Development and Validation of an Instrument to Assess Clinical Competencies in the Management of Self-Limiting Health Conditions (Psal-Brazil)
Main Article Content
Keywords
Pharmaceutical Care, Surveys and Questionnaires, Validation Studies, Clinical Pharmacy, Pharmaceutical Education
Abstract
Background: The management of self-limiting health conditions (PSAL) is a service generally performed by professional pharmacists in community pharmacies, which directly impacts in the reduction of demand for other levels of care in the public health system. To achieve this, pharmacists must invest in their continued education in order to further develop their clinical skills. Objective: To develop and validate a clinical skills assessment instrument to be used to train pharmaceutical professionals and undergraduate students to manage self-limiting health conditions. Methods: Firstly, the assessment instrument was developed, based on a literature review. Then, the instrument was validated using the Delphi Method. Experts were invited to evaluate the instrument on five criteria. For content validation, the Content Validation Index (CVI) was calculated and items were considered validated if the CVI ≥ 0.80. For internal consistency analysis, Cronbach's Alpha was used. Results: Of the 26 invited experts, 19 participated in the first round and 17 in the second. Items (13) Monitoring and (14) Verbal communication, from the initial version, did not reach consensus in terms of objectivity (0.79) and clarity (0.79), respectively. After the changes suggested by the experts were made, a second round was carried out, in which all items reached consensus, CVI ≥ 0.80. Other suggestions were accepted and the final version of the instrument addressed 15 questions to analyze the quality of the service and one question to assess the level of clinical skills development, as initial, intermediate or advanced. The Cronbach's Alpha average increased significantly from the first to the second round. Conclusion: The PSAL-BRASIL assessment instrument was validated with a desirable level of consensus and demonstrated a level of internal consistency classified as almost perfect, seeking to be a reference in the development of clinical skills necessary for pharmaceutical care of self-limiting health conditions.
References
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23. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297-334. https://link.springer.com/article/10.1007/BF02310555
24. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33(1):159.
25. Estrela M, Roque F, Silva TM, Zapata-Cachafeiro M, Figueiras A, Herdeiro MT. Validation of the eHealthResp online course for pharmacists and physicians: A Delphi method approach. Biomed Pharmacother. 2021;140:111739. https://doi.org/10.1016/j.biopha.2021.111739
26. Meredith AH, Wilkinson TA, Campi JA, Meagher CG, Ott MA. Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials. J Pharm Pract. 2021;34(5):678-84. https://doi.org/10.1177/0897190019894146
27. Graham B, Regehr G, Wright JG. Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol. 2003;56(12):1150-6. https://doi.org/10.1016/s0895-4356(03)00211-7
28. Bourne RS, Shulman R, Jennings JK. Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation. Int J Pharm Pract. 2018;26(6):534-40. https://doi.org/10.1111/ijpp.12430
29. Grey E, Harris M, Rodham K, Weiss MC. Characteristics of good quality pharmaceutical services common to community pharmacies and dispensing general practices. Int J Pharm Pract. 2016;24(5):311-8. https://doi.org/10.1111/ijpp.12253
30. Nassar RI, Saini B, Obeidat NM, Basheti IA. Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ). Pharmacy Practice. 2022;20(2):2673. https://doi.org/10.18549/PHARMPRACT.2022.2.2673
31. Vituri DW. Desenvolvimento e validação de um instrumento para avaliação da qualidade do cuidado de enfermagem. MS thesis. Universidade Estadual de Maringá, 2007.
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33. Clay PG, Burns AL, Isetts BJ, Hirsch JD, Kliethermes MA, Planas, et al. PaCIR: A tool to enhance pharmacist patient care intervention reporting. Journal of the American Pharmacists Association: JAPhA. 2019;59(5): 615-23. https://doi.org/10.1016/j. japh.2019.07.008
34. Smith SR. AMEE guide no. 14: outcome-based education: part 2-planning, implementing and evaluating a competency-based curriculum. Medical teacher 1999;21(1):15-22.
35. Galato D, Alano GM, França TF, Vieira AC. Exame Clínico Objetivo Estruturado (ECOE): Uma experiência de ensino por meio de simulação do atendimento farmacêutico. Interface: Communication, Health, Education. 2011;15(36):309-19. https://doi.org/10.1590/S1414-32832010005000032
36. Rocha KSS, Santos SC, Boaventura TC, Santos Júnior GA, Araújo DCSA, Silvestre CC, et al. Development and content validation of an instrument to support pharmaceutical counselling for dispensing of prescribed medicines. Journal of Evaluation in Clinical Practice. 2020;26(1):134-41. https://doi.org/10.1111/JEP.13102
37. Lima TM. Desenvolvimento e validação de indicadores para avaliação da qualidade do acompanhamento farmacoterapêutico.Diss. Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-09112018-102237/pt-br.php
38. Coelho MMA, Mesquita AR, Lima MG. Perceptions of Pharmacy students about their competences for professional practice in community pharmacy. Brazilian Journal of Pharmaceutical Sciences. 2022;58. https://doi.org/10.1590/S2175-97902020000318730
39. Mills E, Laaksonen R, Bates I, Davies G., Duggan C. Self-assessment of competence in a community pharmacy setting. Pharmacy Education. 2005;5(3):63-7. https://doi.org/10.1080/15602210500282491
40. Antomarchi J, Delotte J, Jordan A, Tran A, Bongain A. Development and validation of an objective structured assessment of technical skill tool for the practice of vertex presentation delivery. Archives of Gynecology and Obstetrics.2014;290(2):243-7. https://doi.org/10.1007/S00404-014-3204X/FIGURES/1
41. Chipman JG, Schmitz, CC. Using Objective Structured Assessment of Technical Skills to Evaluate a Basic Skills Simulation Curriculum for First-Year Surgical Residents. Journal of the American College of Surgeons. 2009;209(3):364-370.e2. https://doi.org/10.1016/J.JAMCOLLSURG.2009.05.005
42. Wass V, van der Vleuten C, Shatzer J, Jones R. Assessment of clinical competence. The Lancet. 2001; 357(9260):945-9. https://doi.org/10.1016/S0140-6736(00)04221-5
43. Troncon LEA. Utilização de pacientes simulados no ensino e na avaliação de habilidades clínicas. Medicina (Ribeirão Preto). 2007;40(2):180-191. https://www.revistas.usp.br/rmrp/article/view/315/316
2. Amador-Fernández N, Benrimoj SI, Lima AOL, García-Cárdenas V, Gastelurrutia MÁ, Berger J, et al. Strengthening patients’ triage in community pharmacies: A cluster randomised controlled trial to evaluate the clinical impact of a minor ailment service. PLoS One. 2022;17(10):e0275252-e0275252. https://doi.org/10.1371/journal.pone.0275252
3. Lee R, McCarthy L. Canadian “minor ailments” programs: Unanswered questions. Can Pharm J. 2015;148(6):302-4. https://doi.org/10.1177/1715163515611144
4. Paudyal V, Watson MC, Sach T, Porteous T, Bond CM, Wright DJ, et al. Are pharmacy-based minor ailment schemes a substitute for other service providers? British Journal of General Practice. 2013;63(612):e472-e481. https://doi.org/10.3399/bjgp13X669194
5. Lima SHP de, Silva DCS, Silva GV, Melo LGA, Oliveira LAC, Bezerra L JC, et al. Cuidados farmacêuticos no manejo de problemas
de saúde autolimitados: gripe / Pharmaceutical care in the management of self-limited health problems: influenza. Brazilian J
Dev. 2022;8(7):50516-24. https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/50127
6. Mendonça SAM, De Freitas EL, De Oliveira DR. Competencies for the provision of comprehensive medication management
services in an experiential learning project. PLoS One. 2022;12(9):e0185415. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185415
7. Mesquita AR, Souza WM, Boaventura TC, Barros IMC, Antoniolli AR, Silva WB, et al. The Effect of Active Learning Methodologies on the Teaching of Pharmaceutical Care in a Brazilian Pharmacy Faculty. PLoS One [Internet]. 2015;10(5):e0123141. https://doi.org/10.1371/journal.pone.0123141
8. Araújo M, Barros VA, Lima AB. A simulação realística como ferramenta de ensino em uma pós-graduação de farmácia clínica: relato de experiência. IJHE - Interdiscip J Heal Educ. 2017;2(2). https://ijhe.emnuvens.com.br/ijhe/article/view/347
9. Morais YJ, Santos VRC, Soler O. Realistic simulation as a mediator of the teaching-learning process in undergraduate Pharmacy: systematic review. Res Soc Dev. 2021;10(10):e241101018783-e241101018783. https://rsdjournal.org/index.php/rsd/article/view/18783
10. Costa AP, Reis TM, Santana RS. Elaboração de diretriz clínica para o cuidado farmacêutico na febre article info abstract. 2022;12(03):54550-3. https://doi.org/10.37118/ijdr.24038.03.2022
11. Costa, AP, Alves BMCS, Silva DLM, Martins RLM, Silva FA, Zimmermann IR, et al. Clinical guidelines for smoking cessation: comparative analysis with AGREE II. BRASÍLIA MÉDICA, 2022.
12. Lima BFR, Alves BMCS, Tavares NUL, Lima RF, Ginani VC, Reis TM, et al. Quality appraisal of clinical guidelines for the management of constipation according to AGREE II instrument. Res Soc Dev [Internet]. 2022;11(3):e57911327086-e57911327086. https://rsdjournal.org/index.php/rsd/article/view/27086
13. Vaz JMA, Alves BMCS, Duarte DB, Marques LAM, Santana RS. Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method. Cephalalgia. 2022;42(3):239-49. https://doi.org/10.1177/03331024211037297
14. Costa AP, Alves BMCS, Silva DLM, Martins RLM, Silva FA, Zimmermann IR, et al. Diretrizes clínicas para cessação do tabagismo: análise comparativa com o agree ii. Brasília Med 2022;59(Anual):1-11. https://doi.org/10.5935/2236-5117.2022v59a285
15. Jaam M, Awaisu A, El-Awaisi A, Stewart D, El Hajj MS. Use of the Delphi technique in pharmacy practice research. Res Soc Adm Pharm [Internet]. 2022;18(1):2237-48. https://doi.org/10.1016/j.sapharm.2021.06.028
16. Staykova MP. Rediscovering the Delphi Technique: A Review of the Literature. Adv Soc Sci Res J. 2019;6(1):218-29. https://journals.scholarpublishing.org/index.php/ASSRJ/article/view/5959
17. Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684-706. https://doi.org/10.1177/0269216317690685
18. Vinuto J. A amostragem em bola de neve na pesquisa qualitativa. Tematicas. 2014 22(44):203-20. https://econtents. bc.unicamp.br/inpec/index.php/tematicas/article/view/10977
19. Olsen AA, Wolcott MD, Haines ST, Janke KK, McLaughlin JE. How to use the Delphi method to aid in decision making and build consensus in pharmacy education. Curr Pharm Teach Learn. 2021;13(10):1376-85. https://doi.org/10.1016/j.cptl.2021.07.018
20. Rubio D, Berg-Weger M, Tebb S, Lee E, Rauch S. Objectifying content validity: conducting a content validity study in social work research - Documento - Gale Academic OneFile. Soc Work Res. 2003; 27(2):94-111.https://gogale.ez54.periodicos.capes.gov. br/ps/i.do?p=AONE&u=capes&id=GALE%7CA105367299&v=2.1&it=r
21. Vituri DW, Matsuda LM. Validação de conteúdo de indicadores de qualidade para avaliação do cuidado de enfermagem. Rev da Esc Enferm da USP. 2009;43(2):429-37. https://doi.org/10.1590/s0080-62342009000200024
22. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Cien Saude Colet. 2011;16(7):3061-8. https://doi.org/10.1590/s1413-81232011000800006
23. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297-334. https://link.springer.com/article/10.1007/BF02310555
24. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33(1):159.
25. Estrela M, Roque F, Silva TM, Zapata-Cachafeiro M, Figueiras A, Herdeiro MT. Validation of the eHealthResp online course for pharmacists and physicians: A Delphi method approach. Biomed Pharmacother. 2021;140:111739. https://doi.org/10.1016/j.biopha.2021.111739
26. Meredith AH, Wilkinson TA, Campi JA, Meagher CG, Ott MA. Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials. J Pharm Pract. 2021;34(5):678-84. https://doi.org/10.1177/0897190019894146
27. Graham B, Regehr G, Wright JG. Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol. 2003;56(12):1150-6. https://doi.org/10.1016/s0895-4356(03)00211-7
28. Bourne RS, Shulman R, Jennings JK. Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation. Int J Pharm Pract. 2018;26(6):534-40. https://doi.org/10.1111/ijpp.12430
29. Grey E, Harris M, Rodham K, Weiss MC. Characteristics of good quality pharmaceutical services common to community pharmacies and dispensing general practices. Int J Pharm Pract. 2016;24(5):311-8. https://doi.org/10.1111/ijpp.12253
30. Nassar RI, Saini B, Obeidat NM, Basheti IA. Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ). Pharmacy Practice. 2022;20(2):2673. https://doi.org/10.18549/PHARMPRACT.2022.2.2673
31. Vituri DW. Desenvolvimento e validação de um instrumento para avaliação da qualidade do cuidado de enfermagem. MS thesis. Universidade Estadual de Maringá, 2007.
32. Araújo DCSA, Menezes PWDS, Cavaco AMDN, Mesquita AR, Lyra Júnior DP. Instrumentos para avaliação de habilidades de comunicação no cuidado em saúde no Brasil: uma revisão de escopo. Interface - Comunicação, Saúde, Educação. 2020;24:1- 13. https://doi.org/10.1590/INTERFACE.200030
33. Clay PG, Burns AL, Isetts BJ, Hirsch JD, Kliethermes MA, Planas, et al. PaCIR: A tool to enhance pharmacist patient care intervention reporting. Journal of the American Pharmacists Association: JAPhA. 2019;59(5): 615-23. https://doi.org/10.1016/j. japh.2019.07.008
34. Smith SR. AMEE guide no. 14: outcome-based education: part 2-planning, implementing and evaluating a competency-based curriculum. Medical teacher 1999;21(1):15-22.
35. Galato D, Alano GM, França TF, Vieira AC. Exame Clínico Objetivo Estruturado (ECOE): Uma experiência de ensino por meio de simulação do atendimento farmacêutico. Interface: Communication, Health, Education. 2011;15(36):309-19. https://doi.org/10.1590/S1414-32832010005000032
36. Rocha KSS, Santos SC, Boaventura TC, Santos Júnior GA, Araújo DCSA, Silvestre CC, et al. Development and content validation of an instrument to support pharmaceutical counselling for dispensing of prescribed medicines. Journal of Evaluation in Clinical Practice. 2020;26(1):134-41. https://doi.org/10.1111/JEP.13102
37. Lima TM. Desenvolvimento e validação de indicadores para avaliação da qualidade do acompanhamento farmacoterapêutico.Diss. Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-09112018-102237/pt-br.php
38. Coelho MMA, Mesquita AR, Lima MG. Perceptions of Pharmacy students about their competences for professional practice in community pharmacy. Brazilian Journal of Pharmaceutical Sciences. 2022;58. https://doi.org/10.1590/S2175-97902020000318730
39. Mills E, Laaksonen R, Bates I, Davies G., Duggan C. Self-assessment of competence in a community pharmacy setting. Pharmacy Education. 2005;5(3):63-7. https://doi.org/10.1080/15602210500282491
40. Antomarchi J, Delotte J, Jordan A, Tran A, Bongain A. Development and validation of an objective structured assessment of technical skill tool for the practice of vertex presentation delivery. Archives of Gynecology and Obstetrics.2014;290(2):243-7. https://doi.org/10.1007/S00404-014-3204X/FIGURES/1
41. Chipman JG, Schmitz, CC. Using Objective Structured Assessment of Technical Skills to Evaluate a Basic Skills Simulation Curriculum for First-Year Surgical Residents. Journal of the American College of Surgeons. 2009;209(3):364-370.e2. https://doi.org/10.1016/J.JAMCOLLSURG.2009.05.005
42. Wass V, van der Vleuten C, Shatzer J, Jones R. Assessment of clinical competence. The Lancet. 2001; 357(9260):945-9. https://doi.org/10.1016/S0140-6736(00)04221-5
43. Troncon LEA. Utilização de pacientes simulados no ensino e na avaliação de habilidades clínicas. Medicina (Ribeirão Preto). 2007;40(2):180-191. https://www.revistas.usp.br/rmrp/article/view/315/316
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Development and Validation of an Instrument to Assess Clinical Competencies in the Management of Self-Limiting Health Conditions (Psal-Brazil). Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Apr. 21];23(1):1-12. Available from: https://pharmacypractice.org/index.php/pp/article/view/3029
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How to Cite
1.
Development and Validation of an Instrument to Assess Clinical Competencies in the Management of Self-Limiting Health Conditions (Psal-Brazil). Pharm Pract (Granada) [Internet]. 2025 Mar. 26 [cited 2025 Apr. 21];23(1):1-12. Available from: https://pharmacypractice.org/index.php/pp/article/view/3029