Identifying Gaps in Community Pharmacists’ Competence in Medication Risk Management in Routine Dispensing

Abstract

Background: Community pharmacists increasingly contribute to medication risk management while dispensing medicines to outpatients. Their risk management actions are shifting from medication counselling towards reviewing medications and following-up their therapeutic effects and outcomes. Acquiring these more clinical tasks require more patient care-oriented competences. Objective: To identify gaps in community pharmacists’ competence in medication risk management in routine dispensing. Setting: All community pharmacies in Finland. Method: A national cross-sectional online survey was conducted through the Association of Finnish Pharmacies (n=574 community pharmacies) and the university pharmacies (n=2) in 2015. One pharmacist from each pharmacy was recommended to report on behalf of their outlet. Main outcome measure: Community pharmacists’ self-assessed competence to: 1) identify medication-related risks, 2) utilise electronic tools in medication risk management, and 3) identify their perceived needs for developing competence in medication risk management. Results: Responses were received from 169 community pharmacies (response rate 29%). The highest proportion of good competency estimates were self-assessed in confirming doses (98% of the respondents evaluated their competence to be good) and identifying drug-drug interactions (83%). Competence to identify adverse effects, such as serotonergic load (10%) and anticholinergic load (12%), was most seldomly perceived as good. Of the wide range of electronic databases available, respondents most commonly reported using daily summaries of product characteristics (97% of the respondents), the checklist-type generic medicines information database that supports in medication counselling (85%), and the programme assisting in identifying drug-drug interactions (83%). The most commonly reported training needs were related to the identification of serotonergic load (63%), anticholinergic load (62%), and evaluating the clinical significance of drug-drug interactions (54%). Conclusion: The results indicate remarkable gaps in community pharmacists’ current competence in medication risk management, particularly in their competence in applied and geriatric pharmacotherapy.

Collaborative medication reviews in community pharmacies—Drug‐related problems and the process of communicating them with physicians: A retrospective validation study

“…The study design simulated the current practice in community pharmacies; therefore, the PPs and the AP did not have access to patients' medical records and laboratory results while conducting medication reviews. Like all community pharmacists in Finland, the PPs and AP had access to the same electronic databases for medication risk management as do physicians and other health‐care professionals 2 , 29 (Table 1 ). In most cases, the PPs and AP used the SALKO electronic medication review tool, which was specially designed for medication reviews in community pharmacies.…”

Developing and piloting a self-assessment tool for medication review competence of practicing pharmacists based on nationally set competence criteria

“…This concerns key competences needed for reviewing medications, such as estimating the clinical significance of the identified medication-related problems and risks, participating in implementing medication changes and interpreting and understanding laboratory test values. As the proportion of the aging population is growing, the importance of geriatric applied pharmacotherapy will also increase because of many age-related factors influencing drug suitability and dosing [ 20 , 51 , 70 ]. Furthermore, addressing the implied competence gaps related to interprofessional collaboration and collaboration with patients and their proxies could support medication adherence and self-management, also avoid preventable harm [ 4 , 15 , 20 , 45 , 52 , 53 , 71 – 74 ].…”

“…As the proportion of the aging population is growing, the importance of geriatric applied pharmacotherapy will also increase because of many age-related factors influencing drug suitability and dosing [ 20 , 51 , 70 ]. Furthermore, addressing the implied competence gaps related to interprofessional collaboration and collaboration with patients and their proxies could support medication adherence and self-management, also avoid preventable harm [ 4 , 15 , 20 , 45 , 52 , 53 , 71 – 74 ].…”

“…Nowadays community pharmacies are considered one of the most important medicines information sources [ 35 , 36 ]. However, compared to the shift in tasks, the development of community pharmacists’ competence has been lagging behind, even though undergraduate and continuing education have evolved remarkably [ 4 , 20 ].…”

“…Medication review competence can be considered as a contemporary, basic pharmaceutical competence that should be acquired in undergraduate training [ 18 , 19 ]. Even so, there are a high number of practicing pharmacists who lack these crucial competences, or at least need to improve their current skills [ 4 , 20 ]. Several national and international general level competence frameworks have been developed for pharmacists [ 21 – 30 ].…”