Effect of Pharmacy Counseling on Readmissions in Patients with Acute Exacerbations of COPD: A Randomized Controlled Trial

Abstract

Objective: To investigate the effects of pharmacy counseling on clinical and economic outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.Material and Methods: The outcomes consisted of 28-day hospital readmissions related to AECOPD, direct costs, medication adherence calculated by proportion of days covered (PDC), and health-related quality of life (HRQoL) measured by chronic obstructive pulmonary disease assessment test (CAT). The data derived from the intervention group, for which pharmacy counseling was provided, was compared with that obtained from the control group provided with usual pharmaceutical care. The study also drew comparisons between the PDC and CAT scores of pre- and postintervention periods.Results: Forty-four patients (23 intervention and 21 control) were included in the analysis. There were no significant differences in the readmission rate (13% vs 19%, p-value>0.050), nor the number of readmitted patients (3 vs 3, p-value >0.050). A decrease in direct costs did not reach statistical significance (p-value>0.050). In addition, no difference between the PDC scores was found (96.67 vs 100.00, p-value>0.050). Intervention patients obtained significantly lower CAT scores than the control patients did (9 vs 19, p-value<0.050). Compared with the pre-intervention period, PDC scores were identical; however, CAT scores measured during the post-intervention period were significantly different.Conclusion: Pharmacy counseling for AECOPD patients could enhance HRQoL. Drug therapy and pulmonary rehabilitation may cause such improvement. Further work, which has adequate participants, is required to detect a significant difference in readmissions between the two groups.

Effectiveness of Hospital Pharmacist Interventions for COPD Patients: A Systematic Literature Review and Logic Model

“…The research covered ten countries and regions with China being the most common study country (n=19), followed by the United States (n=4), 26 , 27 , 32 , 44 India (n=3), 37 , 41 , 48 Jordan (n=1), 29 Spain (n=1) 17 and Thailand (n=1). 52 The research site was mainly based on a single hospital (n=28) and only 1 study were conducted based on a collaboration of hospital 44 and community pharmacy. In all studies, hospital pharmacists participated in the intervention, either as the sole healthcare profession (n=25) or as a member of a multi-disciplinary team (n=4).…”

“…As shown in Table 3 , pharmacists played multiple roles in COPD management in the hospital setting, most of which focused on prescribing, 17 , 27–29 , 32 , 34 , 35 , 39 , 40 , 43 , 44 , 50 , 52 , 53 medicine administration, 17 , 26 , 27 , 29–53 monitoring of medicine use 17 , 26 , 27 , 29–43 , 46 , 47 , 50 , 52 , 53 and other non-pharmacologic therapy management. 27 , 29 , 30 , 35 , 37–39 , 41–43 , 46–48 , 50 , 52 As a member of the medical team, hospital pharmacists collaborated with clinicians to formulate treatment plans. They provided recommendations for the types, indications, doses, frequency of administration, and possible side effects for each prescribed medication.…”

“… Online consultation - Established an online platform for online consultation and education. 28 Prasungriyo et al 52 √ √ √ √ B=Prescribing : Medication reconciliation - Together with medication dispensing, hospital pharmacists provided medication reconciliation. D=Administration : Counseling - Included basic knowledge of COPD, pathophysiology and risk factors in the development of the disease, a review of the technique for using inhalers, the importance of medication adherence Education - Printed material containing succinct information regarding the disease, medications, and instructions on using the inhalers was made available to intervention patients.…”

“…Such education intervention was primarily directed at patient instruction, including information about: 1) COPD, COPD medicines, administration and dosing, management of COPD symptoms, possible adverse reactions; 27 , 29–33 , 35–53 2) rational use of specific antibiotics; 27 , 39 and 3) proper inhaler use. 27 , 36–39 , 41 , 48 , 49 , 51 , 52 In terms of educational methods, in addition to face-to-face communication, 29–32 , 35–52 pharmacists also provided relevant reading materials for patients 27 , 29 , 37 , 38 , 40–43 , 49 , 51 , 52 or started a WeChat or online interactive platform, 42 , 49 , 51 or conducted follow-up phone calls, 30–32 , 38 , 40 , 41 , 44 , 49 , 51 in order to resolve doubts during medication administration, optimize compliance and monitor for drug-related problems.…”

“…The most common inputs included in the studies were educational materials, including booklets, 27 , 29 patient information leaflets, 37 , 41 videos, 42 , 49 , 52 popular science articles, 42 , 49 , 51 brochures 42 , 49 and printed materials. 52 In addition, various forms of face-to-face education were also common, including lectures, 30 interviews, 31 counselling sessions, 37 , 41 and classroom teaching. 43 Some studies played the role of the network, and input WeChat interactive platform, 42 online consulting platform.…”