Hospital discharge service by pharmacists cuts COPD readmission rates

Patients hospitalized for chronic obstructive pulmonary disease (COPD) are at high risk for 30- and 60-day readmissions. In 2008, the mean 60-day admission rate following an emergency department visit of COPD patients was 18% and the mean readmission rate was more than 30%.

Researchers from Houston, Texas, undertook a two-phase study to determine the effect of clinical pharmacy services with multidose medication dispensing on discharge (MMDD) on 30- and 60-day readmissions of COPD patients, according to a report in the July 15th issue of the American Journal of Health-System Pharmacists, published online, ahead of print.

MTM essentials in COPD management: Part 1

In the first phase of the study or preintervention group, data was collected from 2011-2012 for 412 patients with COPD who had been hospitalized at two Harris Health hospitals in Harris County, Texas, and been treated with inhalers containing fluticasone propionate and salmeterol or budesonide and formoterol fumarate dihydrate. In the second phase of the study (postintervention group), data was collected for 208 patients with COPD who had received patient counseling from a clinical pharmacist and were enrolled in the MMDD program.

These patients had received the same medications as the preintervention patients. The inhaler medications for the postintervention group were relabeled by a pharmacist with an appropriate outpatient label and contained at least 7 days of medication following use in the hospital. Patients were counseled on appropriate inhalation technique prior to discharge.

Favorable results for MMDD program

Patients in the preintervention group had an adherence rate to their medications of 55% and a 30-day readmission rate of 21.4% and a 60-day readmission rate of 33%. Patients in the postintervention group had a 100% adherence rate to their medications as they received the remaining multidose inhaler that they had used while hospitalized. In this group, the 30-day readmission rate was only 8.7% and the 60-day readmission group was 23%.

“Implementation of an MMDD program was associated with a reduction in 30-day and 60-day hospital readmissions and an increase in a measure of medication adherence,” noted John Blee, PharmD, pharmacy manager at Houston Methodist Sugar Land Hospital, Sugarland, Texas, and his colleagues. “Direct pharmacy cost savings were modest. However, the gain for the healthcare system was substantial due to decreased hospital readmissions,” the researchers wrote.

Future randomized, controlled studies are required to verify the results, the authors said. The study was supported by a grant from the ASHP Research and Education Foundation.