COPD CARE Reducing Veterans Readmissions and Increasing Access to Care

Ed Portillo Recognized as Gold Status Fellow of the Veterans Health Administration's Diffusion of Excellence program

A pharmacist-created program that reduces hospitalizations among veterans with Chronic Obstructive Pulmonary Disease (COPD) is expanding nationwide.

COPD CARE (Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations) was developed by Ed Portillo, PharmD, a pharmacist at the William S. Middleton Memorial Veterans Hospital and assistant professor at the University of Wisconsin–Madison School of Pharmacy.

Portillo set out to help veterans who suffer from COPD because he saw patients hospitalized weekly from exacerbations (including flu, pneumonia and allergens) of the disease, he says in an article on the UW-Madison School of Pharmacy’s web site.

With COPD CARE, veterans discharged from the hospital for an exacerbation receive a 45-minute clinic visit with a clinical pharmacist and a registered nurse. 

The pharmacist provides COPD disease state management, including prescribing therapy, ordering labs, and placing referrals. The nurse educates the patient on an action plan for how to prevent a hospitalization when symptoms flare up and provides essential disease-state education to patients.

As a result of the program, the veterans’ prescriptions are not fragmented between different locations and providers, Portillo says. “This is a team-based intervention where pharmacists are really managing patients during care transitions from the hospital to home, which is huge,” Portillo said. “If we want to reduce 30-day readmissions, pharmacists and our primary care teams have to be seeing patients in the clinic as soon as possible.”

In a six-month trial of the program in 2016, COPD CARE slashed patients’ 30-day readmission rate from 18.4% to zero. In addition, access to care (a follow-up visit with a care provider) more than doubled, from 35.1% to 73.7% within 30 days of hospital or emergency room discharge.

In the majority of cases, the COPD CARE service resulted in a prescription for essential maintenance inhalers, referrals to smoking cessation services, pulmonary rehab to strengthen the muscles around patients’ lungs, and telehealth. 

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In nearly 53% of visits, the pharmacist-nurse teams corrected patients’ inhaler technique, and in almost 37% of visits, modified their dosing frequency for better home care results, the article said.

Including clinical pharmacists as important members of the primary care team is essential to the success of programs like this, according to Portillo. “Pharmacists are so well-trained to do this. Having us pharmacists in the forefront managing conditions, especially during care transitions, is like having a secret weapon to improve patient outcomes.”

Thanks to the program’s success in the pilot and additional years, COPD CARE was selected as a National Gold Status Practice by the Veterans Health Administration, and the agency intends to implement it nationwide.