level of clinical knowledge related to medications and therapeutics in making decisions or recommendations

0.381

  11

Identify pharmacotherapy-induced resistance and anti-microbial stewardship

0.125

 1.2. Patient Data Collection, Assessment, and Therapeutic Planning Skills

  1

Collect and organize all patient-specific information needed by the pharmacist to prevent, detect, and resolve medication-related problems and make appropriate evidence-based, patient-centered medication therapy recommendations as part of the interdisciplinary team

1.000

0.768

  2

Determine if the medication is used with no medical indication

1.000

  3

Determine if the immunization regimen is incomplete

1.000

  4

Determine if the current medication therapy regimen contains something inappropriate (dose, dosage form, duration, schedule, route of administration, method of administration)

1.000

  5

Determine if there is therapeutic duplication

1.000

  6

Determine if the medication to which the patient is allergic has been prescribed

1.000

  7

Determine the presence of adverse drug or device-related events or potential for such events

1.000

  8

Determine clinically significant drug–drug, drug–disease, drug–nutrient, or drug–laboratory test interactions or potential for such interactions

1.000

  9

Determine if the medical therapy has been interfered with by social, recreational, non-prescription, or non-traditional drug use by the patient

1.000

  10

Determine if the patient is not receiving the full benefit of prescribed medication therapy

1.000

  11

Determine if there are problems arising from financial impact of medication therapy on the patient

1.000

  12

Determine if the patient lacks understanding of medication therapy

1.000

  13

Determine if the patient is not adhering to medication regimen

1.000

  14

Assess options available for problem solving, considering possible outcomes of therapeutic actions

1.000

  15

Use benefit–risk assessments for evaluating alternative treatment strategies

1.000

  16

Optimize use of drugs including: addition, deletion, dose adjustment, IV to Po switch, renal dosing, dose reduction, etc.

1.000

  17

Use an organized collection of patient-specific information, summarize patients’ healthcare needs

1.000

  18

Evaluate medication-use patterns in a specified patient population (geriatrics, pediatrics, etc.)

1.000

  19

Make a referral to the appropriate healthcare provider based on the patient’s acuity and the presenting problem, when presented with a patient with healthcare needs that cannot be met by the pharmacist

1.000

  20

Design an evidence-based therapeutic regimen

1.000

  21

Identify therapeutic goals and design a patient-centered regimen that meets the evidence-based therapeutic goals established for a patient

1.000

  22

Integrate patient-specific information, disease and drug information, ethical and quality of life issues

1.000

  23

Consider pharmacoeconomic principles: identify cost effective medicines and medical devices using valid and relevant pharmacoeconomic data

1.000

  24

Note: Unidimensional; full loading; low variance

 1.3. Monitoring and Follow-Up Skills

  1

Accurately assess the patient’s progress toward the therapeutic goal(s)

0.893

0.865

  2

Redesign a patient-centered, evidence-based therapeutic plan as necessary based on the evaluation of monitoring data and therapeutic outcomes

0.882

  3

When appropriate, initiate the patient-centered, evidence-based therapeutic regimen and monitoring plan for a patient according to the institutions’ policies and procedures

0.882

  4

Design a patient-centered, evidence-based monitoring plan for a therapeutic regimen that effectively evaluates the achievement of patient-specific goals

0.720

  5

Kaiser–Meyer–Olkin (KMO) 0.412, Bartlett’s test of sphericity < 0.001, Percentage of variance explained 71.78%

 1.4. Medication Safety and Surveillance

  1

Consider that reporting an ADR is part of pharmacist duties

0.932

0.565

  2

Identify high-risk medicines and high-risk administration of medicines relevant to the healthcare setting

0.932

  3

Plan and implement medicines management actions to minimize the risk related to these medicines

0.852

  4

Identify a potential adverse drug reaction

0.663

  5

Demonstrate knowledge on reporting an adverse drug reaction to relevant authorities

0.174

 1.5. Transition of Care and Reconciliation Skills

  1

Document, reconcile and update patient medication history and received interventions

0.434

0.197

  2

Communicate pertinent pharmacotherapeutic information to the receiving healthcare professionals, when a patient is transitioning from one healthcare setting to another

0.434

  3

Ensure that accurate and timely medication-specific information reconciliation procedure regarding a specific patient reaches those who need it at the appropriate time

0.911

  4

Note: Unidimensional; full loading; low variance

Domain 2: soft skills

 2.0. Communication skills

  1

Use effective communication practices when documenting a direct patient-care activity

0.858

0.518

  2

Use effective patient education techniques to provide counseling to patients and caregivers, including information on medication therapy, adverse effects, compliance, appropriate use, handling, and medication administration

0.799

  3

Provide clear and concise consultations to other health professionals

0.788

  4

Explain the characteristics of exemplary documentation systems that may be used in the organizations’ environment

− 0.263

  5

Appropriately select direct patient-care activities for documentation

0.201

 2.2. Interdisciplinary approach

  1

Demonstrate cooperative, collaborative, and communicative working relationships with members of interdisciplinary healthcare teams as appropriate

1.000

0.794

  2

Prioritize and manage daily activities to deliver appropriate patient-centered care to each patient

1.000

  3

Demonstrate collaborative professional pharmacist–patient relationships as appropriate

1.000

  4

Recommend or communicate a patient-centered, evidence-based therapeutic regimen and corresponding monitoring plan to other members of the interdisciplinary team and patients systematically, logically, accurately, and timely and secure consensus from the team and patient

1.000

Unidimensional; full loading; low variance

 2.3. Professionalism, ethics, and patient advocacy

  1

Demonstrate pride in and commitment to the profession through appearance, personal conduct, and association membership

1.000

0.774

  2

Act ethically in the conduct of all job-related activities

1.000

  3

Demonstrate ownership of and responsibility for the welfare of the patient by addressing pharmacy-related patient care problems

1.000

  4

Respect the rights of patients in therapeutic decisions and assist in providing information to facilitate their decision

1.000

  5

Respect and maintain the individuals’ right to confidentiality

1.000

  6

Engage in regular professional development activities

1.000

  7

Engage in professional organization activities

1.000

Unidimensional; full loading; low variance

 2.4. Leadership and Self-Management

  1

Demonstrate pride in and commitment to the profession through appearance, personal conduct, and association membership

1.000

0.284

  2

Act ethically in the conduct of all job-related activities

1.000

  3

Demonstrate ownership of and responsibility for the welfare of the patient by addressing pharmacy-related patient care problems

1.000

  4

Respect the rights of patients in therapeutic decisions and assist in providing information to facilitate their decision

1.000

  5

Respect and maintain the individuals’ right to confidentiality

1.000

Unidimensional; full loading; low variance

Domain 3: Ability to conduct clinical research

 3.1. Research Project Management Skills

  1

Employ accepted manuscript style to prepare a final report of a practice-related project

0.969

0.957

  2

Implement a practice-related project as specified in its design (clinical trials and observational studies)

0.919

  3

Describe, explain and discuss commonly used research methodologies

0.897

  4

Suggest a feasible design for a practice-related project

0.891

  5

Effectively present the results of a practice-related project

0.868

  6

Secure any necessary approvals, including IRB, for one’s design of a practice-related project

0.861

  7

Participate in pharmacy practice research and clinical research

0.850

Domain 4: Ability to provide effective education

 4.1. Educational skills

  1

Use effective educational techniques in the design of all educational activities

0.876

0.397

  2

Use knowledge of audio–visual aids and handouts to enhance the effectiveness of communications

0.550

  3

Use public speaking skills to speak effectively in large and small group situations

0.476

  4

Use skill in case-based teaching

0.476

Domain 5: Use information technology to make decisions and reduce errors

 5.1. Informatics Skills

  1

Exercise skill in elementary use of databases and data analysis software

0.952

0.815

  2

Explain security and patient protections such as access control, data security, data encryption, privacy regulations, as well as ethical and legal issues related to the use of information technology in pharmacy practice

0.866

  3

Use healthcare delivery systems and health informatics to optimize the care of individual patients and patient populations

0.761

Domain 6: Pharmacist preparedness and response in emergency situations

 6.1. Emergency Preparedness and Response (EPR)

  1

Follow actions and recommendations of local authorities

0.983

0.977

  2

Address medication shortage and mitigation plan

0.963

  3

Balance stockpile and availability of drugs for existing/chronic conditions

0.963

  4

Check for FDA/EMA Emergency Use Authorizations (EUAs) and expedited review and approval of tests/drugs for treatment

0.961

  5

Check for training opportunities

0.926

  6

Partner with local authorities

0.905

  7

Check for volunteering opportunities

0.875

 6.2. Operation management

  1

Secure PPEs or other needed materials

0.982

0.988

  2

Participate in interdisciplinary training to EPR teams

0.976

  3

Procure essential medications and supplies

0.972

  4

Develop workplace training and safety protocols (e.g., social distancing)

0.968

  5

Monitor workers/assistants for symptoms

0.968

  6

Secure sanitizers and other medications when needed

0.967

  7

Ensure medication delivery/safe storage

0.936

  8

Adapt working hours to meet essential services during crises

0.919

 6.3. Patient care and population health interventions

  1

Manage panic buying

0.968

0.877

  2

Answer EPR-related calls

0.966

  3

Identify at-risk populations

0.965

  4

Educate patient about the ongoing crisis using evidence-based information and communications

0.952

  5

Continue medication reviews, screening and/or testing/vaccination services safely

0.146

  6

Maintain patient confidentiality

0.114

 6.4. Evaluation, research, and dissemination for impact and outcomes

  1

Participate in research and studies on EPR

0.940

0.879

  2

Publish and/or disseminate findings

0.940

  3

Combat misinformation by disseminating evidence-based information to patients and sharing it on social media

0.934

  4

Develop training programs to peers and other healthcare workers

0.711