Key-words:
Competency - framework - Libya - pharmacists - pharmacy practice
Introduction
The increase in health demands resulted from an endless and complex range of medicines,
and poor adherence to these medicines has shifted the pharmacists' role toward a patient-centered
approach.[[1]],[[2]] Pharmaceutical care currently emphasizes that the pharmacist's role to involve
”a practice in which the practitioner takes responsibility for a patient's drug-related
needs and is held accountable for this commitment.”[[2]] Over the past three decades, pharmaceutical care transformed pharmacy into more
accountable patient care, primarily to ensure that a patient achieves positive outcomes
from drug therapy promoting the pharmacist as a vital member of the health-care team
who is accountable for and committed to the outcome of medication therapy. Furthermore,
the World Health Organization (WHO) has expanded the professional roles of pharmacists.
The WHO stressed that future pharmacists must be equipped with fundamental knowledge
concerning supply chain management, rational use of medicines, pharmaceutical care
provision, pharmacovigilance, drug information service, pharmacoeconomics, antimicrobial
stewardship, and other clinical and administrative sciences, in addition to attitudes,
skills, and behaviors to practice effectively in the society.[[3]] Pharmacists, therefore, should be held accountable for the cost, quality, and results
of services provided to patients. They should also act as advisors to physicians and
nurses and contribute to medicine policy decisions.
While the level of pharmacists' involvement in health-care provision varies across
different parts of the world, the scope of pharmacy practice still encompasses a great
number of services.[[4]] A competent and capable workforce is a prerequisite for all health-care professions.
Improving therapeutic outcomes, quality of patients' lives, scientific progress, and
promotion are everyday health necessities based on competency.[[5]] The International Pharmaceutical Federation (FIP) has developed a global and competency
framework for pharmacists.[[6]] This framework was formed after grouping several documents into categories.[[7]],[[8]],[[9]],[[11]] A comparative study identified common behaviors within the different frameworks
resulting in a comprehensive table of elements which were further categorized into
several domains.[[12]]
In 2011, FIP and WHO adopted an updated version of good pharmacy practice (GPP).[[13]] The joint FIP/WHO guidelines on GPP defined the aim of pharmacy practice to “contribute
to health improvement and help patients with health problems make the best use of
their medicines.” To support this practice, there must be an established national
framework of quality standards and guidelines. This document has underlined the requirements
of GPP and how to set standards required for GPP, which are organized around four
major roles for pharmacists. Each function is structured in several roles, and for
each role, a list of minimum national standards to be established.[[13]] In the 2012 FIP Centennial Declaration, pharmacists and pharmaceutical scientists
accepted responsibility and accountability for improving global health and patient
outcomes by improving the development, distribution, and responsible use of medicines.[[14]]
The practice of the pharmacy profession in Libya is still limited to primary dispensing
roles. However, through personal efforts, Libyan pharmacists started to work to advance
modern practices by expanding their roles in different practice settings, reflecting
positively on the country's health-care system. The Libyan Pharmacists Syndicate records
in 2019 showed just above 2000 pharmacists renewed their license to practice in the
community and hospital pharmacies.[[15]] Therefore, it is vital to create and adopt the globally shared vision to guide
the country-level initiatives to develop an operative pharmaceutical workforce. This
study aims to assess the status of pharmacy practice in Libya through self-assessing
competencies of hospital and community pharmacists, using the Global Competency Framework
for Pharmacists and the Joint FIP/WHO guidelines on GPP.
Materials and Methods
This is a cross-sectional online survey questionnaire study. The questionnaire was
based on the Global Competency Framework for Pharmacists and the Joint FIP/WHO guidelines
on GPP. The finalized questionnaire was emailed to 205 hospital/community pharmacists
all over Libya. The questionnaire comprised four domains: (a) Pharmaceutical Public
Health, (b) Pharmaceutical Care, (c) Organization and Management, and (d) Professional/Personal
profiles. Each domain comprises several indicators, which were transformed into questions
(Qs) with four options to choose from, with their times' frequency interpretation.
These options are (1) consistently (85 to100% of the time), (2) usually (51 to 84%
of the time), (3) sometimes (25 to 50% of the time), and (4) rarely (0 to 24%) of
the time. Thirty-three indicator questions were arranged according to the above four
domains of pharmacy practice. The answers were assigned numbers from 1 to 4 on a Likert
scale, in the same order of the above options for statistical analysis purposes. The
questions were translated to the Arabic language to facilitate complete comprehension,
and the questionnaire was further tested for reliability and validity by applying
Cronbach's alpha test using SPSS software version 22 Statistical Software SPSS (IBM
Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM
Corp.). Data were collected over 4 months in 2018, and statistical analysis techniques
were employed.
Results
Profiles of the participating pharmacists
A total of 199 responders (68% female and 32% male) were included with 93% response
rate. 47.0% were community pharmacists, 39.4% worked both in hospital and community,
and 13.6% practiced exclusively in hospitals. 10% of respondents graduated in 1980–989;
15% graduated in 1990–1999. Thirty percent graduated in 2000–2009 and 45% graduated
in the past 8 years before the study (2010–2017).
The overall pharmacy competencies
The overall pharmacy competency indicators were reportedly met consistently by 45.3%
of respondents, usually by 25% of responders and only sometimes or rarely by 15.9%
or 13.8% of respondents, respectively [[Table 1]] and [[Figure 1]].
Figure 1: Overall responses to pharmacy competency indicators
Table 1: Statistical analysis representing the Likert scale mean for the answers to indicators
of pharmacy practice domains questions
Pharmaceutical public health competencies
Responses to the 3 questions on pharmaceutical public health indicators are presented
in [[Table 2]]. The majority (>85%) of pharmacists either consistently or usually participate
in health promotion by assessing the primary health-related needs, taking into account
the cultural and social background of the patient. Likewise, about 85% of pharmacists
consistently or usually play a role in advising the community regarding disease prevention
and healthy lifestyle. Concerning medicines information and advice, 88% of pharmacists
are either consistently or usually provide the population in general with the appropriate
information related to the safe and rational use of medicines and devices (including
the selection, use, contraindication, storage, and medicines' side effects).
Table 2: Responses to pharmaceutical public health domain indicators
Pharmaceutical care competencies
The responses to the 14 questions in the pharmaceutical care indicators domain are
presented in [[Table 3]]. Majority of pharmacists indicated that they either rarely or sometimes try to
identify and prioritize all medicines-related problems. About 81% of respondents affirmed
dispensing medicines accurately and checking whether these medicines are for minor
or major ailments. On the contrary, two-thirds of the pharmacists seldom or only sometimes
report any defective or substandard medicines to the appropriate authorities [[Table 3]]. More than 90% of respondents reported that they consistently validate prescriptions
to ensure that they are legal and correctly interpreted. Besides, approximately 80%
of responders reported that they consistently dispense devices such as inhalers and
glucose meters properly. Concerning documenting medications and dispensing errors,
pharmacists' answers indicated that these errors are rarely documented [[Table 3]]. Regarding medicines' information and checking, the results showed that 80% of
respondents' pharmacists do consistently or usually ensure that medicines-related
information such as route of administration, dose, form, time, frequency, and packaging
is correct. The answers also indicated that pharmacists advise patients on the proper
storage conditions of the medicines [[Table 3]]. Furthermore, 60% of participating pharmacists consistently perform initial assistance
to patients when needed and appropriately refer them to a physician or a specialist.
Nearly 80% of participants in the survey indicated that they are consistently discussing
the appropriate use of the drug with their patients, taking into account patients'
preferences. Three quarters of participants suggested that they do not document any
intervention or change in the patient's medical records. Finally, only half of surveyed
pharmacists consistently review the patient's medical history [[Table 3]].
Table 3: Responses to pharmaceutical care domain indicators
Organization and management competencies
The responses to the 5 questions in the organization and management indicators are
presented in [[Table 4]]. The responses suggest that 65% of participants consistently contribute to and
participate in the medicines supply chain of hospitals and community pharmacies. Furthermore,
68% of the participants ascertained that they consistently keep track of the medicines
stocks, check the stores, and forecast future shortages. Besides, 60% of them stated
that they consistently consider the cost of medicines in relation to their effect
when procuring medicines for their institutions or pharmacies. Over half (57%) of
participants consistently ensure that the pharmacies, stores, and facilities comply
with the legal specifications and conditions to ensure that pharmaceutical services
are appropriately provided. Furthermore, 72% of the respondents suggested that they
favor team-based work to working alone.
Table 4: Responses to organization and management indicators
Professional and personal competencies
The responses to the 11 questions in the domain of professional skills indicator are
presented in [[Table 5]]. Majority (90%) of respondents are either consistently or usually showing the ability
to establish effective communication with others [[Table 5]]. This indicates that Libyan pharmacists have positive and active relationships
with others and can adapt this skill to serve their work. Moreover, 80% of those pharmacists
suggested that they usually direct communication with their patients to meet patients'
needs without going into irrelevant topics. In addition, 54% of participants alleged
that they keep updated with what is new in pharmacy education and practice and try
to learn and adapt what is new and develop it to benefit the practice. However, only
6% of the participants consistently document their achievements concerning continuous
professional development (CPD). Yet, 76% document such as activity sometimes or seldom.
Three quarters of the participants consistently interact with pharmacy students and
graduates. Only 26% of respondents could usually find their limitations and shortcomings
in experience and knowledge. However, when participants were questioned about their
knowledge concerning the national health laws and legislation, only 49% appeared to
have excellent knowledge of the laws and regulations governing the pharmacy profession
in the country. Furthermore, the responses to the questions dealing with the participation
of pharmacists in research, publications, and pharmacovigilance revealed that this
matter is rarely considered important. However, 67% indicated that their interventions
are consistently based on scientific evidence.
Table 5: Assessment of professional skills
Discussion
The evaluation of the pharmaceutical public health competencies domain suggested that
most Libyan pharmacists are participating in the health promotion of the society by
assessing the primary health-related needs, taking into account the cultural and social
background of patients. Results also suggested that Libyan pharmacists play a role
in advising the community about disease prevention and a healthy lifestyle. Pharmacists
appeared to contribute effectively to providing the population with appropriate information
about the safe and rational use of medicines and devices. It is, however, worth mentioning
that pharmacy education in Libya does not emphasize public health education. Therefore,
it is important to consider including it within pharmacy curricula, as did many Arab
and international pharmacy schools.[[16]]
When evaluating pharmaceutical care competencies, the study concluded that surveyed
pharmacists are competent when it comes to medicines dispensing through accurately
checking and validating the prescription and the dispensed medication(s). Nevertheless,
they seldom report any problems or defects related to medicinal products they dispense
to the authority. This is because of the deficiency in knowledge, competence, and
training in specific fields of education and practice such as pharmacovigilance, identifying
and documenting medication errors, counterfeit medicines identification.[[17]] Although the pharmaceutical care concept is well known to many, its systematic
and comprehensive application; through the assessment and detection of medicines-related
problems, constructing a pharmaceutical care plan, and follow-up evaluation are not
practiced due to numerous barriers.[[18]],[[19]] On the other hand, pharmacists counsel patients on the proper use of medicines,
perform initial assistance to patients when needed, and discuss with patients the
appropriate use of medicines considering patients' preferences and appropriately referring
them to a physician when necessary.
The evaluation of managerial and organizational competencies indicated that the questioned
pharmacists are aware of their duty as managers and participants in the medicines
supply chain.[[20]] Most participated pharmacists elaborated on their ability to consider costs versus
medicines effect when procuring medicines for their institutions or pharmacies. However,
it is essential to point out that the assessment of cost and effect will not be valid
unless pharmacoeconomic methods of evaluation are used to obtain accurate inference
of results that may be considered when selecting certain medicines and therapeutic
alternatives.
When evaluating personal competence, pharmacists appeared to show the ability to establish
effective communication with others.[[21]] Most participated pharmacists in our survey claimed that they update their knowledge
and adopt new ways to benefit the practice. Some appeared to have excellent knowledge
of the laws and regulations governing the profession of pharmacy in the country, even
though these laws and legislations need amendments to support the modern practice
of the profession. The study participants are considered an authentic slice of the
pharmacists' community, reflect professional practices in general, and suggest that
Libyan pharmacists are proactive in building personal and professional competencies.
Global engagement between schools and colleges of pharmacy in the west and those in
the Arab world has increased, and it has been suggested to enriching and fruitful
engagement, sensitivity toward the cultural and clinical needs of the people, and
in particular, the professionals of that region are critical.[[22]] This is very limited under the circumstances in Libya at the time of this study.
Conclusions
This study revealed that pharmacy practice in Libya tends to be more population- and
system-focused rather than professional- and patient-focused. The assessment of Libyan
pharmacists' competencies, using the “Global Competency Framework for Pharmacists,”
indicated that significant adjustments in pharmacy education curricula must include
new teaching methodologies, knowledge, skills, competencies, and CPD certifications
for pharmacists to modernize pharmacy practice in the country. It is vital to emphasize
the importance of practicing patient-centered pharmaceutical care. In addition, pharmacists'
specializations must be clearly defined in Libyan health laws and legislations. Financial
incentives and reimbursements must also be established for the various pharmacy specialties
and services to provide high-quality pharmaceutical services.
Authors' contribution
Both authors contributed to the conception, drafting, revision, and finalization of
this manuscript. The work was conducted in partial fulfillment for the degree Master
of Pharmaceutical Sciences, Faculty Pharmacy, University of Tripoli, Tripoli, Libya.
Compliance with ethical principles
The exercise was undertaken as a quality improvement exercise. All data were collected
anonymously.
Reviewers:
Salahuddin Mohammed (Oxford, UK)
Abdulahad Dogan (Van, Turkey)
Editors:
Salem A Beshyah (Abu Dhabi, UAE)
Elmahdi A Elkhammas (Columbus, OH, USA)
