Transitions of Care Pharmacy Education May Lower Readmission Rates for Patients with COPD

Transitions of care (TOC) pharmacy services have been shown to lower readmission rates for patients with COPD and related conditions at Rhode Island Hospital.

Concerned with medication errors and communication breakdowns that can occur during transitions from the hospital to the community, researchers affiliated with Lifespan-Rhode Island Hospital Department of Pharmacy, Providence, RI; The University of Rhode Island College of Pharmacy, Kingston, RI; and Brown University School of Public Health, Providence set out to determine whether pharmacists assisting in TOC could improve outcomes through interventions.

The researchers presented their study and resulting preliminary data during a recent poster session at the 2019 American Society of Health-System Pharmacists (ASHP) Summer Meetings in Boston.

According to the researchers, patients with COPD have complex medication regimens and are at high risk of 30-day readmission. They reviewed an existing TOC pharmacy program at Rhode Island Hospital and collaborated with health care professionals, including respiratory therapists, physicians, and pharmacists to determine areas that could be improved upon.

The researchers noted that not all inhaler devices being offered to patients had educational handouts that were easily readable and offered in English and Spanish, and patients frequently did not obtain the inhaler spacers prescribed to them. Cost was a factor for patients receiving these prescriptions, since many were left uncovered by health insurance, according to the study authors.

Another area receiving a look by researchers was the practice of utilizing MEDCOINS scores to determine patients at highest risk for readmission and those who would benefit the most from telephonic follow-ups. According to the study authors, this scoring system was not developed specifically for COPD. They recommended that all patients with COPD should receive telephonic follow-up within 1 week of discharge.

Based on the TOC analysis, a standardized pharmacy education program for COPD was implemented at Rhode Island Hospital in late 2018. It incorporates medication review, patient education, and follow-up phone calls within a week of patient discharge.

Patient education included a pictorial handout for each device, as well as a list of web links that provide video tutorials. Education from respiratory therapy professionals, as well as inhaler spacers, also were provided.

During the study, 31 patients had received inpatient TOC pharmacy education. None of the patients who received follow-up phone calls from the TOC pharmacy team had been readmitted to the hospital 30 days after discharge, and all but 3 of the 31 patients received a spacer.

According to the researchers, the results of the study are limited to pharmacist impact without control for other health care professionals.

However, buoyed by its success, the program's model is being implemented at another facility in the Lifespan health system, according to researchers. TOC pharmacists and other health care professionals participating in COPD education at Rhode Island Hospital have reported improved streamlining of education across the health system.

This study was funded by a 2018 Ambulatory Care PRN Seed Grant from the American College of Clinical Pharmacy.

Reference

Zuern A, Wood M, Zullo A, McAuliffe L, Berard-Collins C. Standardization of Transitions of Care Pharmacy Education for COPD Patients. Presented at: American Society of Health-System Pharmacists (ASHP) Summer Meetings and Exhibition, Boston, MA; June 11, 2019. Accessed June 24, 2019.