Implementation of a pharmacist-driven chronic obstructive pulmonary disease transitions of care service at a large academic medical center

Introduction

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and one in five COPD hospitalizations result in a readmission within 30 days. Pharmacists have been identified as key members of interdisciplinary teams to improve transitions of care.

Objective

The objective of this study was to develop, implement, and evaluate outcomes for a pharmacist-driven COPD transitions of care bundle at an academic medical center.

Methods

A COPD care bundle was implemented for patients presenting with a COPD exacerbation from December 1, 2021 to February 28, 2022. A historical control group was created from patients who were discharged between December 1, 2020 and February 28, 2021. Patient characteristics, pharmacist-driven interventions, and time required for the intervention were assessed descriptively. Inhaler technique was assessed before and after pharmacist education utilizing standardized rubrics. The percentage change in inhaler scores was assessed with a Wilcoxon signed-rank test. Readmission outcomes were analyzed using a chi-squared test.

Results

There were 30 patients in the intervention group and 46 in the control group. There were 104 interventions requiring provider collaboration, of which 84 (81%) were accepted. A median (interquartile range, IQR) of 46 (37–55) min was spent per patient in the intervention group. At baseline, patients scored a median of 84.6% (75–100) of steps correctly across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% [92.3–100] (p < 0.0001). There were eight (26.7%) 30-day all-cause readmission rates in the intervention group and 15 (32.6%) in the control group (p = 0.58).

Conclusion

Most pharmacist recommendations were accepted by providers. Medication education led to improved understanding of inhaler technique, but there was no difference in 30-day readmission rates. Further development of this service is warranted based on these findings.