Peer Review History

Original SubmissionAugust 23, 2024
Decision Letter - Naeem Mubarak, Editor

PONE-D-24-33395Developing a competency assessment framework for pharmacists in primary health care settings in IndiaPLOS ONE

Dear Dr. Kumar,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Naeem Mubarak, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments:

The manuscript has strengths but needs major revisions to improve its quality and merit.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you, managing editorial, for giving me this opportunity to review the article “Developing a competency assessment framework for pharmacists in primary health care settings in India” in this prestigious journal. This article provides the initial primary stages and roles for developing the competency assessment framework for primary health care in India.

Abstract

In the background, it's crucial to highlight the significance of the competency framework for pharmacists, as it underpins their professional development and performance.

The method of assessment was insufficiently described.

To whom were the competency framework and associated behaviour discussed and agreed upon? Please clarify the statement.

In general, there is a lack of information about the competencies, just the number of competencies and the number of roles. Kindly add some lines in the result or conclusion about which competency framework for pharmacists has been introduced.

Introduction

Please add an example from the primary rather than the community set-up to elaborate on the importance of competency at the primary healthcare level.

Add a few lines about the availability of pharmacists at the primary healthcare level and then explain their importance to their country's prospects.

The authors are advised to specify the status of pharmacists at their country level because these studies are of Indian origin. So, the targeted approach will be more important than covering the whole world.

Please advise the authors to reference the statements, as no competency assessment has already been conducted in their country.

There is no introduction regarding the competency tool and globally available competencies for pharmacists at the primary level.

Method

Authors are advised to use the assessment tool for literature review for effective data collection and representation.

In stage two, on which basis the experts were selected for consultation.

In stage three, which instrument was used for assessing competencies? Please specify.

There should be numbered score definitions in the assessment tool.

Is there only English grammar pretesting required for the competency assessment tool?

Results

The competencies selected in the literature review are related to the in-service pharmacist or not. These competencies were related to pharmacists or taken as general.

On which basis were the eleven roles made for pharmacist competencies, and on which bases were they selected?

In role 2, how is it possible for a pharmacist to observe the optimal use of medical products?

In role 3, please specify which drugs require high compliance with regulations.

In role 4, although medical product management and documentation are solely the responsibility of the pharmacist as they are available in the pharmacy, the pharmacist assists the medical officer with these tasks.

In role 7, on which limit the ethical practice will be allowed. Please specified.

In role 10, Is it possible for the author to please specify the list of diagnostic tests and checks in emergencies?

In role 11, authors are advised to please specify the programs for continuing professional development in Indian origin.

Authors are advised to reduce the paragraph content as already described in the table.

Authors are advised to provide the details of the validation of the competency assessment tool.

Which tests were performed during the pre-testing of the competency assessment tool?

Discussion

The discussion regarding the factors related to coping with pre-service education is limited. The authors advised adding more possible measures to cope with these challenges at the government level.

The discussion regarding the importance and implications of competence assessment was very limited, making this portion weak.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

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Revision 1

Sr. No. Section Comments Response Description-Response (Page and Line Number

1. Abstract In the background, it's crucial to highlight the significance of the competency framework for pharmacists, as it underpins their professional development and performance. Referring to the suggestion, I made the required changes. Please refer to ln No. 35 to 40 on page 2

2 The method of assessment was insufficiently described. Referring to the suggestion, I made the required changes. Please refer to ln No. 42 to 49 on page 2

3 To whom were the competency framework and associated behaviour discussed and agreed upon? Please clarify the statement. Referring to the suggestion, I made the required changes. Please refer to ln No. 53 to 54 on page 2

4 In general, there is a lack of information about the competencies, just the number of competencies and the number of roles. Kindly add some lines in the result or conclusion about which competency framework for pharmacists has been introduced. Referring to the suggestion, I made the required changes. Please refer to ln No. 88 to 101 on page 3.

5 Introduction Please add an example from the primary rather than the community set-up to elaborate on the importance of competency at the primary healthcare level. I tried my best to include articles from primary healthcare settings.

6 Add a few lines about the availability of pharmacists at the primary healthcare level and then explain their importance to their country's prospects. Referring the suggestion, made the necessary changes. Please refer to ln No. 198 to 202 on page 6.

7 The authors are advised to specify the status of pharmacists at their country level because these studies are of Indian origin. So, the targeted approach will be more important than covering the whole world. Yes, I tried my best to share status in an Indian setting Please refer to ln No. 211 to 217 on page 6.

8 Please advise the authors to reference the statements, as no competency assessment has already been conducted in their country We learned from literature search and expert consultation that there is no competency assessment framework.

9 There is no introduction regarding the competency tool and globally available competencies for pharmacists at the primary level. We discussed about the FIP competency framework and later in stage 1, we listed the competencies under different domains from various studies. Please refer to ln No. 179 to 197 on pages 5 and 6.

10 Method Authors are advised to use the assessment tool for literature review for effective data collection and representation. In stage 1, we used a systematic approach to searching literature through a defined search strategy and followed PRISMA guidelines. Please refer to Fig 1 for details.

11 In stage two, on which basis the experts were selected for consultation? We identified experts based on selection criteria such as education, years of experience, and current role. Please refer to the experts section. Please refer to ln No. 277 to 281 on page 8.

12 In stage three, which instrument was used for assessing competencies? Please specify. Referring to the suggestion, we made the changes. Please refer to ln No. 268 to 269 on page 8.

13 There should be numbered score definitions in the assessment tool. We developed the score definition for the instruments assessing skills as Observational checklists and mini-clinical exercises. Please refer to table 8 Score definition. Please refer to table 5 on page 14

14 Is there only English grammar pretesting required for the competency assessment tool? No, we pre-tested the competency assessment tool in bilingual format in English and Odia. Please refer to ln no 466 and 467.

15 Results The competencies selected in the literature review are related to the in-service pharmacist or not. These competencies were related to pharmacists or taken as general. Yes, the literature review is related to the pharmacists working in primary health care settings.

16 On which basis were the eleven roles made for pharmacist competencies, and on which bases were they selected? In stage 2, during the consultation, it emerged that rather than considering the domain, it is better to use the role as a basis to define competencies. These roles are primarily based on the Indian Public Health Standard, 2022, and later on, the consensus among experts, 11 roles were finalized. Please refer to ln no 318-320 on page 9.

17 In role 2, how is it possible for a pharmacist to observe the optimal use of medical products? In role 2, one of the competencies is- Able to encourage the use of medical products.

The pharmacist can encourage patients to return unused, unwanted, or expired medicines to the Pharmacy for safe disposal. Pharmacists can also maintain records of returned medical products to monitor usage further.

The additional file mentions these two ways as behaviors for the said competencies. For details, please refer to Additional file 2. Please refer to additional file 2.

18 In role 3, please specify which drugs require high compliance with regulations. Medical products with narcotics and psychotropic agents require high compliance with regulations.

We made the suggested changes. Please refer to ln no 362-363 on page 12.

19 In role 4, although medical product management and documentation are solely the responsibility of the pharmacist as they are available in the pharmacy, the pharmacist assists the medical officer with these tasks. Primary health Centres conduct various activities for public health programs, including Leprosy, Tuberculosis, and Vector disease control programs. In those cases, the Pharmacist is supposed to assist the medical officer with medical product management and documentation.

20 In role 7, on which limit the ethical practice will be allowed. Please specified. Regarding ethical practice, the consensus made among the experts as one of the behaviors is -

“Be well versed with the Code of Ethics of the Pharmacy Council of India and as given in Pharmacy Practice Regulation.” (Please refer to additional file 2 )

Made the required changes in the manuscript. Please refer to additional file 2.

21 In role 10, Is it possible for the author to please specify the list of diagnostic tests and checks in emergencies? We specified the list of diagnostics in the manuscript. These tests are described as behaviors in Additional File 2. Please refer to additional file 2

22 In role 11, authors are advised to please specify the programs for continuing professional development in Indian origin. In India, there is no structured program for pharmacists' continuing professional development. The National Health Mission, along with other initiatives, organizes capacity-building programs regularly. In light of this, one behavior that emerged from expert consensus is actively participating in the various training programs offered by the National Health Mission and other health programs established by the Ministry of Health and Family Welfare (MoHFW) and State Health Departments.

For details, please refer to additional file 2. Please refer to additional file 2.

23 Authors are advised to reduce the paragraph content as already described in the table. We removed two tables-table 4 and 5.

24 Authors are advised to provide the details of the validation of the competency assessment tool. Which tests were performed during the pre-testing of the competency assessment tool? We developed the CAT using a content validation (Stage 4) approach. Later, under stage 5, we pre-tested the CAT in one of the public health facilities to understand the construct regarding language clarity and local programmatic variations. Please refer to ln no 467 to 475 on pages 15 and 16.

25 Discussion The discussion regarding the factors related to coping with pre-service education is limited. The authors advised adding more possible measures to cope with these challenges at the government level. We made the needful changes. Please refer to ln no 493 to 515 on pages 16 and 17.

26 The discussion regarding the importance and implications of competence assessment was very limited, making this portion weak. We made the needful changes. Please refer to ln no 522 to 536 on page 17.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Naeem Mubarak, Editor

Developing a competency assessment framework for pharmacists in primary health care settings in India

PONE-D-24-33395R1

Dear Dr. Sanjeev Kumar,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Naeem Mubarak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript requires no further changes.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The author has thoroughly addressed all the comments and suggestions. After reviewing the updated manuscript, I find the revisions satisfactory and in line with the objectives of the work. At this stage, I have no further suggestions or comments to add.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: No

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Formally Accepted
Acceptance Letter - Naeem Mubarak, Editor

PONE-D-24-33395R1

PLOS ONE

Dear Dr. Kumar,

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on behalf of

Dr Naeem Mubarak

Academic Editor

PLOS ONE

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