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

Domain 0: Fundamental Skills

0.1 Legal Considerations

0.1.2 Identify issues, pending legislation, and regulations across all levels of government

0.1.1 Apply laws and regulations that impact pharmacy practice

Kaiser–Meyer–Olkin (KMO) = 0.500; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 84.08%

0.2 Product Procurement & Management

0.2.2 Anticipate, identify and troubleshoot problems with the supply chain

0.2.3 Manage inventory

0.2.1 Select and acquire products through the appropriate supply chain

0.2.4 Handle drug waste

Kaiser–Meyer–Olkin (KMO) = 0.784; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 70.85%

0.3 Compounding

0.3.2 Perform elementary, non-sterile compounding: to be removed?

0.3.1 Compound extemporaneous preparations

Kaiser–Meyer–Olkin (KMO) = 0.500; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 84.50%

0.4 Pharmacy Operation

0.4.3 Comprehend and adopt a given set of pharmacy operating procedures

0.4.2 Apply typical pharmacy dispensing workflow

0.4.12 Work on the skill attitude and value that is essential to the practice and profession

0.4.9 Balance concrete specific motivation with constructive and professional criticism

0.4.8 Describe the roles and responsibilities of each pharmacy staff member

0.4.5 Evaluate prescription for legitimate medical use

0.4.4 Comprehend and adopt an existing collaborative drug therapy management system

0.4.10 Set and work towards meaningful goals with your staff

0.4.6 Prioritize and thoroughly complete tasks even with multiple interruptions occurring concurrently

0.4.13 Monitor the progress of the staff

0.4.7 Implement dispensing processes when pharmacy automation is utilized

0.4.11 Allow training development by staff and supervisors

0.4.1 Managing pharmacy operations efficiently

Kaiser–Meyer–Olkin (KMO) = 0.956; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 64.30%

0.5 Quality Improvement

0.5.3 Develop a plan for quality/performance improvement

0.5.1 Optimize the concepts of quality measurement and improvement

0.5.2 Apply national/international standards/guidelines/best practices related to your community pharmacy practice

Kaiser–Meyer–Olkin (KMO) = 0.726; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 77.19%

0.6 Pharmacy Automation

0.6.1 Own a computerized system for dispensing medications

0.6.2 Understand the role of computerized pharmacy management systems in dispensing

0.6.3 Dispense prescriptions utilizing technology-assisted workflow when applicable

Kaiser–Meyer–Olkin (KMO) = 0.727; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 77.46%

Domain 1: Safe and Rational Use of Medicines

Clinical Skills

1.1.5 Demonstrate knowledge of appropriate administration techniques for dosage forms commonly dispensed in community pharmacies

1.1.7 Proactively perform counseling and education which comply with current guidelines

1.1.6 Describe common doses of drugs requiring monitoring and collaborative drug therapy management

1.1.4 Describe and apply clinical practice guidelines to patient care

1.1.3 Individualize therapy through the implementation of a patient’s profile to the selection and modification of a medication regimen in collaboration with the prescriber

1.1.9 Commonly monitor for medication errors, drug interactions, and lab tests

1.1.2 Ensure the optimal use of medicines

1.1.8 Assist patients with chronic diseases regarding the appropriate use of chronic medications

1.1.1 Demonstrate and routinely apply clinical skills and provide patient care services

Kaiser–Meyer–Olkin (KMO) = 0.949; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 70.98%

1.2 Medication Therapy Management

1.2.5 Identify and resolve medication therapy problems, manage drug interactions, and resolve gaps in care

1.2.4 Conduct a comprehensive medication review

1.2.3 Conduct a patient interview and provide education

1.2.7 Document services and follow-up with other health professionals

1.2.6 Recommend therapeutic alternatives and generic substitutions in collaboration with the prescriber

1.2.2 Define and appropriately document comprehensive MTM services

1.2.1 Develop a patient-centered, culturally responsive approach to medication management

1.2.8 Use multiple MTM platforms as required by third-party payers and OPL

Kaiser–Meyer–Olkin (KMO) = 0.921; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 64.32%

1.3 Compliance and Adherence

1.3.2 Identify and resolve patient-specific barriers to medication adherence

1.3.1 Support and assist patient behavior change

1.3.3 Facilitate patient self-administration of medications and disease monitoring for minor diseases

Kaiser–Meyer–Olkin (KMO) = 0.728; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 76.83%

1.4 Problem-Solving/ Referrals

1.4.1 Make appropriate recommendations or referrals

1.4.2 Assess and resolve issues related to medication safety

Kaiser–Meyer–Olkin (KMO) = 0.500; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 87.70%

1.5 Over-the-Counter Medicine

1.5.3 Assist with patient self-care, including helping patients make appropriate selections of herbal supplements

1.5.2 Assist with patient self-care, including helping patients make appropriate selections of dietary supplements

1.5.1 Assist with patient self-care, including helping patients make appropriate selections of OTC medications

Kaiser–Meyer–Olkin (KMO) = 0.736; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 79.80%

1.6 Pharmacovigilance

1.6.3 Demonstrate knowledge of reporting an adverse drug reaction to relevant authorities

1.6.2 Consider that reporting an ADR is part of pharmacist duties

1.6.1 Identify a potential adverse drug reaction

Kaiser–Meyer–Olkin (KMO) = 0.733; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 78.06%

Domain 2: Pharmacy Management

2.1 Functions

2.1.4 Describe basic finance terms and analyze a financial statement

2.1.3 Develop a business plan for clinical service programs

2.1.2 Identify cash flow problems and apply solutions to address them

2.1.6 Describe strategies for asset protection and safety

2.1.5 Apply healthcare economics and pharmacoeconomics

2.1.7 Use pharmacy technology effectively

2.1.1 Manage inventory costs and inventory levels or order points

Kaiser–Meyer–Olkin (KMO) = 0.589; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 70.51%

2.2 Managed Care/Drug Coverage Policies

2.2.7 Identify major factors influencing drug costs for a managed care organization (e.g., pharmacy costs, drug pricing methodologies, contracts/rebates, discounts)

2.2.6 Identify major factors that contribute to prescription drug-related fraud and abuse

2.2.5 Discuss the concept of drug utilization review, and formulary management and provide functional definitions of key managed care strategies (e.g., prior authorizations, step therapy, quantity limits)

2.2.3 Provide guidance to patients seeking assistance to apply for drug payment programs

2.2.1 Explain the general concept of managed care, associated with the benefit structure of a health plan

2.2.8 Meet payer requirements for reimbursement

2.2.4 Troubleshoot denied claims

2.2.2 Adapt best treatment strategies to patient socioeconomic status

2.2.9 Reducing drug costs for the NSSF by providing less expensive drugs when applicable

Kaiser–Meyer–Olkin (KMO) = 0.940; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 66.53%

Domain 3: Professional Skills

3.1 Health Literacy

3.1.2 Adjust counseling delivery and communicate at all levels of health literacy

3.1.3 Solve adherence challenges created by low health literacy

3.1.1 Determine the patient's level of health literacy by observation or interview

Kaiser–Meyer–Olkin (KMO) = 0.728; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 77.25%

3.2 Patient Communication

3.2.4 Demonstrate respect for patient confidentiality and privacy rights

3.2.3 Support patient behavior change through skills such as motivational interviewing

3.2.5 Demonstrate patient compassion and empathy

3.2.1 Listen closely and attentively to patients

3.2.2 Discuss pharmaceutical and other medical information thoroughly with patients and any family members

Kaiser–Meyer–Olkin (KMO) = 0.876; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 76.06%

3.3 Health Professional Communication

3.3.2 Contribute to effective interdisciplinary collaboration and integrated care

3.3.1 Communicate effectively with colleagues, prescribers, and other health care providers

3.3.3 Document appropriate therapeutic recommendations related to medication therapy

Kaiser–Meyer–Olkin (KMO) = 0.743; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 80.28%

3.4 Team Communication

3.4.3 Supervise and motivate employees, staff, students, interns, and residents

3.4.4 Delegate tasks appropriately

3.4.2 Identify and manage conflict at all levels

3.4.5 Articulate team objectives and measure and report team performance

3.4.1 Communicate with the pharmacy team, colleagues, prescribers, and other care providers in an efficient manner

Kaiser–Meyer–Olkin (KMO) = 0.872; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 73.33%

3.5 Leadership Abilities & Personal Skills

3.5.4 Be a gatekeeper to patient health

3.5.5 Organize work and balance patient care and personal development

3.5.3 Embrace and advocate changes that improve patient care

3.5.6 Engage in regular professional development activities

3.5.7 Be active in professional organizations

3.5.2 Demonstrate professional behavior (attitude, dress, appearance, etc.) in practice settings

3.5.1 Display confidence in patient care skills

Kaiser–Meyer–Olkin (KMO) = 0.916; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 69.76%

3.6 Drug Information Skills

3.6.5 Deliver timely drug information to the general public and other health professionals

3.6.2 Utilize a variety of drug-related reports, monographs, reviews, and policies using drug literature evaluation skills

3.6.3 Evaluate the appropriateness of clinical trials and other study designs, including validation of methodology and assessment of data credibility

3.6.6 Implement career advancement through continuous professional development

3.6.1 Access and utilize appropriate drug information resources and provide an accurate and credible solution in both written and oral forms

Kaiser–Meyer–Olkin (KMO) = 0.847; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 69.68%

3.7 Ethical Considerations

3.7.1 Understand professional ethics as they apply to the practice of pharmacy

3.7.2 Apply knowledge and understanding of ethical aspects of pharmacy practice required to evaluate a patient care decision

Kaiser–Meyer–Olkin (KMO) = 0.500; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 87.04%

Domain 4: Public health Fundamentals

4.1 Clinical Applications of Public Health

4.1.5 Collect, assess, and make recommendations based on the results of health and wellness screenings and diagnostic tests

4.1.6 Promote healthy lifestyle and nutrition and describe how it impacts drug therapy and overall health/well-being

4.1.4 Be knowledgeable about immunization schedules and requirements and actively involved in vaccination campaigns

4.1.7 Describe the role of a pharmacist in emergency situations

4.1.8 Participate in the population-based provision of care (as distinguished from direct patient care)

4.1.3 Participate in education and intervention in public health initiatives applicable to pharmacy practice

4.1.2 Educate population to access and understand health information on the selection and rational use of medicines and other health products

4.1.1 Assess and support local and national health priorities and initiatives

Kaiser–Meyer–Olkin (KMO) = 0.934; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 70.34%

Domain 5: Emergency Preparedness and Response (EPR)

5.1 Emergency Preparedness and Response

5.1.5 Partner with local authorities

5.1.3 Address medication shortage and mitigation plan

5.1.4 Balance stockpile and availability of drugs for existing/chronic conditions

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

5.1.2 Check for training opportunities

5.1.1 Check for volunteering opportunities

5.1.8 Involve trainees and staff in emergency response

5.1.7 Follow actions and recommendations of local authorities

Kaiser–Meyer–Olkin (KMO) = 0.902; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 68.21%

5.2 Operations Management

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

5.2.6 Adapt working hours to meet essential services during crises

5.2.5 Monitor workers/assistants for symptoms

5.2.7 Secure sanitizers and other medications when needed

5.2.4 Secure PPEs or other needed materials

5.2.2 Ensure medication delivery/safe storage

5.2.1 Procure essential medications and supplies

5.2.8 Participate in interdisciplinary training for EPR teams

Kaiser–Meyer–Olkin (KMO) = 0.935; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 69.62%

5.3 Patient Care and Population Health Interventions

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

5.3.3 Identify at-risk populations

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

5.3.5 Manage panic buying

5.3.1 Maintain patient confidentiality

5.3.6 Answer EPR-related calls

Kaiser–Meyer–Olkin (KMO) = 0.886; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 65.51%

5.4 Evaluation, Research, and Dissemination for Impact and Outcomes

5.4.2 Publish and/or disseminate findings

5.4.1 Participate in research and studies on EPR

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

5.4.4 Develop training programs for peers and other healthcare workers

Kaiser–Meyer–Olkin (KMO) = 0.839; Bartlett’s test of sphericity P < 0.001; Percentage of variance explained 81.95%