Interventional, Quasi-Experimental Study of a Chronic Obstructive Pulmonary Disease Education Care Plan for Hospital Discharge.

Nicole E Cieri-Hutcherson,Amany K Hassan,Brian P Kersten,Letitia N Warunek

doi:10.3390/pharmacy9040202

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality, and reduced quality of life for patients. Proper use of inhaler devices is critical for effective drug delivery and prevention of COPD progression. The primary endpoint of this study was a mean percent increase in correct steps associated with inhaler technique after pharmacist education. The co-primary endpoint was a 25% increase in the proportion of patients correctly identifying the appropriate use of short-acting versus long-acting inhaler types. This was an interventional quasi-experimental study of patients hospitalized at a 491-bed tertiary academic medical center with a COPD exacerbation to assess a pharmacist-led COPD care plan. Eligible patients included general floor, adult patients admitted with a primary diagnosis of COPD exacerbation. The primary investigator recorded initial inhaler technique scores through a paper checklist, and provided education about device types and usage. Patients were reassessed within 48 h to determine if pharmacist education improved inhaler knowledge. A total of 67 patients received the COPD care plan before hospital discharge. At baseline, patients scored a median of 81.8% (67.5–97.0) of steps correct across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% (90.9–100.0) (p < 0.0001). The proportion of patients correctly identifying when to use short-acting versus long-acting inhalers increased from 73.1% to 98.5% (p < 0.0001). Implementation of a pharmacist-led care plan for patients admitted for COPD exacerbation was associated with an increase in correct steps for appropriate inhaler technique and understanding of inhaler device types after pharmacist education.

Highlights

Chronic obstructive pulmonary disease (COPD) is a chronic disease, characterized by respiratory symptoms and airflow limitations
The purpose of this study was to evaluate the impact of this pharmacist-led care plan on inhaler technique for patients admitted with COPD exacerbation
The majority of patients excluded did not carry a diagnosis of COPD and were on high-dose steroids for another indication or were not using inhalers prior to hospital admission (Figure 1)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic disease, characterized by respiratory symptoms and airflow limitations. In response to increased hospital readmissions in the United States, the Centers for Medicare and Medicaid Services (CMS) introduced an initiative in 2011 to transition from fee-for-service payments to bundled payments for multiple services to create incentive for providers to provide high-quality care while reducing health care costs [5]. The focus of this transition was to reduce hospital readmissions within 30 days of hospital discharge for specific patient populations; COPD was added as a target population in October 2014 [6,7]. Multiple strategies have demonstrated benefits in reducing hospital readmissions for other disease states such as heart failure; evidence for use in COPD remains limited [8,9]

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