Proposed Joint Commission Standard Spotlights Infectious Diseases Pharmacist Predicament

The Joint Commission's proposed standard on antimicrobial stewardship means higher demand for infectious diseases pharmacists and physicians, but will there be enough specialists to satisfy it?

The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 20,000 health care organizers and programs in the United States.1

This organization is an important driver of safety and quality in health care today, and many pharmacists are intimately familiar with it.

In November 2015, the Joint Commission proposed a new standard for antimicrobial stewardship that would apply to critical-access hospitals, general hospitals, ambulatory health care, nursing care centers, and office-based surgical sites. As it stands, the proposed standard (MM.09.01.01) would require all of these settings to have an antimicrobial stewardship program.2

While antimicrobial resistance threatens human health worldwide and concerns persist regarding the sluggish antimicrobial drug development pipeline, antimicrobial stewardship efforts have become an important component in the fight to preserve existing antimicrobial agents.3-6

Guidelines for developing an institutional program to enhance antimicrobial stewardship produced by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America have identified the 2 core members of an antimicrobial stewardship program as an infectious diseases physician and a clinical pharmacist with infectious diseases training.6

For pharmacists who seek a clinical infectious diseases specialist position, the Society of Infectious Diseases Pharmacists and the Infectious Diseases Practice and Research Network of the American College of Clinical Pharmacy has recommended completion of specialty residency training.7

For physicians to become eligible to take the American Board of Internal Medicine certification exam in infectious diseases, 2 years of infectious diseases fellowship must be completed.8

Unfortunately, there is a disconnect between the anticipated demand for core antimicrobial stewardship program personnel and the current trajectory of the infectious diseases physician and infectious diseases pharmacist workforces.

As this proposed Joint Commission standard and other major initiatives make establishing antimicrobial stewardship programs a priority, it can be expected that the demand for core program personnel will increase.

Meanwhile, the supply of infectious diseases physicians and pharmacists is a point of considerable concern.

An assessment of infectious diseases pharmacy training programs performed in late 2014 identified just 89 postgraduate training programs in existence.9 On a positive note, data from the 2014 pharmacy residency match shows that 94% of infectious diseases pharmacy residencies were filled.13

As for the state of affairs for infectious diseases physicians, things continue to trend from bad to worse.

The 2016 infectious diseases fellowship match results include striking statistics, such as that more than 80% of programs were left with at least one unfilled position, 60% of fellowships were unfilled, and 117 training positions were unfilled.12

Considering these points concomitantly, the existing capacity and expected output from physician and pharmacist infectious diseases training programs is far from enough to support the many thousands of organizations and programs certified by the Joint Commission to which MM.09.01.01 would apply.

As the new Joint Commission standard on antimicrobial stewardship moves forward from proposed status, it is anticipated to draw more attention to the current infectious diseases physician and pharmacist workforce predicament.

As an infectious diseases pharmacist, it is my hope that this proposed standard will do the following:

1. Draw more awareness to the problem of antimicrobial resistance.

2. Lead to the creation of effective strategies that support this important new standard.

The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

References

1. The Joint Commission. About the joint commission. http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx. Accessed December 7, 2015.

2. The Joint Commission. Proposed new standard on antimicrobial stewardship. https://jointcommission.az1.qualtrics.com/CP/File.php?F=F_5tDHGzIVDMHenDn. Accessed December 7, 2015.

3. US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed December 7, 2015.

4. World Health Organization. Antimicrobial resistance global report on surveillance. 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1. Accessed December 7, 2015.

5. Boucher HW, et al. 10 x ’20 progress--development of new drugs active against gram-negative bacilli: an update from the Infectious Diseases Society of America. 2013;56(12):1685-94.

6. Dellit TH, et al. Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159-77.

7. Ernst EJ, et al. Recommendations for training and certification for pharmacists practicing in infectious diseases pharmacotherapy. Pharmacother. 2009;29:482-8.

8. Infectious Diseases Society of America. Recommendations for ID training program curricula. http://www.idsociety.org/ID_Curriculum/. Accessed December 7, 2015.

9. Gauthier TP, et al. Clinical infectious diseases pharmacists in the United States: a problem of both supply and demand. Clin Infect Dis. 2015; 60(5): 826-827.

10. Chandrasekar P, et al. Infectious diseases subspecialty: declining demand challenges and opportunities. Clin Infect Dis. 2014;59(11):1593-8.

11. Chandrasekar P. Bad news to worse news: 2015 infectious diseases fellowship match results. Clin Infect Dis. 2015;60(9):1438.

12. Controversies in hospital infection prevention. Annual ID match day post: someone get a fire extinguisher! http://haicontroversies.blogspot.com/2015/12/annual-id-match-day-post-someone-get.html. Accessed December 7, 2015.

13. ASHP residency matching program. Summary of programs and positions offered and filled for the 2014 match. https://www.natmatch.com/ashprmp/stats/2014summpos.html. Accessed December 7, 2015.