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November 25, 2020Chronic Obstructive Pulmonary Diseases Journal of the COPD FoundationOpen Access

Comprehensive and Collaborative Pharmacist Transitions of Care Service for Underserved Patients with Chronic Obstructive Pulmonary Disease

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Why the study?

Mortality risk from COPD increases significantly in the first year after a 30-day hospital readmission.

Does a comprehensive and collaborative pharmacist transitions of care service reduce a 180-day composite of COPD-related hospitalizations and ED visits in underserved adult patients hospitalized with COPD exacerbation?

Population

Underserved adult patients hospitalized with a primary diagnosis of COPD exacerbation

Comparison

Pharmacist transitions of care service vs usual care

Design

Within-site retrospective study

Follow-up

180 days

Key result

A comprehensive pharmacist transitions of care service significantly reduced the 180-day composite of COPD-related hospitalizations and ED visits compared to usual care (mean difference 0.82).

Authors

JKJennifer KimALAmy LinRARandy Absher

Discussion

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Member takes

Overview

Should not yet change practice; leaves open confirmation of benefit in randomized trials.

Study Design

Type

Observational (n=65)

Multicenter

No

Structured PICO

Does a comprehensive and collaborative pharmacist transitions of care service reduce a 180-day composite of COPD-related hospitalizations and ED visits in underserved adult patients hospitalized with COPD exacerbation?

P
Population
Underserved adult patients with a primary care provider at the study clinic and admitted to the affiliated hospital with a primary diagnosis of COPD exacerbation
I
Intervention
Comprehensive and collaborative pharmacist transitions of care service including discharge counseling, medication reconciliation, medication access assistance, therapy changes, and post-discharge long-term follow-up
C
Comparator
Usual care
O
Outcome
180-day composite of COPD-related hospitalizations and emergency department (ED) visitscomposite

Main Result

Effect estimate: Mean difference 0.82 (95% CI 0.05-1.60)

Absolute Event Rate: 35% vs 80%

p-value: p=0.0364

A comprehensive pharmacist transitions of care service significantly reduces 30-day COPD-related hospital readmissions and ED visits in underserved patients.

Limitations

  • Small sample size
  • Pharmacist capture rate varied over time and was difficult to monitor (estimated 50%-80%)
  • Did not capture patients with hospital visits in other health systems
  • Pharmacist only intervened with patients admitted to the hospital rather than those who visited the ED without hospitalization
  • Cost analysis was based on previous literature estimates rather than actual complex admission costs

Cite This Study

Kim et al. (2020) conducted an observational in Chronic Obstructive Pulmonary Disease (COPD) exacerbation (n=65). Comprehensive and collaborative pharmacist transitions of care service vs. Usual care was evaluated on 180-day composite of COPD-related hospitalizations and emergency department (ED) visits (Mean difference 0.82, 95% CI 0.05-1.60, p=0.0364). A comprehensive pharmacist transitions of care service significantly reduced the 180-day composite of COPD-related hospitalizations and ED visits compared to usual care (mean difference 0.82).

synapsesocial.com/papers/6a1259a7a4bed3c7b166f355https://doi.org/10.15326/jcopdf.2019.0175
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