As our new fellows and infectious diseases pharmacy residents begin this academic year, we are witnessing the nascent but pivotal relationship develop between the ID clinician and the pharmacist. Earlier this year, a study published in Clinical Infectious Diseases examined that relationship and its impact on patient care. As a pharmacist and ID physician dyad, we have rarely found published literature that details the important relationship of mutual trust and teamwork between our disciplines.
What the study found
This multicenter study aimed to quantify and characterize the types of questions that ID pharmacists field from ID clinicians, as well as the resulting impact on patient care. The study included both academic and nonacademic centers and found that ID pharmacists documented receipt of 1,518 curbside questions over six months, most commonly involving regimen optimization, dosing, safety and monitoring, and antimicrobial resistance.
Inquiries came by phone, text, internal secure messaging platforms or in person. Notably, 89% of questions led to pharmacist-driven changes in clinical management, including dose adjustments, new antimicrobial selections and new monitoring plans, thus demonstrating the substantial impact of ID pharmacists on patient care. The median time spent was 11.3 minutes per question, totaling 287 hours. ID pharmacists in nonacademic settings received more inquiries per day, often from ID attending physicians, than those at academic medical centers.
Overall, the results underscore the essential role of ID pharmacists in multidisciplinary teams, their influence on clinical decision-making and the need for adequate ID pharmacist staffing to support ID services.
ID pharmacy perspective
ID pharmacists often receive “curbside” questions that help optimize patient diagnosis and treatment across the health care system. These are essential services that are often outside the normal daily patient care workflow set up to manage antimicrobial stewardship needs. This article does a phenomenal job objectively characterizing efforts of ID pharmacists, and it underscores the important relationship between ID physicians and ID pharmacists. Describing these efforts could be important in describing resources needed to help provide patient care in complex areas frequently involving multidrug-resistant organisms, promoting optimal dosing regimens, addressing transition of care needs for complex infections, and managing adverse effects and drug interactions.
ID physician perspective
ID pharmacists are integral contributors of the patient care team. They are often in the background, ensuring that care is optimized not just for the single patient but for the larger institution. Through phone, text, e-messaging and in-person discussion, ID pharmacists impact patient care. This study notes that our ID pharmacist partners devote significant time and effort to inquiries from ID consultants, which often go undocumented and are not compensated but are highly valued. This impact is not routinely captured when discussing program enhancements or maintaining staffing for antimicrobial stewardship programs in a period of financial austerity in health care and an environment questioning the role of artificial intelligence in patient-level clinical care.
This study supports that the collaboration between our ID pharmacists and ID clinicians is fundamental to caring for complex patients, and “phoning a friend” is a common practice with a significant impact on clinical management.
Learn more about IDSA’s Antimicrobial Stewardship Centers of Excellence program.
