Impact of Pharmacist Inhaler Prescribing at Discharge for Chronic Obstructive Pulmonary Disease on Readmission Rates.

Abstract

Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the 6 conditions in the Hospital Readmissions Reduction Program for which institutions are penalized for high 30-day readmission rates. This institution's transitions of care (TOC) pharmacists have prescribing authority to optimize guideline-directed medical therapy (GDMT), defined as discharging on rescue plus triple therapy inhalers under an approved protocol. While several studies evaluate the impact of pharmacist-led interventions on COPD readmission rates, there is a lack of literature with respect to pharmacists prescribing inhalers under an approved protocol. This study aims to evaluate all-cause 30-day COPD readmission rates.

Methods: This was an institutional review board-approved, single-center, retrospective evaluation conducted between May 2021 and August 2023. Patients were included if they met criteria under the Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program COPD model. Patients in the pre-implementation group received usual care, with postdischarge nurse follow-up while patients in the postimplementation group received TOC pharmacy services. The primary outcome was all-cause 30-day readmission rates. Secondary outcomes included readmission reason and proportion of patients discharged on GDMT.

Results: A total of 279 patients were included, with 187 patients in the pre-implementation group and 92 patients in the postimplementation group. All-cause 30-day readmission rates in the pre- and postimplementation groups were 26% and 14%, respectively (p=0.02). The proportion of patients discharged on GDMT was 26% in the pre-implementation group and 100% in the postimplementation group (p<0.001).

Conclusion: Utilizing a TOC pharmacy service may be associated with a reduction in all-cause 30-day readmission rates for patients with COPD.