Development of a Postgraduate Community Pharmacist Specialization Program Using CanMEDS Competencies, and Entrustable Professional Activities

Objectives. To develop and implement a postgraduate, workplace-based curriculum for community pharmacy specialists in the Netherlands, conduct a thorough evaluation of the program, and revise any deficiencies found. Methods. The experiences of the Dutch Advisory Board for Postgraduate Curriculum Development for Medical Specialists were used as a guideline for the development of a competency-based postgraduate education program for community pharmacists. To ensure that community pharmacists achieved competence in 10 task areas and seven roles defined by the Canadian Medical Education Directions for Specialists (CanMEDS), a two-year workplace-based curriculum was built. A development path along four milestones was constructed using 40 entrustable professional activities (EPAs). The assessment program consisted of 155 workplace-based assessments, with the supervisor serving as the main assessor. Also, 360-degree feedback and 22 days of classroom courses were included in the curriculum. In 2014, the curriculum was evaluated by two focus groups and a review committee. Results. Eighty-two first-year trainees enrolled in the community pharmacy specialist program in 2012. That number increased to 130 trainees by 2016 (a 59% increase). In 2015, based on feedback from pharmacy supervisors, trainees, and other stakeholders, 22.5% of the EPAs were changed and the number of workplace-based assessments was reduced by 48.5%. Conclusion. Using design approaches from the medical field in the development of postgraduate workplace-based pharmacy education programs proved to be feasible and successful. How to address the concerns and challenges encountered in developing and maintaining competency-based postgraduate pharmacy education programs merits further research.

Determinants of pharmacists' interventions linked to prescription processing

AIM OF STUDY

The role of pharmacists in today's healthcare is changing rapidly. As they are close to the prescribing process, pharmacists are in the position to identify and adjust prescribing errors before dispensing. The objective of this study was to identify relevant determinants of interventions directly linked to prescription processing in community pharmacy.

METHODS

As part of a yearly continuing education programme, all community pharmacies in the region of 'Zealand' (N = 23) in the south-west of The Netherlands kept detailed records of all interventions directly linked to prescription processing during one week in May 1998. For every patient involved in an intervention, a control-patient was matched on pharmacy practice, date, gender and age.

RESULTS

A total of 39,357 prescriptions were evaluated by the 23 pharmacies during the one-week intervention programme. Out of these, one out of 10 resulted into an intervention. Being a first prescription in a new treatment episode was found to be a significant determinant (OR 1.75, 95 CI% 1.18-2.33). Variables reflecting drug therapy complexity (> 3 prescribers, > 15 prescriptions in 3 months before, > 3 different medications) showed all ORs higher than 1.00, but not significant. When looking at the individual drug categories, anti-infectives, respiratory drugs and cardiovascular medicines came out as important drug classes for intervention risk. We could not find any association between the number of signals per pharmacy and the number of interventions.

CONCLUSION

The 'whistle-blower' model of pharmacy based interventions is a valid one but needs a targeted and integral way of implemented thinking and use of information technology. In such an environment, interventions are a logical step of in-process quality control in the drug usage system.