May 8, 2020
Debra Goff, PharmD, FCCP, was selected by the World Health Organization (WHO) to be one of 25 global experts who will help health care professionals and government leaders in low- and middle-income countries implement antimicrobial stewardship (AMS) plans based on a toolkit WHO published in October 2019.
Dr. Goff, associate professor of Pharmacy Practice and Science at The Ohio State University College of Pharmacy and an infectious disease specialist and clinical pharmacist at The Ohio State University Wexner Medical Center, will serve as the only American pharmacist, and one of two pharmacists, on the team who will focus on the role pharmacists can play in helping health care facilities ward off antimicrobial resistance (AMR). Three other Americans—all physicians—were selected to join the team.
Dr. Goff’s background in AMR, including her efforts co-founding the antimicrobial stewardship program at the Wexner Medical Center and leading The Ohio State University – South Africa Antibiotic Stewardship “Train-the-Trainer” mentorship program, qualified her to voluntarily help WHO develop the toolkit over the last year and a half. The toolkit provides guidance on how to improve antibiotic prescribing practices and perform AMS interventions to reduce the risk of AMR.
When helping to develop the toolkit, Dr. Goff said that she focused on scaling up the role pharmacists play in the AMS strategies being proposed.
“The pharmacists in many of these countries have the knowledge, but they’re not empowered to do anything besides dispense and replace ward stock,” Dr. Goff said. “This toolkit is going to show them how a pharmacist has the drug therapy knowledge to make interventions and how they are going to add that into their existing day – and add this additional responsibility to impact patient care.”
Dr. Goff’s experiences with AMS training programs in South Africa and in other countries have prepared her for challenges that may lie ahead in the WHO initiative.
“In most countries, there aren’t enough pharmacists, physicians or nurses, and so you have to take the existing workforce and scale up their knowledge,” she said.
Another barrier Dr. Goff anticipates is altering the sometimes decades-old prescribing habits of physicians.
“When you perceive you’ve done no harm to a patient, it’s really hard to try to change your instinct to prescribe. But we’re running out of effective antibiotics; resistance rates are escalating around the world,” she said.
Dr. Goff points to the overuse of antibiotics and a decline in the development of new antibiotics as driving a global crisis of AMR that is particularly devastating to low-resource parts of the world.
“It’s so encouraging to see this very specific toolkit for low- and middle-income countries be released, and have teams of experts that know how to execute this no matter what the barriers are,” Dr. Goff said. “We’re done talking about it, we need action, and that’s what this toolkit and this initiative are allowing us to do. We are going to those countries and we are going to teach them one-on-one how to do this.”
A glimpse of Dr. Goff’s time spent in South Africa with The Ohio State University – South Africa Antibiotic Stewardship “Train-the-Trainer” mentorship program.