Outcomes of a Pharmacy-Driven Inpatient Chronic Obstructive Pulmonary Disease (COPD) Transitions of Care (TOC) Management Process

Abstract

Background Current data shows 30% of patients hospitalized for Chronic Obstructive Pulmonary Disease (COPD) exacerbation are readmitted within 30 days. Medication management during transitions of care (TOC) has shown impact on clinical outcomes, however there is insufficient data to suggest how pharmacy TOC services might benefit this patient population. Objective Evaluate the effects of pharmacy-driven COPD TOC services on hospital re-presentation rates. Methods A single-center retrospective chart review conducted of patients hospitalized for a COPD exacerbation. A comprehensive admission-to-discharge TOC service was provided by early immersion pharmacy students, advanced immersion pharmacy students, and an attending pharmacist in a layered learning model. The primary outcome was 30-day re-presentation rate. Secondary outcomes were 90-day re-presentation rate, volume of interventions made and description of the service. Results From 1/1/2019 to 12/31/2019, there were 2422 patients admitted for COPD exacerbation management and 756 patients received at least one intervention from the COPD TOC service. 30% needed a change to inhaler therapy. The provider accepted 57.8% of the recommended changes, and 36% and 33% of eligible patients received an inhaler technique education and bedside delivery of the new inhaler, respectively. Outcomes in the 30-day re-presentation and 90-day censored re-presentation rates for the intervention and control group were 28.5% vs 25.5% ( P = .12) and 46.7% vs 42.9%, respectively. Conclusion This study did not find a significant change in 30-day re-presentation rate with a pharmacy-driven COPD TOC service. It did find that a significant number of patients admitted with COPD exacerbation may need an inhaler change, and demonstrates the utility of this kind of TOC service for identifying and correcting medication-related problems unique to this disease state. There were opportunities for improvement in percent of patients receiving the full intended intervention.

Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma

“…This study highlights the high incidence of inappropriate inhaler prescribing in patients with COPD or asthma warranting hospitalization, as well as the impact of pharmacy team involvement on inhaler access and optimization in patients admitted to the hospital with COPD or asthma. The current study found a higher rate of inappropriate inhaler therapy in patients with COPD or asthma compared to Roberts and colleagues who recommended inhaler changes for approximately 30% of COPD patients prior to discharge ( n = 223) 14 . Results of this study are significant because maintenance inhaler therapy is essential to treating COPD and asthma and can significantly improve quality of life and reduce exacerbations that may lead to hospital admission and readmission 1,2 .…”

“…Interventions included pharmacist-assessed clinical appropriateness as well as inhaler compatibility with insurance formulary restrictions. [11][12][13][14] Recently, a single-center retrospective chart review evaluating a pharmacy-driven COPD transitions of care service identified that up to 30% of admitted patients were recommended to have a change in inhaler therapy prior to discharge based on access barriers or current guidelines. 14 However, this study did not report the reasons for recommending an inhaler change, what medications were included, or what recommendations were made, and focused on admitted patients with COPD alone.…”

“…[11][12][13][14] Recently, a single-center retrospective chart review evaluating a pharmacy-driven COPD transitions of care service identified that up to 30% of admitted patients were recommended to have a change in inhaler therapy prior to discharge based on access barriers or current guidelines. 14 However, this study did not report the reasons for recommending an inhaler change, what medications were included, or what recommendations were made, and focused on admitted patients with COPD alone. The purpose of this analysis was to evaluate how frequently a pharmacist's review of prescribed maintenance inhalers in admitted patients identified inappropriate prescribing, as defined by alignment with insurance coverage and clinical guidelines.…”

“…Several studies have investigated discharge care bundles with pharmacist‐led interventions to reduce COPD readmissions. Interventions included pharmacist‐assessed clinical appropriateness as well as inhaler compatibility with insurance formulary restrictions 11–14 . Recently, a single‐center retrospective chart review evaluating a pharmacy‐driven COPD transitions of care service identified that up to 30% of admitted patients were recommended to have a change in inhaler therapy prior to discharge based on access barriers or current guidelines 14 .…”

“…14 Results of this study are significant because maintenance inhaler therapy is essential to treating COPD and asthma and can significantly T A B L E 3 Inhaler therapy reviewed for appropriateness-Inhaler level.Abbreviation: SD, standard deviation.T A B L E 5 Type of new inhaler recommended.…”