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RESEARCH ARTICLE Open Access
Pharmacist provision of primary health care:
a modified Delphi validation of pharmacists’
competencies
Natalie Kennie-Kaulbach
1†
, Barbara Farrell
2,9*
, Natalie Ward
2,3
, Sharon Johnston
2
, Ashley Gubbels
2
,
Tewodros Eguale
4
, Lisa Dolovich
5
, Derek Jorgenson
6
, Nancy Waite
7
and Nancy Winslade
8†
Abstract
Background: Pharmacists have expanded their roles and responsibilities as a result of primary health care reform.
There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The
aim of this study was to develop and validate competencies for pharmacists’effective performance in these roles,
and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care
services.
Methods: Using a modified Delphi process including assessing perception of the frequency and criticality of
performing tasks, we validated competencies important to primary health care pharmacists practising across
Canada.
Results: Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a
second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153
sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the
domains of care provider and professional, followed by communicator and collaborator, with the lower importance
rankings relatively equally distributed across the manager, advocate and scholar domains.
Conclusions: Expert pharmacists working in primary health care estimated their most important responsibilities to
be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these
patient care responsibilities, such as those related to communication, collaboration and professionalism were also
highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in
these evolving practices, to help other health care professionals learn about pharmacists’contributions to primary
health care, to establish standards and performance indicators, and to prioritize supports and education to
maximize effectiveness in this role.
Keywords: Primary health care, Pharmacy, Pharmacists, Competencies, Scope of practice
Background
The increasing burden of chronic conditions on
patients, their families and communities, and the health
system, is leading the developed world to investigate
new approaches to caring for patients. Primary health
care, as the first level of contact with the health system
for many individuals, has been refocused to emphasize
health promotion, illness prevention and chronic disease
management [1]. To address the challenge of access to
primary health care, interprofessional models are emer-
ging. Pharmacists are playing a growing part in primary
health care reform by fulfilling an increasing range of
roles and responsibilities.
While pharmacists are well established in providing
primary health care services in community pharmacy
practice, their role and contribution to primary health
care teams and their expanded roles in community
* Correspondence: BFarrell@bruyere.org
†Contributed equally
2
C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère
Research Institute, Ottawa, Ontario, Canada
Full list of author information is available at the end of the article
Kennie-Kaulbach et al.BMC Family Practice 2012, 13:27
http://www.biomedcentral.com/1471-2296/13/27
© 2012 Kennie-Kaulbach et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
pharmacy practice are being discovered as health care
reforms unfold in many countries. In the majority of
provinces in Canada, the scope of pharmacist practice is
being expanded and regulations and reimbursement
models are evolving to further support pharmacist pro-
vision of primary health care [2,3]. However, to ensure
the optimal function of emerging interprofessional pri-
mary care teams, it is essential to clearly understand the
scope and roles of the various professions participating
in these teams [4]. For the profession of pharmacy in
Canada, although entry-to-practice competencies exist,
there are currently no competencies articulated that
focus on the roles of pharmacists in the evolving pri-
mary health care field. The aim of this study was to
develop and validate competencies for pharmacists’
effective performance in these roles, and in so doing,
document the perceived contribution of pharmacists
providing collaborative primary health care services.
Methods
We used a modified Delphi technique with initial expert
development of a draft list of competencies followed by
two online surveys and a teleconference to validate com-
petencies important to primary health care pharmacists
practising across Canada.
Primary health care pharmacist competency framework
development
Core primary health care competencies required for
pharmacists were drafted based on review of innovative
primary health care pharmacists’practices, existing
entry-to-practice competencies and educational out-
comes for Canadian pharmacists and key literature
review [2,5-10]. The framework from the Association of
Faculties of Pharmacy (AFPC) educational outcomes for
Canadian pharmacists was selected in order to illustrate
the differences in competencies expected of pharmacists
who focus on provision of primary health care in com-
munity or primary health care team settings relative to
the competencies required of newly graduated pharma-
cists who provide primary health care routinely as part of
patient consultation and dispensing of medications [5].
This format also aligns with the CanMeds model, which
is the Royal College of Physicians and Surgeons of Cana-
da’s framework that identifies the essential competencies
required of physicians [11]. The CanMeds framework
articulates seven roles and associated competencies
required of physicians; medical expert (central role),
communicator, manager, health advocate, scholar and
professional. A number of professions and organizations
in Canada have adopted the CanMeds format when
defining competencies required for their professions,
including the Canadian Patient Safety Institute [12] and
the Canadian Association of Physician Assistants [13].
Adoption of this common format for the primary health
care pharmacist competencies was meant to support
understanding of the roles and responsibilities of phar-
macists relative to the roles of other members of the pri-
mary health care team. Using this format, domain
descriptions focused on identifying the emerging roles of
pharmacists in primary health care environments. Com-
petency elements were key features of the domains that
provided a description of the core tasks, activities or
responsibilities of the primary health care pharmacist
(PHCP). The competency sub-elements provided detail
of the competencies required of pharmacists to fulfill
these primary health care roles.
Key informant review
The proposed competencies were vetted by 10 key infor-
mants selected purposefully by the project team as phar-
macists who were leaders in patient care, education, or
research in the primary health care setting and provided
representation from across Canada. They reviewed the
proposed competencies for representativeness and rele-
vancetopharmacypracticeconsideringtheirroleand
experience in the primary health care setting, provided
written comments and gave feedback in telephone inter-
views. Based on this review, draft competencies for
primary health care pharmacists were prepared.
Modified Delphi validation
The project team identified Canadian pharmacists with
practices that focussed on providing direct patient care
and follow up, who had a collaborative working relation-
ship(s) with one or more physicians and who documen-
ted ongoing care in patient records (i.e. providing
primary health care at an expert or proficient level) [14].
Such pharmacists were identified via review of innova-
tive practices described in the Pharmacy Moving
Forward project which identified and documented emer-
ging innovative pharmacy practices and models across
Canada [15] and review of members of the Ontario
Pharmacist Family Health Team Listserv. Identified
pharmacists were contacted by e-mail to both to obtain
their consent to participate in the competency validation
surveys, a teleconference call and to complete the sur-
veys. To encourage participation, pharmacists were
informed that a participant who had completed the sur-
veys would be randomly selected to receive a $100 gift
certificate.
The first of the on-line surveys functioned as a pilot to
test both the clarity of the survey instructions and the
thoroughness of the draft PHCP competency description.
Open comments were reviewed to identify common con-
cerns identified by the respondents. To further clarify
concerns and revise the competencies, respondents who
had partially or fully completed the questionnaire were
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invited to participate in a teleconference. Participants
were presented with a brief summary of the ratings
results of the first survey and asked to discuss the format
of the survey, the rating scales, sub-element wording and
applicability to individual’s practice. Revisions were made
to the original competency document and survey based
on the feedback received from the first survey, the tele-
conference and review and comments by research team
members. In addition, at the time of the review, AFPC
had released a final version of the educational outcomes
that had included some revisions to the original docu-
ment used for developing the PHCP competencies. The
research team reviewed all of these comments and docu-
ments and made specific revisions to the PHCP compe-
tency document to clarify wording and reduce the
number of sub-elements. The survey rating scales were
also adjusted for the criticality question to make sure the
relevance of competencies to practice, the profession and
society were easier to comprehend. The revised survey
was then re-administered to the same group of pharma-
cists to obtain the final validation ratings of the PHCP
competencies.
The surveys requested pharmacists rate each draft
competency sub-element on a six-point Likert scale,
identifying first how often they performed the sub-
element in practice and second how critical they
believed competent performance of the sub-element was
to achievement of the patient’s desired health outcomes
[16]. Open comment boxes were used to invite respon-
dents to comment on clarity and missed items.
For each sub-element a mean frequency and mean cri-
ticality rating were calculated by considering all respon-
dents’ratings. For partially completed surveys, mean
criticality and frequency values were imputed and sensi-
tivity analysis was done based on the pharmacists with
complete data. Using methodologies established by Kane
et al., [16] an initial importance weighting was calcu-
lated for each sub-element by multiplying the mean fre-
quency and criticality values. This importance weighting
was then adjusted to ensure that criticality and fre-
quency contributed equally to the resulting importance
weighting. This adjustment was necessary to accommo-
date for the greater variability inherent to frequency
weightings relative to criticality weightings, since this
greater variability lead to an undesirable higher contri-
bution of frequency when simple multiplication was
used.
To calculate importance weightings for elements, the
frequency and criticality ratings for sub-elements that
belonged to the same element were aggregated [16].
Values of elements which belong to the same domain
were then aggregated to create domain level frequency
and criticality ratings. Adjusted importance weights were
then calculated for each element and domain using the
same adjustment procedure as for the sub-elements to
ensure equal contribution of criticality and frequency.
This study was approved by the Bruyère Continuing
Care Research Ethics Board.
Results
Both the first round and second round surveys were sent
to 87 pharmacists who had been identified as providing
primary health care at the proficient or expert level. In
the first round 16 pharmacists responded partially or
completely (response rate = 18%) and in the second
round of the survey, 33 pharmacists partially or fully
completed the survey (response rate = 38%). Table 1 pro-
vides the demographic data on key informants (N = 10),
teleconference participants (N = 4) and the 21 of 33 sec-
ond round survey respondents who provided demo-
graphic information (N = 21). Only complete responses
were included in this analysis so there are no missing
values from these demographic characteristics.
Consistent with trends in pharmacy practice, the
majority of participants were female [17]. Given that
participants had to be proficient or expert, it was also
anticipated that participants would have a number of
yearsofpracticeexperienceandTable1confirmsthis
expectation. While key informants were heavily repre-
sented by those integrated into family practice or in aca-
demia, respondents to the final survey represented a
wide range of primary health care environments, includ-
ing community pharmacy.
The revised PHCP competencies that formed the basis
of the validation (second) survey had seven domains, 34
elements and 153 sub-elements. The seven domains and
role definitions are described below.
As Medication Therapy Experts, primary health
care pharmacists (PHCPs) integrate knowledge,
skills and professional attitudes to effectively con-
tribute to improved quality of drug therapy
through the provision of patient-centred care and
in collaboration with health care providers.
In functioning as a Medication Therapy Expert,
PHCPs fulfill roles relating to care and services for
individual patients as well as roles emphasizing the
responsibilities of pharmacists to populations of
patients, and to their communities.
Role Definitions:
Advocate: Primary health care pharmacists use their
expertise and influence to advance the health and
well-being of individual patients, communities and
populations.
Care Provider: Primary health care pharmacists use
their knowledge and skills to provide pharmaceutical
care and to facilitate management of patient’smedi-
cation and overall health needs.
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Collaborator: Primary health care pharmacists work
collaboratively with patients, family physicians, and
other primary health care professionals and in teams
to provide effective, quality health care and to fulfill
their professional obligations to the community and
society at large.
Communicator: Primary health care pharmacists
communicate with diverse audiences, using a variety
of strategies that take into account the situation,
intended outcomes of the communication and the
target audience.
Manager: Primary health care pharmacists use man-
agement skills in their daily practice to optimize the
care of patients, and to make efficient use of health
resources.
Professional: Primary health care pharmacists hon-
our their roles as self-regulated professionals
through both individual patient care and fulfillment
of their professional obligations to the community
and society at large.
Scholar: Primary health care pharmacists have and
can apply the core information required to be a
medication therapy expert, and are able to master,
generate, interpret and disseminate pharmaceutical
knowledge.
Table 2 provides an example of a competency domain,
description, one of its’elements and its’related sub-ele-
ments (for the role of patient care). Additional file 1
provides the complete PHCP competencies.
Outlined below is the final wording used in the valida-
tion survey for pharmacists to rate the frequency and
criticality of performance of each sub-element in the
final PHCP competencies.
Frequency question
As your practice develops in the next 5 years, how
frequently do you see yourself performing each of
the listed tasks (assuming you are working full-
time)?
6 - continuously (i.e. hourly or more)
5-betweentwoandsixtimesperday(butnot
hourly)
4 - once per day (i.e. five times/week)
3 - between one and four times/week (but not daily)
2 - between one and three times per month (but not
weekly)
1 - less than once per month
Criticality question
Considering each time that the competency unit
should be performed, what risk (immediate or long
term) would it cause patients, either directly or by
affecting access to health services, if you did not per-
form the task competently?
6 - life threatening
5 - serious consequences
4 - worsens situation
3 - prevents improvement in situation
2 - causes inconvenience
1 - no impact
Table 1 Participant demographics
Key informants
N=10
n (%)
Teleconference Participants
N=4
n (%)
Final Survey
N = 21*
n (%)
Gender
Female 8 (80%) 2 (50%) 13 (62%)
Male 2 (20%) 2 (50%) 8 (38%)
Age
20 - 29 years 000
30 - 39 years 2 (20%) 1 (25%) 8 (38%)
40 - 49 years 6 (60%) 2 (50%) 8 (38%)
50 - 59 years 2 (20%) 1 (25%) 2 (9.5%)
60 - 69 years 0 0 2 (9.5%)
70 years and above 0 0 1 (5%)
Practice Type^
Community pharmacy 1 (10%) 1 (25%) 5 (24%)
Ambulatory Clinic 1 (10%) 0 4 (19%)
Consulting to family practice 0 0 3 (14%)
Integrated into family practice 3 (30%) 3 (75%) 12 (57%)
Other (e.g. academia, health care organization) 8 (80%) 0 2 (10%)
* 21 of the 33 respondents completed the demographics section in the final survey.
^ More than one practice site is indicated for some participants.
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Competency elements directly related to provision of
patient care ranked highest including ‘elicit and complete
an assessment of required information to determine the
patient’s medication-related and relevant health needs’
(ranked 1) and ‘assess if a patient’s medication-related
needs are being met’(ranked 2). Competencies that
ranked lowest were less directly linked to provision of
patient care including ‘participate in practice research’
(ranked 33) and ‘formally educate diverse audiences
regarding medications and appropriate medication use,
health promotion or self-management’(ranked 34). The
adjusted importance rankings for the competency ele-
ments are shown in Table 3. Complete frequency and cri-
ticality ratings and importance rankings for all sub-
elements are provided in online Additional file 2.
Adjusted importance weight for the seven competency
domains is shown in Figure 1. The results indicate that
PHCPs fulfill a variety of roles related to the provision of
patient care, collaboration with health care providers and
meeting health system needs. The ‘care provider’domain
held the highest importance (26%) following closely by
‘professional’(21%). “Health advocate”,‘scholar’and
‘manager’domains had the lowest importance weight-
ings, although when combined (24%) still represent a sig-
nificant contribution to PHCP roles.
Discussion
A comprehensive set of competencies required of phar-
macists to provide primary health care was developed
and validated by practising primary health care pharma-
cists. Despite the increasing emphasis on primary health
care and the transition to collaborative patient care
teams, to our knowledge, this is the first literature that
defines the primary health care roles and responsibilities
that pharmacists can fulfill within these teams.
The PHCP competencies expand on the newly devel-
oped national educational outcomes for pharmacy gradu-
ates [5] by describing the competencies required of
pharmacists who focus their practice on providing pri-
mary health care in a range of practice settings. The
inclusion of specific primary care-related competencies
in, for example, advocacy and management provide addi-
tional guidance as to how pharmacists not only provide
primary health care to individual patients, but also how
they fulfill primary health care responsibilities to commu-
nities and the health care system. The PHCP competen-
cies are also consistent with Model Standards of Practice
for Canadian Pharmacists [9], although the format of the
PHCP competencies was selected specifically to align
with the CanMeds format that is being adopted by pro-
fessions across Canada [11].
Consistent with expectations, the competencies most
directly related to patient care were rated the most impor-
tant by practising pharmacists. The top five ranked com-
petency elements focused on the pharmacist’s expertise in
identifying and managing medication therapy problems
that affect patient’s overall health outcomes. Competencies
that underlie and are required for successful fulfillment of
Table 2 Example of competency domain, element, and sub-elements
Domain 2. As Care Providers, primary health care pharmacists use their knowledge and skills to provide pharmaceutical care and to facilitate
management of patient’s medication and overall health needs.
Description Primary health care pharmacists possess the core knowledge, skills and attitudes required to be able to:
i. manage patients:
•who require the pharmacist’s participation in their care;
•who are willing and able to accept the responsibilities required by this care;
•with common and uncommon medication-therapy problems or complex medication-related needs; and identify patients with highly
complex medication-related needs.
•who require urgent care and provide basic first aid and CPR;
ii. are able to acquire the knowledge and skills required to manage patients with highly complex medication-related needs.
iii. provide care in accordance with accepted frameworks that expand the pharmacist’s scope of practice (e.g. medical directives);
iv. recommend appropriate sources of support for patients experiencing common difficulties in daily living;
v. advise patients on common, current health promotion campaigns;
vi. are able to refer patients for the management of medication therapy needs that fall beyond their individual scope of practice;
vii.are able to triage patients to other primary health care providers.
Element Elicit and complete an assessment of required information to determine the patient’s medication-related and relevant health needs.
Sub-
element
elicit the reason(s) for the patient’s visit or referral to the pharmacist;
Sub-
element
obtain and evaluate relevant history from the patient, his/her chart, caregivers and other health care professionals (e.g. medication
experience, medication history, current medication record, past and current medical history, allergies, immunizations, social drug use, previous
adverse reactions, etc);
Sub-
element
order and/or retrieve and assess relevant lab tests and diagnostic tests;
Sub-
element
perform and interpret findings of relevant physical assessment;
Sub-
element
complete an assessment of the patient’s ability to take/use/administer his/her medications.
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these patient care responsibilities, such as those related to
communication, collaboration, and professionalism, were
also highly ranked. Consistent with other professions in
Canada, the competencies related to management, health
advocacy, and scholarship were rated lower in both fre-
quency and criticality [18,19]. These lower ratings could
reflect a lower relevance of these activities relative to the
direct patient care activities which are the main focus of
most practicing pharmacists not in full time administra-
tion or teaching and research. Pharmacists may have pro-
vided lower ratings to those less frequently performed
competencies which require a system-level focus as their
effect is less immediately obvious compared to recalling
direct patient care which can often be quantified in num-
bers seen, and impact assessed by immediate adverse
events avoided or questions answered. Nonetheless, these
Table 3 Importance rankings (rank adjusted) for competency elements
Domain Competency Element F C I Rank
Advocate Promote the health of individual patients 4.63 3.80 3.40% 16
Promote the health of patients and patient groups within their communities 2.17 2.99 0.88% 30
Support the role of pharmacists in the primary health care system 2.92 3.24 1.45% 27
Health care
Provider
Develop and maintain professional, collaborative relationships required for patient care 5.52 4.03 4.69% 6
Elicit and complete an assessment of required information to determine the patient’s medication-related
and relevant health needs
5.24 4.46 5.70% 1
Assess if a patient’s medication-related needs are being met 5.20 4.39 5.44% 2
Determine if a patient has health needs that require management 4.06 4.72 5.09% 4
Refer patients for management of priority health and wellness needs that fall beyond the scope of
practice of pharmacists
3.55 3.91 2.79% 18
Develop a shared plan of care that addresses a patient’s medication-therapy problems and priority health
needs
5.11 3.79 3.37% 13
Implement the care plan 4.79 3.68 3.25% 17
Elicit clinical and/or lab evidence of patient outcomes 4.71 4.49 5.21% 3
Assess and manage patients’new medication-related needs 4.70 4.10 4.16% 9
Document their patient care activities 5.08 4.22 4.82% 5
Collaborator Function as members of teams 4.53 3.16 2.81% 23
Work collaboratively with the patient and his/her health care professionals to provide care and services
that facilitate management of the patient’s health needs
4.32 4.01 3.41% 14
Communicator Communicate non-verbally and verbally with others 5.66 3.68 4.10% 12
Communicate in writing 5.28 3.16 3.28% 21
Present information 2.16 2.68 1.14% 31
Use communication technology 3.68 2.97 2.15% 26
Communicate effectively in special high-risk situations and address challenging communication issues 3.88 4.39 3.35% 10
Manager Manage their personal practice 4.74 3.47 3.23% 19
Support the sustainability of their practice 2.70 2.99 1.58% 28
Participate in the development of policies and procedures supportive of the safe and effective use of
medications and the provision of quality primary health care
3.33 3.21 2.10% 24
Recognize the occurrence of errors and unsafe practices and respond effectively to mitigate harm to the
patient, ensure disclosure, and prevent recurrence
2.11 4.55 1.88% 22
Participate in quality assurance and improvement programs 2.20 3.24 1.40% 29
Professional Demonstrate professionalism throughout patient encounters 5.78 3.68 4.18% 11
Practice in an ethical manner which assures primary accountability to the patient 5.18 3.98 4.05% 8
Practice in a manner demonstrating professional accountability 5.67 3.95 4.40% 7
Ensure their personal competence to fulfil the evolving primary health care pharmacist’s role 2.83 3.40 1.90% 25
Support the profession and its evolving role in the primary health care system 1.89 2.83 1.05% 32
Scholar Demonstrate a thorough understanding of the fundamental knowledge required of pharmacists by
applying this knowledge in daily practice
4.49 3.92 3.45% 15
Provide drug information and recommendations regarding medications and appropriate medication use
for uptake and implementation into practice
4.12 3.52 2.85% 20
Formally educate diverse audiences regarding medications and appropriate medication use, health
promotion or self-management
1.54 2.78 0.52% 34
Participate in practice research 1.54 2.81 0.54% 33
Adjusted percentage weights and ranks assigned to competency elements using I = CF where C and F contributed equally to Importance (weight)
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non-direct patient care competencies still represented
almost one quarter of the overall role importance for these
primary health care pharmacists. As with other health pro-
fessionals, further study is needed to determine the reason
non direct patient care competencies receive lower ratings
for criticality despite the professions’identification of
these as fundamental to the practice of pharmacy [2]. It
might be helpful to educators to determine if pharmacists
have similar challenges to physicians in interpreting the
meaning and relevance of competencies such as health
advocacy and management [20,21].
As pharmacists have increasingly expanded their role to
function as primary health care providers and the primary
health care system continues to evolve, gaps in knowledge,
and skills have been identified that indicate a need for
bridge or specialty education [22-24]. The articulation of
competencies and prioritization of pharmacist roles in pri-
mary health care have been helpful in informing the devel-
opment of educational and continuing professional
development programs such as the ADapting Pharmacist’s
skills and Approaches to maximize Patient’s drug Therapy
effectiveness (ADAPT) program for primary health care
pharmacists [25].
Strengths of this work include the broad range of
resources consulted during the initial development of the
draft PHCP competencies, the inclusion of pharmacists
who provide primary health care in a range of practice
sites, the sampling of pharmacists across Canada and the
methodologically rigorous approach to rating of the
importance of the PHCP competencies. Rather than rely-
ing on group consensus or participant’suseoftheir
personal perspectives of the importance of the varying
roles, a standardized rating scale was developed, piloted
and refined prior to final use. Although the origins of
Kane’s criticality and frequency ratings methodology was
for use in the development of entry-to-practice examina-
tions, the methodology provided a robust approach to
standardizing participant’s approaches to the rating of
importance. Modifications in the rating scales and ques-
tions were required to recognize that some primary health
care activities are provided on a relatively continuous basis
in the background of performance of professional tasks.
For example, the most frequent category was changed to
‘continuously’rather than relying on a discrete number of
times per day (e.g. 7 or more times per day). For the criti-
cality rating, the question asked also required modification
to specify that responsibilities could either directly or
indirectly affect patient’s outcomes. This allowed pharma-
cists flexibility in considering the impact of competencies
related to, for example, management or advocacy on
patient outcomes through mechanisms such as ensuring
access to timely and competent care and services.
There are some limitations to this study. Response rates
were low and the PHCP competencies were, therefore,
validated by a limited number of primary health care phar-
macists. Further work should be done to determine if
these results are relevant to a greater number of pharma-
cists who provide primary health care. However, relying
on those pharmacists with the most expertise should have
provided a comprehensive set of competencies to identify
the greatest range of potential primary health care roles
for pharmacists. A second limitation is that the compe-
tency validation was based on the roles and responsibilities
of pharmacists as projected for the next five years. There
may be roles and responsibilities that will continue to
evolve that necessitate re-examination of these PHCP
competencies over time.
Future work should consider wider validation of these
PHCP competencies through consultation with a larger
group of practising pharmacists and the consideration of
perspectives of stakeholders such as patients, other health
care professionals working in primary health care teams
and provincial governments. This would allow a broader
perspective on the importance of these roles of primary
health care pharmacists. In addition to this further vali-
dation of perceived roles, empirical evaluation of the fre-
quency, criticality and impact of pharmacists’fulfillment
of these roles is necessary. New techniques that have
been validated for evaluating the quality of pharmacist’s
daily performance would be useful in these studies [26].
Conclusions
In summary, competencies for primary health care phar-
macists have been developed and validated that clarify
the roles that pharmacists can fulfill and outline the
Figure 1 Adjusted importance weight for the competency
domains.
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contributions that pharmacists could make to an effec-
tive primary health care system. Direct patient care with
emphasis on managing patients’medication-related
needs remains the clear focus of primary health care
pharmacists, with recognition that fulfillment of this
responsibility requires communication, collaboration
and professionalism. Less highly rated are roles related
to management, health advocacy and scholarship and
further work is necessary to determine the reason for
these lower ratings. This validated list of competencies
for pharmacists practicing in primary health care should
be of use to practitioners, policy-makers, and educators
and is an important first step to developing measures
for assessing the performance and impact of pharma-
cists’provision of primary health care services.
Additional material
Additional file 1: Primary Health Care Competencies. Primary Health
Care Pharmacist Competencies. This document provides role definitions,
competencies and competency sub-elements for the Primary Health Care
Pharmacist competency framework.
Additional file 2: Importance Rankings (rank adjusted) for
Competency Sub-elements. Importance Rankings (rank adjusted) for
Competency Sub-elements. The document provides importance ratings
for all primary health care competency elements and sub-elements.
Abbreviations
(PHCP): Primary Health Care Pharmacist; (ADAPT): ADapting Pharmacist’s skills
and Approaches to maximize Patient’s drug Therapy effectiveness
Acknowledgements
The study was funded by Health Canada under the Health Care Policy
Contribution Program in collaboration with the Canadian Pharmacists
Association.
Author details
1
Summerville Family Health Team, Mississauga, Ontario, Canada.
2
C.T. Lamont
Primary Health Care Research Centre, Élisabeth Bruyère Research Institute,
Ottawa, Ontario, Canada.
3
Department of Sociology and Anthropology,
University of Ottawa, Ottawa, Ontario, Canada.
4
Clinical and Health
Informatics Research Group, Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, Quebec, Canada.
5
Department of Family Medicine, McMaster University, Centre for Evaluation
of Medicines, Hamilton, Ontario, Canada.
6
College of Pharmacy and
Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
7
School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.
8
Faculty of Medicine, McGill University and Winslade Consultants Inc,
Montreal, Quebec, Canada.
9
Scientist, C.T. Lamont Primary Health Care
Research Centre, Élisabeth Bruyère Research Institute, 43 Bruyère Street,
Ottawa, Ontario K1N 5C8, Canada.
Authors’contributions
NK developed the competencies, participated in study design/methodology
and analysis and drafted the manuscript. BF was the study principal
investigator, directed the study design/methodology, participated in analysis
and made critical revisions to the manuscript. NWard contributed to study
design/methodology, participated in data acquisition and analysis and
writing of the manuscript. SJ participated in analysis and writing of the
manuscript. AG participated in data acquisition and analysis and editing of
the manuscript. TW participated in statistical data analysis and editing of the
manuscript. LD contributed to study design/methodology and analysis and
editing of the manuscript. DJ and NWaite participated in data analysis and
editing of the manuscript. NWinslade contributed to competency
development, participated in study design/methodology and analysis and
made critical revisions to the manuscript. All authors have read and
approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 19 December 2011 Accepted: 28 March 2012
Published: 28 March 2012
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Cite this article as: Kennie-Kaulbach et al.: Pharmacist provision of
primary health care: a modified Delphi validation of pharmacists’
competencies. BMC Family Practice 2012 13:27.
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