Comprehensive and collaborative pharmacist transitions of care service for underserved patients with chronic obstructive pulmonary disease

Abstract

Background Mortality risk from chronic obstructive pulmonary disease (COPD) increases significantly in the first year after a 30-day hospital readmission. Objective To evaluate a comprehensive and collaborative pharmacist transitions of care service for patients hospitalized with COPD compared to usual care. Design, Setting, and Participants This was an institutional review board approved, within-site, retrospective study, including underserved adult patients with a primary care provider at the study clinic, admitted to the affiliated hospital with a primary diagnosis of COPD exacerbation. Intervention The service comprised of discharge counseling, medication reconciliation, medication access assistance, therapy changes, and post-discharge long-term follow up. Main Outcomes and Measures The primary outcome was a 180-day composite of COPD-related hospitalizations and emergency department (ED) visits. Secondary outcomes were 30-, 60-, 90-, and 180-day events, costs, pharmacist interventions, time to follow up, and pneumonia. Results Sixty-five patients were identified with a total of 101 index admissions. The mean age was 62.5 years, approximately 55.3% were female, and 67.7% were black or African American. The primary composite was significantly lower in the pharmacist intervention group compared to usual care [mean difference 0.82, P = 0.0364, 95% confidence interval (CI) 0.05-1.60], driven by lower 30-day hospitalizations in the intervention group (mean difference 0.15, P = 0.0099, 95% CI 0.04-0.27). Within the intervention group, the primary composite was significantly lower after the intervention compared to before the intervention (P < 0.0247), driven by 30-day hospitalizations (P = 0.0019) and 30- and 60-day ED visits (P = 0.0020 and 0.0310, respectively). Cost associated with COPD-related hospitalizations was significantly lower in the pharmacist intervention group compared to usual care ($173,808, P = 0.0330) as well as before intervention ($79,662, P = 0.0233). The most common pharmacist intervention was patient education. There was no significant difference in time to follow up or pneumonia. Conclusions A comprehensive, collaborative pharmacist transitions of care service significantly reduced 30-day COPD-related hospital readmissions, ED re-visits, and associated costs in an underserved population.