Implementation of antimicrobial stewardship certification program and its impact on low-resource settings

Antimicrobial resistance has become an increasing concern worldwide. Antimicrobial stewardship (AMS) is a critical approach to protect against the danger of untreatable microbes. AMS programs frequently rely on the expertise of infectious diseases-trained physicians and pharmacists, yet access to such expertise is frequently limited in rural or smaller facilities like critical access hospitals (CAHs) and skilled nursing facilities (SNFs). However, nearly all these facilities have a staff or contract pharmacist available, even in more rural parts of the United States. These pharmacists may be important potential resources to promote stewardship in these low-resource settings.

The North Dakota Department of Health and Human Services and North Dakota State University collaborated to provide free AMS certification to predominantly rural pharmacists through a program offered by the Society of Infectious Diseases Pharmacists (SIDP) between 2018 and 2022, except in 2020 (due to the COVID-19 pandemic). Eighty-five pharmacists out of 113 applications were selected to complete the program. The preferential selection was based on whether pharmacists worked in a CAH or SNF or were willing to assist the above healthcare facilities in AMS activities. Fifty-four percent of the participants completed the program and developed an AMS intervention at their facilities, with 32% having interventions in progress at the time of assessment and 9% lost to follow-up over 4 years.

Pharmacists were incentivized to gain expertise in AMS in low-resource settings by providing free SIDP certification through the state health department. This may be a cost-effective use of state dollars to promote AMS in low-resource settings.