We describe the proportion of pharmacist representation among current and corresponding prior editions of Infectious Diseases Society of America (IDSA) clinical practice guidelines (CPGs). Pharmacist representation was 13% and 21% in previous and current editions, respectively, increasing significantly since 2011. We advocate for continued collaborations between IDSA and pharmacy organizations to enhance multidisciplinary representation in CPGs

Bookstaver, P Brandon

Davis, Sarah Elizabeth

Freeman, Lauren K

Lindsay, Jasmine N

Luther, Vera P

Norman, Brian F

Ohl, Christopher A

Thompkins, April W

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University of South Carolina Scholar Commons Faculty Publications Pharmacy, College of 11-1-2018 Multidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases Pharmacists Lauren K. Freeman University of South Carolina - Columbia Jasmine N. Lindsay University of South Carolina - Columbia Sarah Elizabeth Davis University of South Carolina - Columbia Brian F. Norman University of South Carolina - Columbia April W. Thompkins University of South Carolina - Columbia See next page for additional authors Follow this and additional works at: https://scholarcommons.sc.edu/phar_facpub  Part of the Pharmacy and Pharmaceutical Sciences Commons Publication Info Published in Open Forum Infectious Diseases, Issue 11, 2018, pages ofy287-. © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com This Article is brought to you by the Pharmacy, College of at Scholar Commons. It has been accepted for inclusion in Faculty Publications by an authorized administrator of Scholar Commons. For more information, please contact digres@mailbox.sc.edu. Author(s) Lauren K. Freeman, Jasmine N. Lindsay, Sarah Elizabeth Davis, Brian F. Norman, April W. Thompkins, Vera P. Luther, Christopher A. Ohl, and P Brandon Bookstaver This article is available at Scholar Commons: https://scholarcommons.sc.edu/phar_facpub/31 BRIEF REPORT • OFID • 1Open Forum Infectious DiseasesB R I E F  R E P O R TMultidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases PharmacistsLauren K. Freeman,1,a Jasmine N. Lindsay,1 Sarah Elizabeth B. Davis,1  Brian F. Norman,1,b April W. Thompkins,1,c Vera P. Luther,2 Christopher A. Ohl,2 and  P. Brandon Bookstaver3,1South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina; 2Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; 3Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, South Carolina    We describe the proportion of pharmacist representation among current and corresponding prior editions of Infectious Diseases Society of America (IDSA) clinical practice guidelines (CPGs). Pharmacist representation was 13% and 21% in previ-ous and current editions, respectively, increasing significantly since 2011. We advocate for continued collaborations between IDSA and pharmacy organizations to enhance multidiscipli-nary representation in CPGs.Keywords. authorship; clinical practice guidelines; GRADE criteria; infectious diseases; pharmacist. Medical societies develop clinical practice guidelines (CPGs) to facilitate and inform evidence-based patient care through the synthesis of best available evidence, often by consensus con-ference or expert panels. Standards for developing trustworthy CPGs, developed by the National Academy of Medicine (NAM; formerly the Institute of Medicine), recommend that guide-line development committees be composed of experts from a variety of disciplinary backgrounds, including both clinical and methodological specialists [1]. A diverse, interdisciplinary committee is especially important when recommendations must be made from low-level evidence or when applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria in evaluating data [2].Infectious diseases pharmacists play a key role in team-based patient care and are recognized as important members of the infectious diseases community. Contributions of infectious dis-eases pharmacists extend well beyond direct patient care into research, medical education, and other scholarly activities, making them valuable members of guideline committees [3, 4]. Pharmacist involvement in high-impact guidelines that include pharmacotherapeutic recommendations is variable, although a formal assessment has yet to be published in this topic area [5–8]. This paper examines multidisciplinary authorship of Infectious Diseases Society of America (IDSA) CPGs, specifi-cally evaluating the role of infectious diseases pharmacists.METHODSThis study examined the authorship on CPGs issued or endorsed by the IDSA through September 2017. The primary end point was the frequency of pharmacist representation in current guideline editions. The proportion of CPGs with pharmacist representation was compared between current guidelines and the immediate corresponding prior edition. Pharmacist representation in CPGs was defined as the inclusion of at least 1 pharmacist on the respective guideline authorship panel and was reported as a proportion of total guidelines. In some cases, current guidelines were the initial guideline from the IDSA in a particular disease state or topic area and did not have a corresponding prior edition, thus leading to more cur-rent editions than prior. The current guidelines were identified through public access via the IDSA website (www.idsociety.org). Prior guideline editions were identified and retrieved through a MEDLINE search using University of South Carolina access. Guidelines were sorted by topic area as designated by the IDSA for secondary analysis. All CPG author credentials were evaluated, and the total number of pharmacists was reported as a proportion of all guideline panel members. Pharmacist author characteristics (eg, additional degrees, place of employment, and credentials) were collected from institutional websites and/or available web profiles. The chi-square or Fisher exact test was utilized for comparison of results between current and prior guidelines. Three investigators (L.F., J.L., P.B.B.) were responsi-ble for data collection and analysis.RESULTSFifty-eight current edition IDSA guidelines were identified as of September 2017, and all included antimicrobial therapy Open Forum Infectious Diseases®© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.comDOI: 10.1093/ofid/ofy287Received 21 August 2018; editorial decision 29 October 2018; accepted 10 November 2018.Prior presentation: This research was presented and accepted for Continuing Pharmacy Education at the American College of Clinical Pharmacy Annual Meeting; October 7–10, 2017; Phoenix, AZ.aPresent affiliation: Augusta University Medical Center, Augusta, Georgia.bPresent affiliation: Greenville Health System, Greenville, South Carolina.cPresent affiliation: Methodist Le Bonheur Healthcare, Germantown, Tennessee.Correspondence: P. Brandon Bookstaver, PharmD, Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208 (bookstaver@cop.sc.edu).Downloaded from https://academic.oup.com/ofid/article/5/11/ofy287/5187949 by guest on 25 May 20222 • OFID • BRIEF REPORTrecommendations. The proportion of pharmacist representa-tion on CPGs was 21% (12/58). Thirty-nine corresponding prior guideline editions were identified, with 13% (5/39) having a pharmacist author (P = .402 compared with current edition) (Table  1). Pharmacist representation on CPGs significantly increased after 2011 (33%, 9/27, compared with 11%, 8/70; P = .017). Examining pharmacist representation on CPGs over incremental time periods results as follows: 1996–2000: 19%, 3/16; 2001–2005: 6%, 1/17; 2006–2010: 13%, 4/31; 2011–2015: 30%, 7/23; and 2016–2018: 2/10, 20%).Of 1245 total authors among both current and prior editions, 3% (n = 33) were pharmacists. Twenty-nine unique pharmacists were represented overall, which remained consistent between current (n = 15) and prior (n = 14) editions (P >  .05). When examining IDSA CPGs by topic categories, the antimicrobial agent use category was the most represented by pharmacist authorship, 50% of current guidelines (3/6) and 40% of prior editions (2/5). Among the 17 guidelines with a pharmacist, 71% (12/17) included a single pharmacist author. Three pharmacists appeared on multiple guidelines. Pharmacist authors were 55% male, the majority of whom possessed added credentials (eg, board certification or a fellowship designation: 86%, 25/29), and 86% worked in an academic and/or clinical setting. Pharmacy organizations endorsed 6% of the 97 total guidelines examined, including 4 among current editions (7%).DISCUSSIONThe goal of this study was to examine the current inclusion of pharmacists on CPGs endorsed or sponsored by the IDSA. Pharmacists were represented among 21% of current CPGs in this cohort, including an 8% increase compared with prior editions. Additionally, after the introduction of the NAM recommendations for interdisciplinary guideline committees in 2011, there was a sig-nificant increase in pharmacist representation from 11% to 33%. Although this is certainly encouraging, it also represents oppor-tunity. This relatively low rate of overall pharmacist authorship (19%) is not unique to IDSA-sponsored guidelines. When exclud-ing Clinical Pharmacogenomic Implementation Consortium and Veterans Affairs/Department of Defense guidelines, which have universal pharmacist participation, only 20% of national guide-lines across a spectrum of disciplines include a pharmacist author [8]. Notably, high-impact guidelines such as the International Antiviral Society-USA Panel guidelines on treatment and preven-tion of HIV in adults and the updated Surviving Sepsis guidelines do not have pharmacist members on the expert panel despite numerous pharmacotherapeutic recommendations and recog-nized contributions of pharmacists in these specialty areas [8, 9]. Not surprisingly, the antimicrobial use category within the IDSA had the highest rate of pharmacist authorship, albeit with small numbers. We did not differentiate between IDSA-sponsored and -endorsed guidelines, which may impact pharmacist inclusion, which is a limitation of the present study.Pharmacists have long contributed to patient safety and improved outcomes through medication optimization with enhanced par-ticipation in infectious diseases clinical practice among steward-ship, consult, and ambulatory clinic teams [9, 10]. The view of the pharmacist’s role in patient care by the IDSA has greatly changed over the last 20 years. The controversial position statement of the IDSA Clinical Affairs Committee in 1997, “Hospital Pharmacists and Infectious Diseases Specialists,” failed to recognize pharmacists as health care partners in the management of infectious diseases patients [11]. That position statement has since been removed by the IDSA, and pharmacists enjoy many organizational opportuni-ties and recognitions equal to those of physician members. We feel that it is important for the IDSA to continue to stay committed to multidisciplinary infectious diseases practice, including in the con-stantly expanding field of antimicrobial stewardship [12, 13]. The pharmacy profession has also continued to see growth in academic scholars, contributing significantly to the peer-reviewed literature. This coincides with the increase in pharmacist presence on guide-line panels observed after 2011.The value of pharmacokinetics/pharmacodynamics (PK/PD) in antimicrobial selection and drug dosing continues to be rec-ognized as a major contributor to antimicrobial safety, devel-opment of resistance, and patient outcomes. One example of recognition of pharmacists as PK/PD and microbiology experts is their representation on the Clinical Laboratory Standards Institute expert committees [14]. Additionally, the rise in microbial genomics and availability of enhanced rapid molecu-lar diagnostics will continue to revolutionize recommendations for both empirical and definitive antimicrobial therapy [15]. Pharmacists, as experts in medications and microbial genomic testing interpretation, are uniquely positioned to bring quality discussion and insight to expert guideline committees.Table  1. Rates of Pharmacist Authorship on Current and Prior Edition Infectious Diseases Society of America Clinical Practice GuidelinesGuideline  Characteristic, n/N (%)Prior Guideline EditionCurrent Guideline Edition P ValueOverall pharmacist representation5/39 (13) 12/58 (21) .402Pharmacist representation by IDSA CPG subcategoryAntimicrobial agent use 2/5 (40) 3/6 (50) -Infections by organ system 1/14 (7) 5/26 (19) -Infections by organism 1/14 (7) 4/19 (21) -Other 1/6 (17) 0/7 (0) -Pharmacist proportion of total authorship14/434 (3) 19/811 (2)Pharmacist as first, senior, or corresponding author0/5 (0) 1/12 (8) -Single pharmacist author 3/5 (60) 9/12 (75) -Multiple pharmacist authors2/5 (40) 3/12 (25) -Pharmacy organization endorsement2/39 (5) 4/58 (7) -Abbreviations: CPG, clinical practice guideline; IDSA, Infectious Diseases Society of America. Downloaded from https://academic.oup.com/ofid/article/5/11/ofy287/5187949 by guest on 25 May 2022BRIEF REPORT • OFID • 3Guideline revisions are constantly needed given the updates in available diagnostics, approval of new antimi-crobials, and emerging clinical evidence. The IDSA and pharmacy organizations value inclusion in organizational activities, which may translate well to development of inter-disciplinary CPG expert panels. A  100% increase in phar-macist authorship on subsequent IDSA guideline editions would mean that approximately 40%–50% of CPGs would have pharmacist representation. The IDSA may consider a specific recommendation for sponsored guidelines to include multidisciplinary representation, including infectious dis-eases pharmacists, when an expert and scholar is available in the topical area. Of note, the most recently published IDSA guideline (not included in this analysis) on Clostridium diffi-cile management includes pharmacist representation on the expert panel and is endorsed by 2 pharmacy organizations. Four of the 11 current IDSA guidelines with a pharmacist author in this present study had a corresponding phar-macy organization as a sponsoring or endorsing group. It is important for the IDSA to connect with leading national pharmacy organizations such as the American College of Clinical Pharmacy, the American Society of Health-System Pharmacists, and the American Pharmacists Association, as well as discipline-specific organizations such as the Society of Infectious Diseases Pharmacists, to identify pharmacists who may complement physician panelists and are appropri-ate for representation on CPGs.CONCLUSIONSPharmacist representation on IDSA-sponsored and -endorsed CPGs is just above 20% and has increased among current edi-tions. Multidisciplinary representation, including infectious diseases pharmacists on CPG committees, as recommended by the NAM, will compliment physician experts and enhance appropriateness of antimicrobial therapy recommendations. Continued collaboration between infectious diseases and pharmacy organizations on CPG expert panels is strongly encouraged.AcknowledgmentsPotential conflicts of interest. P.B.B.: advisory board member for CutisPharma; advisory board for Melinta Therapeutics; research grant recipient from ALK Abello, Inc.; speaker’s bureau for Melinta Therapeutics; speaker honorarium received from ALK Abello, Inc. All other authors have nothing to disclose. All authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.References1. Institute of Medicine of the National Academies. Standards for developing trust-worthy clinical practice guidelines (CPGs). In: Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press; 2011. Available at: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2011/Clinical- Practice-Guidelines-We-Can-Trust/Clinical%20Practice%20Guidelines%202011%20Insert.pdf2. Atkins D, Briss PA, Eccles M, et al; GRADE Working Group. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res 2005; 5:25.3. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016; 62:e51–77.4. Tseng A, Foisy M, Hughes CA, et al. Role of the pharmacist in caring for patients with HIV/AIDS: clinical practice guidelines. Can J Hosp Pharm 2012; 65:125–45.5. Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the International Antiviral Society-USA Panel. JAMA 2018; 320(4):379–96.6. James PA, Oparil S, Carter BL, et  al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel mem-bers appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311:507–20.7. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017; 45:486–552.8. Thompkins AW, Norman BF, Hill BK, Antosz KS, Bookstaver PB. Pharmacist authorship on clinical practice guidelines. J Am Coll Clin Pharm. In press. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/jac5.10569. Koshman SL, Blais J. What is pharmacy research? Can J Hosp Pharm 2011; 64:154–5.10. American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy 2008; 28:816–7.11. Clinical Affairs Committee. Hospital pharmacists and infectious diseases special-ists. Clin Infect Dis 1997; 25:802.12. Dodds Ashley E, Davis SL, Heil EL, et al. Best care for patients achieved through multidisciplinary stewardship. Clin Infect Dis 2018; 67:1637.13. Ostrowsky Belinda B. Infectious diseases physicians: leading the way in anti-microbial stewardship. Clin Infect Dis 2018; 66:995–1003.14. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI Supplement M100. Wayne, PA: Clinical Laboratory Standards Institute; 2018.15. Relling MV, Klein TE. CPIC: clinical pharmacogenetics implementation consor-tium of the pharmacogenomics research network. Clin Pharmacol Ther 2011; 89:464–7.Downloaded from https://academic.oup.com/ofid/article/5/11/ofy287/5187949 by guest on 25 May 2022

Multidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases Pharmacists

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Multidisciplinary Authorship Among Infectious Diseases Society of America Clinical Practice Guidelines: Examining the Contributions of Infectious Diseases Pharmacists

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