{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T18:14:38Z","timestamp":1783707278867,"version":"3.55.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community and retail pharmacies are essential to primary healthcare delivery in Pakistan; however, significant disparities in workforce distribution, medicine availability, and service quality persist between urban and rural settings. The absence of standardized performance monitoring systems limits the ability to identify and address these inequities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To design, develop, and validate a key performance indicators (KPI) dashboard for monitoring equity in community and retail pharmacy service delivery in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multi-phase methodological study was conducted. Phase I involved qualitative needs assessment using semi-structured interviews with pharmacists, technicians, and administrators (n\u2009=\u200928) to identify service gaps. Phase II employed a modified Delphi technique with expert panel consensus to refine KPIs. Phase III included dashboard development using Microsoft Power BI. Phase IV comprised validation through content validity index (CVI) assessment and usability testing using the System Usability Scale (SUS). Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven KPIs across workforce, efficiency, quality, safety, availability, and equity domains were finalized. Significant disparities were observed between urban and rural pharmacies, including higher stock-out duration (13.1 vs 6.2 days), lower counseling rates (55% vs 78%), and poorer workforce ratios (1:120 vs 1:65). The dashboard demonstrated high usability (SUS score: 82.5) and strong content validity (S-CVI\/Ave: 0.89).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The developed KPI dashboard provides a feasible and scalable tool for real-time monitoring of pharmacy performance and equity. Its implementation can support evidence-based decision-making and improve equitable pharmaceutical service delivery in Pakistan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349972","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:35:33Z","timestamp":1783704933000},"page":"e0349972","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Design and validation of a key performance indicator dashboard for equity in community and retail pharmacy services in Pakistan"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8894-3692","authenticated-orcid":true,"given":"Muhammad","family":"Hammad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2676-2367","authenticated-orcid":true,"given":"Rasikh","family":"Arif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Zeb","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Nasir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"issue":"1","key":"pone.0349972.ref001","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1186\/s12913-025-13387-0","article-title":"Primary health care roles of community pharmacists in low- and middle-income countries: a mixed methods systematic review","volume":"25","author":"EW Hedima","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"pone.0349972.ref002","doi-asserted-by":"crossref","first-page":"12721","DOI":"10.3389\/jpps.2024.12721","article-title":"Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries","volume":"27","author":"R Raju","year":"2024","journal-title":"J Pharm Pharm Sci"},{"issue":"10","key":"pone.0349972.ref003","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/MLR.0000000000002196","article-title":"Defining Pharmacy Access: A Review of Pharmacy-Level Research in the United States","volume":"63","author":"EE Duru","year":"2025","journal-title":"Med Care"},{"issue":"6","key":"pone.0349972.ref004","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.51253\/pafmj.v73i6.8649","article-title":"Balance scorecard (BSC): Incorporating \u201cKey performance indicators\u201d (KPI) in the Evaluation of the Healthcare System","volume":"73","author":"SH Khan","year":"2023","journal-title":"Pak Armed Forces Med J"},{"issue":"3","key":"pone.0349972.ref005","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5530\/PTB.2018.4.15","article-title":"National Survey of Medication Safety Practice: Preparation of Medication and Dispensing at Primary Healthcare Centers\/Community Pharmacies in Riyadh, Saudi Arabia","volume":"4","author":"YA Alomi","year":"2019","journal-title":"PTB Reports"},{"issue":"2","key":"pone.0349972.ref006","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2019-000849","article-title":"Effect of a formalised discharge process which includes electronic delivery of prescriptions to pharmacies on the incidence of delayed prescription retrieval","volume":"9","author":"AK Sachedina","year":"2020","journal-title":"BMJ Open Quality"},{"issue":"1","key":"pone.0349972.ref007","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s11096-023-01631-8","article-title":"Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care: a systematic literature review and international consensus development","volume":"46","author":"K Fujita","year":"2024","journal-title":"Int J Clin Pharm"},{"issue":"2","key":"pone.0349972.ref008","article-title":"Developing a quality framework for community pharmacy: a systematic review of international literature","volume":"14","author":"AMK Hindi","year":"2024","journal-title":"BMJ Open"},{"key":"pone.0349972.ref009","doi-asserted-by":"crossref","DOI":"10.1093\/heapol\/czz119","article-title":"Access to medicines through health systems in low- and middle-income countries","volume":"34","author":"S Ozawa","year":"2019","journal-title":"Health Policy Plan"},{"key":"pone.0349972.ref010","volume-title":"Medicines in health systems: advancing access, affordability and appropriate use","author":"M Bigdeli","year":"2014"},{"key":"pone.0349972.ref011","doi-asserted-by":"crossref","first-page":"1512006","DOI":"10.3389\/fpubh.2024.1512006","article-title":"World Health Day 2023: Progress and New Perspectives in Achieving \u2018Health for All\u2019","volume":"12","author":"MD Mart\u00ednez","year":"2024","journal-title":"Frontiers in Public Health"},{"issue":"05","key":"pone.0349972.ref012","doi-asserted-by":"crossref","first-page":"425","DOI":"10.4236\/pp.2013.45060","article-title":"A Literature Review: Pharmaceutical Care an Evolving Role at Community Pharmacies in Pakistan","volume":"04","author":"A Hussain","year":"2013","journal-title":"PP"},{"issue":"3","key":"pone.0349972.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.61919\/jhrr.v4i3.1515","article-title":"E-Pharmacy in Rural Pakistan: Evaluating Platforms\u2019 Reach, Opportunities, and Challenges","volume":"4","author":"S Naz","year":"2024","journal-title":"Journal of Health and Rehabilitation Research"},{"issue":"5","key":"pone.0349972.ref014","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.12669\/pjms.325.11416","article-title":"Quality of pharmacy services and regulatory compliance","volume":"32","author":"SA Jawaid","year":"2016","journal-title":"Pak J Med Sci"},{"issue":"1","key":"pone.0349972.ref015","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13012-023-01304-0","article-title":"A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities","volume":"18","author":"P Gustafson","year":"2023","journal-title":"Implement Sci"},{"issue":"4","key":"pone.0349972.ref016","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/PXH.0000000000000044","article-title":"Data analytics in pharmacy practice \u2013 current review and future directions and recommendations","volume":"3","author":"V Khalil","year":"2024","journal-title":"Current Opinion in Epidemiology and Public Health"},{"issue":"8","key":"pone.0349972.ref017","article-title":"Risk factors for contrast-induced acute kidney injury (CI-AKI): protocol for systematic review and meta-analysis","volume":"9","author":"Y Liu","year":"2019","journal-title":"BMJ Open"},{"issue":"11","key":"pone.0349972.ref018","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution","volume":"6","author":"ME Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pone.0349972.ref019","article-title":"The Delphi technique: making sense of consensus","volume":"12","author":"CC Hsu","year":"2007","journal-title":"Practical Assessment, Research, and Evaluation"},{"issue":"6","key":"pone.0349972.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0020476","article-title":"Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review","volume":"6","author":"R Boulkedid","year":"2011","journal-title":"PLoS One"},{"issue":"2","key":"pone.0349972.ref021","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"issue":"1","key":"pone.0349972.ref022","doi-asserted-by":"crossref","first-page":"2578803","DOI":"10.1080\/20523211.2025.2578803","article-title":"Community pharmacy-led point-of-care testing (POCT): expanding roles and strengthening health systems in low- and middle-income countries (LMICs)","volume":"18","author":"K Alshorman","year":"2025","journal-title":"J Pharm Policy Pract"},{"issue":"2","key":"pone.0349972.ref023","doi-asserted-by":"crossref","first-page":"142","DOI":"10.56557\/jomahr\/2025\/v10i29632","article-title":"Community-Based Healthcare Systems: A Strategic Lever for Achieving Health Equity and Universal Health Coverage","volume":"10","author":"E Foster-Pagaebi","year":"2025","journal-title":"J Med Health Res"},{"issue":"2","key":"pone.0349972.ref024","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3390\/pharmacy11020060","article-title":"Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care","volume":"11","author":"T Grimes","year":"2023","journal-title":"Pharmacy"},{"key":"pone.0349972.ref025","unstructured":"International Pharmaceutical Federation FIP. Global situation report on pharmacy 2025. The Hague: International Pharmaceutical Federation. 2025. https:\/\/www.fip.org"},{"key":"pone.0349972.ref026","unstructured":"World Health Organization. Health workforce: Pharmaceutical personnel \u2013 density of pharmacists (per 1,000 population). 2026. https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/indicator-groups\/indicator-group-details\/GHO\/pharmaceutical-personnel"},{"issue":"11","key":"pone.0349972.ref027","article-title":"Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya","volume":"5","author":"DN Tran","year":"2020","journal-title":"BMJ Global Health"},{"key":"pone.0349972.ref028","article-title":"Challenges and Opportunities in Community Pharmacies in Bangladesh: A Qualitative Study","author":"MdB Amin","year":"2025","journal-title":"Userhub J"},{"issue":"5","key":"pone.0349972.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0063515","article-title":"Access to essential medicines in Pakistan: policy and health systems research concerns","volume":"8","author":"S Zaidi","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0349972.ref030","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40545-022-00431-1","article-title":"Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review","volume":"15","author":"S Shrestha","year":"2022","journal-title":"J Pharm Policy Pract"},{"key":"pone.0349972.ref031","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/978-3-031-62332-5_8","article-title":"Digitization of healthcare in LMICs: challenges and opportunities in data governance and data infrastructure","author":"Z Kozlakidis","year":"2024","journal-title":"Digitalization of medicine in low-and middle-income countries: paradigm changes in healthcare and biomedical research"},{"key":"pone.0349972.ref032","doi-asserted-by":"crossref","first-page":"847696","DOI":"10.3389\/fpubh.2022.847696","article-title":"Health Disparities in Pharmacy Practice Within the Community: Let\u2019s Brainstorm for Solutions","volume":"10","author":"K Hurley-Kim","year":"2022","journal-title":"Front Public Health"},{"issue":"3","key":"pone.0349972.ref033","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3390\/pharmacy11030093","article-title":"Racial and Ethnic Disparities in Community-Based Pharmacies: A Scoping Review","volume":"11","author":"TD Hughes","year":"2023","journal-title":"Pharmacy"},{"issue":"1","key":"pone.0349972.ref034","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s41043-024-00550-2","article-title":"The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift","volume":"43","author":"A Almeman","year":"2024","journal-title":"J Health Popul Nutr"},{"issue":"1","key":"pone.0349972.ref035","doi-asserted-by":"crossref","first-page":"102256","DOI":"10.1016\/j.japh.2024.102256","article-title":"Act for the future of community pharmacy","volume":"65","author":"JL Bacci","year":"2025","journal-title":"J Am Pharm Assoc (2003)"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349972","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:35:40Z","timestamp":1783704940000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349972"}},"subtitle":[],"editor":[{"given":"Ibrahim","family":"Jahun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349972","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}