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Assessment and self-assessment of the pharmacists' competencies using the Global Competency Framework (GbCF) in Serbia Ocena i samoocena kompetencija farmaceuta u Srbiji korišćenjem Globalnog okvira kompetencija

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Background/Aim. Pharmacists' competence represents a dynamic framework of knowledge, skills and abilities to carry out tasks, and it reflects on improving the quality of life and on pa-tients' health. One of the documents for the Evaluation
  Vojnosanit Pregl 2016; 73(9): 803–810. VOJNOSANITETSKI PREGLED Page 803 ORIGINAL ARTICLESUDC: 615.15 DOI: 10.2298/VSP140728040S Assessment and self-assessment of the pharmacists' competencies using the Global Competency Framework (GbCF) in Serbia Ocena i samoocena kompetencija farmaceuta u Srbiji koriš ć enjem Globalnog okvira kompetencija Svetlana Stojkov*, Ivana Tadi ć † , Tatjana Crnjanski*, Dušanka Krajnovi ć †   *Pharmacy “Subotica”, Subotica, Serbia; † Department of Social Pharmacy andPharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia  Abstract Background/Aim.  Pharmacists' competence represents a dy-namic framework of knowledge, skills and abilities to carry out tasks, and it reflects on improving the quality of life and on pa-tients’ health. One of the documents for the Evaluation and Competency Development of Pharmacists is the Global Com-petency Framework (GbCF). The aim of this study was to im-plement the GBCF document into Serbian pharmacies, to per-form assessment and self assessment of the competencies. Me-thods.  The assessment and self-assessment of pharmacists’ competencies were performed during the period 2012 − 13 year in eight community pharmacy chains, in seven cities in Serbia. For assessment and self-assessment of pharmacists competen-cies the GbCF model was applied, which was adjusted to phar-maceutical practice and legislation in Serbia. External assessment  was conducted by teams of pharmacists using the structured ob-servation of the work of pharmacists during regular working hours. Evaluated pharmacists filled out the questionnaire about demographic indicators about the pharmacist and the pharmacy  where they work. Results.  A total of 123 pharmacists were eva-luated. Pharmacists’ Professional Competency Cluster (KK1) had the lowest score (average value 2.98), while the cluster Man-agement and Organizational Competency (KK2) had the highest score (average value 3.15). The competence Recognition of the Diagnosis and Patient Counseling (K8), which belonged to the cluster KK1, had the lowest score (average value for assessment and self-assessment were 2.09, and 2.34, respectively) among the all evaluated competencies. Conclusion.  GbCF might be con-sidered as an instrument for the competencies' evaluation/self-evaluation and their improvement, accordingly. Key words:  pharmaceutics; pharmacies; community pharmacy services; serbia; professional role; questionnaires;  patient satisfaction; quality of life.  Apstrakt Uvod/Cilj.  Kompetencije farmaceuta predstavljaju dinami č ni okvir i obuhvataju znanja, veštine i sposobnosti da se izvrše zadaci sa ciljem unapre đ  enja kvaliteta života i zdravlja boles-nika. Jedan od dokumenata za ocenu i razvoj kompetencija farmaceuta je globalni okvir stru č nosti −   Global Competence Framework  (GbCF). Cilj ovog rada bio je primena GbCF u apotekama u Srbiji i ocena i samoocena kompetencije farma-ceuta. Metode.  U periodu 2012 − 2013. godine izvršena je ocena i samoocena kompetencije farmaceuta u osam apote-karskih lanaca iz sedam gradova u Srbiji. Za ocenu i samoo-cenu stru č nosti farmaceuta primenjen je model GbCF, prila-go đ  en praksi i zakonodavstvu u Srbiji. Eksternu ocenu izvršili su timovi farmaceuta kroz strukturiranu opservaciju (upotre-bom GbCF dokumenta) kompetencija farmaceuta tokom ra-dnog vremena. Ocenjivani farmaceuti su popunili i upitnik o demografskim pokazateljima koji su se odnosili na podatke o samom farmaceutu i apoteci u kojoj radi. Rezultati.  Ocenje-na su ukupno 123 farmaceuta. Najviša ocena kompetencija farmaceuta zabeležena je za skup „Upravljanje i organizacija“ (KK2) (srednja vrednost 3,15), dok je skup „Stru č no znanje“ (KK1) (srednja vrednost 2,98) ocenjen najnižom ocenom. Kompetencija K8 – „Prepoznavanje dijagnoze i savetovanje bolesnika“, koje pripadaju skupu KK1, imale su najniži skor (srednja vrednost u proceni i samoproceni iznosila je 2,09 i 2,34, respektivno) posmatraju ć i sve, kompetencije. Zaklju- č ak.  Dokument za ocenu i razvoj kompetencija farmaceuta GbCF može služiti kao instrument za ocenu/samoocenu kompetencije, a samim tim i za njihovo poboljšanje. Klju č ne re č i: farmaceuti; apoteke; farmaceutske službe, javne; srbija;  profesionalna uloga; upitnici; bolesnik, zadovoljstvo; kvalitet života. Correspondence to: Ivana Tadi ć , Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11 000 Belgrade, Serbia. E-mail:  Page 804 VOJNOSANITETSKI PREGLED Vol. 73, No. 9 Introduction The imperative facing health workers of today is compe-tence. Competence represents a dynamic framework of knowledge, skills and abilities to carry out tasks, and it reflects on improving the quality of life and on patients’ health 1, 2 . Pharmacists’ competencies have been a lasting subject of consideration and research of the professionals as well as the professional bodies 3 − 8 who strive for working out adequate tools for assessing and developing the competenci-es of pharmacists 9 − 12 . One of the most popular benchmarks, the General Level Framework (GLF) 12 , developed by the Competency Develop-ment and Evaluation Group (CoDEG), has found its application in the assessment, and self-assessment of pharmacists, hospitals and public pharmacists across several continents 13-18 , thereby showing a significant progress in the development of competen-cies. The development of the global policy framework (GbCF) might lead to a harmonization of the pharmaceutical profession globally. Although the differences between various education systems and teaching techniques often exist, pharmacists do sha-re a common goal in professional  practice – that is improving  patients’ health. In order to reach this goal, one must strive for achieving competence in his/her work, regardless work conditi-ons, country or culture 7 . Striving for the formulation of the global level competency framework (by expert health authorities and asso-ciations) has resulted in the creation of the Action Plan for the Period 2006 − 2010, following many years of work 3, 4, 7 . In ad-dition, it has resulted in the Draft Document for the Evaluation and Competency Development in Pharmacists 19 , which has  been tested in dozens of countries,   under the title of the GbCF. The document was created by testing it in practice and by de-veloping of the existing forms, primarily the GLF document. The GbCF document and the competency evaluation methodology allow for the option of external assessment and self-assessment of competencies, as well as for setting forth of the individual and systemic objectives towards pharma-cists’ performance improvement. However dominant the external assessment as a way of evaluating the knowledge and work performance is, one may not rule out the value of the self-assessment. It has been proven that the self-assessment is an important skill necessary for the on-going development of health workers 13 − 15, 17 . Self-assessments complement other types of teaching in order to enhance the knowledge, skills, and other professional qualities; they actually develop the ability to manage one’s self-improvement 19 . Even though some legitimate reservations about the objectivity of the self-assessments do exist 20 , they  provide a good basis for altering the everyday practice and for setting of the personal goals related to professional deve-lopment, and they may also help boost self-confidence about one’s own professional values 21 . Unlike the GLF, the GbCF document recognizes the need for the harmonization of pharmaceutical care, and so one of its aims is therefore establishing equal access to the  pharmaceutical care, as well as the equal quality of it on a global level. Application of GbCF contributes to competence development and application the framework of competencies on global level would enable harmonization of competencies and their standardized development and improvement the work of pharmacists 22 . The implementation of the framework in Serbia According to the Health Care Law of the Republic of Ser- bia 23 , every health professional, who provides health care to ci-tizens, is required to have a work license. The Pharmaceutical Chamber of Serbia 24 , as the licensing authority, in issuing He-alth Care Work Licenses to pharmacists in Serbia has not dealt with the evaluation of the pharmacists’ competencies so far. The first evaluation of pharmacists’ competencies in Serbia was carried out at the pharmacy Subotica, using the GLF document (2011 − 12) 25 . At that time, professional com- petencies of pharmacists were assessed, following the exam- ple of neighboring Croatia 16, 18 . An intervention for improv-ing some less developed skills was performed (based on the evaluation results). The GLF was assessed as an effective tool for evaluating and developing competencies, and so a  broader scientific community became intrigued by the pro- ject. In 2012, a Development of Pharmacists' Competencies Convention brought interested pharmacists and representa-tives of the professional bodies together in Subotica, and fa-cilitated work of an Expert Panel regarding validation of the GbCF document. The validation of the document was then  performed. The document was implemented previously in Croatia, and later in Macedonia (both neighboring countries to Serbia, with similar pharmacy practices, legislature and education, and with common cultural, linguistic and tradi-tional backgrounds). After the validation, the document was implemented in several pharmacy chains in Vojvodina. The aim of this study was to implement the GbCF do-cument into Serbian pharmacies as well as to perform asses-sment and self assessment of the pharmacists' competencies. Methods Before the implementation (from July to September of 2012), participation in the research with GbCF document was offered to all 43 pharmacy chains in the region of Voj-vodina. All the pharmacists from pharmacy chains interested to participate in this research gave their written consents for  participation in the project. Prior to the implementation of the assessment, all pharmacists were informed about the do-cument, its contents, objectives and methodology. No one of the surveyed pharmacists declined to participate in the pro- ject. Each of the pharmacists performed self-assessment of the competencies and than their competencies were assessed  by external assessors. External assessments of pharmacists were performed by 8 teams of pharmacists (each consisting of three pharmacists from each pharmacy chain). The external assessors were se-lected by convenient sampling from the pharmacists working in the chains where evaluation was performed, and they as-sessed their peers individually reaching the final decision by consensus of three. Each team member had pharmacy work Stojkov S, et al. Vojnosanit Pregl 2016; 73(9): 803–810.  Vol. 73, No. 9 VOJNOSANITETSKI PREGLED Page 805 Table 1 Demographic characteristics of pharmacists (n = 123) Characteristics Participants, n (%) Gender, n (%) female 119 (96.75) 4 (3.25) male Age (years), ґ  ± SD 42.07 ± 10.48 Work experience (years), ґ  ± SD 15.88 ± 10.93 Education, n (%) master degree-level pharmacists 107 (86.99) master degree-level pharmacists with the additional one postgraduate year 16 (13.01) Position, n (%)  pharmacy manager (units) 59 (47.97)  pharmacist 64 (52.03) Location of relevant pharmacies, n (%) city centre 98 (79.67)  periphery, suburban / rural area 25 (20.33) experience of more than five years and completed an approp-riate training to ensure the consistency and uniform criteria of the assessments. The training covered an introduction to the document and experiences from the practice, as well as a hands-on part: joined assessments together with experienced evaluators of the pharmacists’ competencies. Assessing teams conducted structured observations of the pharmacists’ work in pharmacies for several hours during the course of regular business hours. Several hours of obser-vation (3 − 5 h) were dedicated to evaluating of each pharma-cist, pending the number of patients, the events during prac-tice, and other circumstances. GbCF comprises the areas of pharmacists’ work per-formed in pharmacies. Areas were divided into four clusters:  pharmaceutical public health competencies, pharmaceutical care competencies, organization and management competen-cies and professional / personal competencies. These clusters include twenty competencies (K1-K20). Each competency was measured by specific indicators (SP) −  behavioral state-ments (SP1-SP100) and was related to the professional per-formance of pharmacists. A 2010 version of the partially modified and validated GbCF was used for the assessment and self-assessment of  pharmacists’ competencies; the version had been adjusted to the common practices and the legislation in Serbia. The do-cument consists of several clusters of several individual competencies described by few specific indicators. The Ser- bian version of the GbCF contains three clusters (competency groups): pharmacists’ professional competenci-es (KK1: K1-K8 Competencies), management and organiza-tional competencies (KK2: K9-K14 Competencies) and Per-sonal and Professional Competencies (KK3: K15-K20 Com- petencies). The number of clusters has undergone changes since the srcinal version of the GbCF document, which con-tained four clusters, following the cultural adaptation of this document geared for the wider region of The Balkans (inclu-ding the Republic of Croatia and the Republic of Macedo-nia). However this influenced only reorganization of the number and the kind of competencies without omitting any. This allows a simpler and more efficient use of the document which is more suitable for the Serbian population of the  pharmacists. All work activities of pharmacists were inclu-ded in the measurement. Therefore, the total number of competencies has remained the same (20 in total), while the number of specific indicators has been 101. Specific indica-tors (SP 1-101) provide a detailed description of the behavior features of a competent pharmacist. In assessing the level of the individual pharmacist competency in the particular field, and in assessing how well pharmacist’s knowledge, skills and attitudes reflected the requirements of the document, the assessors applied a structured competency assessment docu-ment, based on the GbCF document, and used a Likert scale, as well the description of the contents of specific behavioral indicators. In the applied 1 − 4 Likert scale, number 1 indica-tes that the assessment does not meet the expected standard, while number 4 indicates that the expected standard practice is always displayed, with only the sporadic errors. Ratings were determined by consensus of the team members, and each assessed pharmacist was informed about the rating re-sults afterwards. In addition, each participant filled out a questionnaire with demographic indicators pertaining to the  pharmacist him/herself, and the pharmacy where he/she worked.  National pharmaceutical associations supported the rese-arch: The Pharmaceutical Chamber of Serbia and the Alliance of the Pharmaceutical Associations of Serbia. In addition, each institution involved in the study gave an official approval. For data analysis we performed several statistical tests: analysis of variance (ANOVA), and univariate tests of signifi-cance. Statistical significance was assessed for the  p  < 0.05. All analyses were conducted using the Statistika  (version 12). Results  Descriptive analysis The pharmacists from the 8 out of 43 pharmacy chains accepted to participate. Accordingly, the study involved 123  pharmacists. The main characteristics of the participating  pharmacists are shown in the Table 1. ґ  – mean value; SD – standard deviation. Stojkov S, et al. Vojnosanit Pregl 2016; 73(9): 803–810.  Page 806 VOJNOSANITETSKI PREGLED Vol. 73, No. 9 Stojkov S, et al. Vojnosanit Pregl 2016; 73(9): 803–810. Table 2   Characteristics of competencies in relationship to the assessment type External assessment Self-assessments Competency code Competency name ґ  ± SD KK1 −  Pharmaceutical professional competencies K1 Health promotion 3.32 ± 0.70 3.12 ± 0.60 K2 Medicines information and advice 3.30 ±0.69 3.24 ± 0.60 K3 Access to medicines 2.91 ± 0.55 2.96 ± 0.61 K4 Compounding medicines 3.19 ± 0.72 3.07 ± 0.85 K5 Dispensing of drugs and medical devices 3.11 ± 0.47 3.20 ± 0.47 K6 Pharmacotherapy 3.27 ± 0.62 3.28 ± 0.56 K7 Drug therapy follow-up 2.66 ± 0.70 2.63 ± 0.70 K8 Recognition of diagnosis and patient counseling 2.09 ± 0.48 2.34 ± 0.67 KK2 Management competencies and organizational K9 Finance and accountable management 3.38 ± 0.61 3.20 ± 0.63 K10 Teamwork and human resources management 2.90 ± 0.65 2.98 ± 0.67 K11 Improvement of the service quality 2.56 ± 0.71 2.55 ± 0.79 K12 Procurement 3.21 ± 0.54 3.05 ± 0.73 K13 Effective inventory control 3.36 ± 0.53 3.22 ± 0.65 K14 Work place management 3.47 ± 0.60 3.37 ± 0.51 KK3 Personal competencies and professional K15 Communication skills 3.06 ± 0.58 3.11 ± 0.56 K16 Professional development and competency improvement 2.94 ± 0.66 3.00 ± 0.61 K17 Legislation and regulations 2.91 ± 0.65 2.96 ± 0.66 K18 Professional and ethical practice 3.40 ± 0.55 3.47 ± 0.53 K19 Quality assurance and research in the work  place 2.62 ± 0.50 2.83 ± 0.61 K20 Self-management 3.30 ± 0.60 3.32 ± 0.50 ґ   −  mean value; SD −  standard deviation.    Assessment results of the external assessors sorted by competency clusters Assessing the competencies according to clusters the areas of measured competencies were quite uniform, with the highest average score recorded for the cluster KK2 = 3.15, then the cluster KK3 = 3.04 and at the end for the KK1 = 2.98. Table 2 shows the mean and standard deviations for each of the competencies. Pharmacists recorded the highest competency scores in the following competencies: K14 – work place management  , K18 −    professional and ethical practice , and K9 −    finance and accountable management  , and the lowest average values for the competence K8 −   recognition of diagnosis and pati-ent counseling , K11 −   improvement of the service quality , and K19 −  q uality assurance and research   in the work place . Among the pharmacists’ professional competencies, the highest level of competence is shown in K1 −   health    promo-tion , and the lowest in K8 −   recognition of diagnosis and pa-tient counseling . Regarding competencies of the organization and mana-gement, the highest level of competence the pharmacists showed in K14 −   work place management  , while the lowest values in K11 −   improvement of the service quality . Professional and personal competencies had the highest values in K18 −    professional and ethical practice .The lowest values were recorded in K19 −   quality assurance and research   in the work place . Summarized scores for each competency cross analyzed with sociodemographic results There were statistically significant differences observed in clusters of competencies KK1 (F = 3.73,  p  = 0.02), KK2 (F = 6.58,  p  = 0.01) and KK3 (F = 5.76,  p  = 0.004) between the different age groups of pharmacists (group A −  below the age of 35, group B −  36 to 50 years of age, and group C −  from 51 to 65 years of age) using ANOVA. The highest level of competencies was observed in the B group, then the C group, and the lowest in the A group. Based on the  post hoc  Tukey honest significant difference (HSD) test, it was con-cluded that there were significant differences between the clusters of KK1, KK2 and KK3 competencies among the  pharmacists from the age groups below 35, and from 36 to 50 years of age (  p  = 0.02 for KK1,  p  = 0.001 for KK2,  p  < 0.05 respectively for KK3). The ANOVA test showed that there were no significant statistical differences between: the Length of Pharmacists’ Work Experience and the Pharmacists’ Professional Competency Cluster KK1 (  p     0.05 F = 2.56); whereas signi-ficant statistical differences were observed between the four groups of length of pharmacists’ work experience (less than  Vol. 73, No. 9 VOJNOSANITETSKI PREGLED Page 807 10 years, from 10 to 20 years, from 20 to 30 years and from 30 to 40 years) and KK2 (  p  < 0.05 , F = 5.11), as well as KK3 Cluster (  p  < 0.05, F = 4.67). In regards to the competency clusters KK1, KK2 and KK3, the t  -test showed that there were statistically signifi-cant differences between the groups of pharmacists with  postgraduate education and pharmacists with a university degree ( t   = -2.83,  p  < 0.05 for KK1, t   = -2, 53,  p  = 0.01 for KK2, t   = -2.14,  p  = 0.03 for KK3), where the specialists showed a higher level of competence. Use of the t  -test showed statistically significant differences related to the type of the working place held: the Head of the pharmacy  vs.  the Pharmacist, where the heads have shown a higher score in the KK2 ( t   = -2.83,  p  < 0.05), while in the other two clusters of competencies (KK1, KK3) the working place did not show significant effects (KK1, t   = -0.19;  p     0.05, KK3,  t   = -1.65,  p     0.05). Differences in the mean competency values between the  pharmacists, grouped by pharmacy location, size and area (rural vs . urban) were not statistically significant. When we analyze the data in all eight pharmacy chains, in 75% of  pharmacy chains the largest value of competency clusters had the cluster KK2, and in 50% of pharmacy chains the lowest value of competency clusters had the KK1.  Analysis of the external assessors’ assessment in relati-on to the self-assessment of pharmacists The results obtained by self-assessments of competen-cies by the pharmacists themselves confirmed the results of external assessors partially (Table 2). It was noted that the assessment by external assessors contained higher score va-lues than the pharmacists’ self-assessments for next compe-tencies: Health promotion, Medicines information and advi-ce, Compounding medicines, Drug therapy follow-up, Fi-nance and accountable management, Improvement of the service quality, Procurement, Effective inventory control and Work place management. Application of the t  -test showed that there were no statistically significant differences in the scores of external assessors and self-assessments of pharmacists in clusters KK1 pharmacists’ professional competencies ( t   = 0.14,  p  = 0.88) and cluster KK3 ( t   = -1, 56,  p  = 0.12). When it comes to cluster KK2, statistically significant differences between the rating of external assessors and assessment of the phar-macists themselves were found ( t   = 2.00,  p  = 0.04). The analysis of individual competencies showed a high correlation between the scores assigned by the external as-sessors and the self-assessment scores of the pharmacists (the Pearson’s correlation coefficients were in range from r = 0.37 to r = 0.61, and all correlations were statistically signifi-cant for the level of  p  < 0.05). The results of the t  -test emp-hasized the statistically significant differences in the following competencies: K1 ( t   = 3.42,  p  < 0.05), K8 ( t   = -4.03,  p  < 0.05), K9 ( t   = 3.51,  p  < 0.001), K12 ( t   = 3.04,  p  < 0.05), K13 ( t   = 2.87,  p  < 0.05), K14 ( t   = 2.08,  p < 0.05), and K19 ( t   = -3.66,  p  < 0.001). The assessment scores were noticeably lower than the self-assessment ones in K8, K9 and K19, whereas in the ot-her competencies, the assessment scores had higher values than the self-assessed scores. Discussion This study is among the first studies in the South Eas-tern Europe, focusing on the pharmacists’ level of competen-cies with the help of a global-level assessment tool. Compe-tencies of the pharmacists were assessed using external as-sessors and the pharmacists themselves, confirming the intelligibility and validity of the model applied. The docu-ment demonstrated a wide framework that allowed asses-sments and self-assessments of pharmacists’ competencies within public pharmacies of Serbia. By cross analyzing of competencies’ scores with the demographic data, the study showed a correlation between the certain demographic indi-cators and the competencies of pharmacists. An analysis of the demographic data revealed that the study used a cross section of pharmacists, as their age, gen-der and educational structure reflected the larger pharmacist  population from the Northern Serbia (Vojvodina Branch of the Pharmaceutical Chamber of Serbia) 24 . Further analysis of our data showed that there was a high degree of interdependence of the areas of competency. According to McRobbie   et al. 1 , pharmacists with a higher level of the certain competency demonstrated the competency in the rest of the areas, thereby proving that competence meant in fact the whole dynamics of knowledge, skills and experience of pharmacists. By cross analyzing the respondents’ demographic data, we determined that the levels of the pharmacists’ competen-cies were related to the theoretical knowledge as well as experience. The specialist pharmacists have a higher level of  pharmacists’ professional competencies. The pharmacists of different ages differed more in professional competencies. The professional and life experience greatly affected the following competencies: Organization and Management, Professional and Personal. Research conducted in the UK, which applied a similar instrument 21  showed that the self-assessed competencies were affected by age in a positive way, whereas the categories: Activity recording and Post-graduate education were more prevalent in younger pharma-cists. Gender, status/working place in a pharmacy and the  pharmacy type also influenced the study’s self-assessment  part, while our study pointed out the importance of the work  place and the level of education. Interestingly enough, the specialist pharmacists showed a higher level of self-criticism in both studies, rating themselves lower as compared to the  pharmacists without an additional education/training. The evaluation of pharmacists’ competencies provided an insight into the areas, where pharmacists’ skills were de-veloped, and where the specific indicators attained higher le-vels (Promotion of health, Work place management, Profes-sional and ethical practice). More significantly, however, the evaluation also identified the areas in need of improvement Stojkov S, et al. Vojnosanit Pregl 2016; 73(9): 803–810.
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