Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: Effects on prescription filling and readmission

Blee, John; Roux, Ryan; Gautreaux, Stefani; Sherer, Jeffrey T.; Garey, Kevin W.

doi:10.2146/ajhp140621

Cited by 30 publications

(31 citation statements)

References 12 publications

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“…Ensuring that patients have all required outpatient respiratory medications in-hand before discharge is an intervention that could improve readmissions. Blee et al 69 reported a reduction in 30-day all-cause readmissions from 21.4% to 8.7% after having pharmacists dispense outpatient respiratory inhalers and deliver inhaler instructions to patients prior to discharge. Because this study used a pre-post intervention analysis, confounding due to different policies implemented at the same time could be present, but removing the additional step for patients to obtain medications after discharge seems likely to be beneficial.…”

Section: Predicting Patients Once Identified At High Risk For Aecopmentioning

confidence: 99%

COPD Readmissions

Shah

Press

Huisingh-Scheetz

et al. 2016

Chest

131

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Of those patients hospitalized for an exacerbation of COPD, one in five will require rehospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based health care. In the United States, COPD is part of Medicare's Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions. This review outlines challenges for improving overall COPD care quality and specifically for the HRRP. These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the target population during hospitalizations, and a lack of literature to guide evidence-based programs for COPD readmissions as defined by the HRRP in the hospital setting. It then identifies risk factors for early readmissions after acute exacerbation of COPD and discusses tested and emerging strategies to reduce these readmissions. Finally, we evaluate the current HRRP and future policy changes and their effect on the goal to deliver value-based COPD care. COPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policy makers, but we still have a long way to go to truly deliver value-based care to patients.

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Section: Predicting Patients Once Identified At High Risk For Aecopmentioning

confidence: 99%

COPD Readmissions

Shah

Press

Huisingh-Scheetz

et al. 2016

Chest

131

View full text Add to dashboard Cite

show abstract

“…Additionally, case management successfully assisted patients through financial aid and pharmaceutical discount programmes that were not compliant with the prescribed medication regimen due to medication availability issues and patient financial constraints. Other studies have noted similar issues with non‐adherence to medication regimens that contribute to patient readmissions (Blee, Roux, Gautreaux, Sherer, & Garey, ). Plus, medication profile errors were rectified during telephonic communication in the patient's electronic medical record.…”

Section: Discussionmentioning

confidence: 69%

“…Other studies have noted similar issues with non-adherence to medication regimens that contribute to patient readmissions (Blee, Roux, Gautreaux, Sherer, & Garey, 2015). Plus, medication profile errors were rectified during telephonic communication in the patient's electronic medical record.…”

Section: Discussionmentioning

confidence: 94%

Improving discharge planning using the re‐engineered discharge programme

2018

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“…20 Each bundle component is evidence-based, applicable to all COPD patients, and was deemed highyield for local context. The bundle components were designed to provide an appropriate COPD medication regimen, 22 a 30-d medication supply of insurance-compatible inhalers, 23 personalized inhaler education, 24 standardized discharge instructions, 24 and a primary care follow-up appointment scheduled within 15 d.…”

Section: Copd Care Bundlementioning

confidence: 99%

COPD Care Bundle in Emergency Department Observation Unit Reduces Emergency Department Revisits

et al. 2019

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BACKGROUND: COPD exacerbations lead to accelerated decline in lung function, poor quality of life, and increased mortality and cost. Emergency department (ED) observation units provide short-term care to reduce hospitalizations and cost. Strategies to improve outcomes in ED observation units following COPD exacerbations are needed. We sought to reduce 30-d ED revisits for COPD exacerbations managed in ED observation units through implementation of a COPD care bundle. The study setting was an 800-bed, academic, safety-net hospital with 700 annual ED encounters for COPD exacerbations. Among those discharged from ED observation unit, the 30-d all-cause ED revisit rate (ie, the outcome measure) was 49% (baseline period: August 2014 through September 2016). METHODS: All patients admitted to the ED observation unit with COPD exacerbations were included. A multidisciplinary team implemented the COPD bundle using iterative plan-do-study-act cycles with a goal adherence of 90% (process measure). The bundle, adopted from our inpatient program, was developed using care-delivery failures and unmet subject needs. It included 5 components: appropriate inhaler regimen, 30-d inhaler supply, education on devices available after discharge, standardized discharge instructions, and a scheduled 15-d appointment. We used statistical process-control charts for process and outcome measures. To compare subject characteristics and process features, we sampled consecutive patients from the baseline (n 5 50) and postbundle (n 5 83) period over 5-month and 7-month intervals, respectively. Comparisons were made using t tests and chi-square tests with P < .05 significance. RESULTS: During baseline and postbundle periods, 410 and 165 subjects were admitted to the ED observation unit, respectively. After iterative plan-do-study-act cycles, bundle adherence reached 90% in 6 months, and the 30-d ED revisit rate declined from 49% to 30% (P 5 .003) with a system shift on statistical process-control charts. There was no difference in hospitalization rate from ED observation unit (45% vs 51%, P 5 .16). Subject characteristics were similar in the baseline and postbundle periods. CONCLUSIONS: Reliable adherence to a COPD care bundle reduced 30-d ED revisits among those treated in the ED observation unit.

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Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: Effects on prescription filling and readmission

Cited by 30 publications

References 12 publications

COPD Readmissions

COPD Readmissions

Improving discharge planning using the re‐engineered discharge programme

COPD Care Bundle in Emergency Department Observation Unit Reduces Emergency Department Revisits

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