Hospital pharmacist discharge care is independently associated with reduced risk of readmissions for patients with chronic obstructive pulmonary disease: A propensity-matched cohort study

Makari, Joy; Dagenais, Joseph; Tadrous, Mina; Jennings, Scott; Rahmaan, Israa; Hayes, Kaleen N

doi:10.1177/17151635211061141

Cited by 3 publications

(7 citation statements)

References 13 publications

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“…The pharmacist participants endorsed the value of interventions that have been shown in the literature to be impactful (e.g., pharmacist-led patient counselling, postdischarge phone calls, and communication with other team members) [1][2][3][10][11][12][15][16][17] . For instance, the implementation of pharmacist-led patient education can result in improved medication knowledge, improved adherence, reduction in morbidity and possibly a reduction in mortality as well.…”

Section: Discussionmentioning

confidence: 99%

“…Corresponding author: Karen Dahri, PharmD, ACPR, FCSHP Pharmaceutical Sciences, Vancouver General Hospital 855 West 12 th Avenue, Vancouver, BC V5Z 1M9 Email: Karen.Dahri@vch.ca Interventions related to optimizing discharge medication practices, which have been evaluated in the literature, include: medication reconciliation on admission/discharge; patient education/counselling; post-discharge follow up in person or via phone; and coordinating care with an interdisciplinary care team. [1][2][3][4][5][6][7][8][9][10][11][12] Some studies have found that interventions led by hospital pharmacists can improve patient outcomes. [1][2][3]11,12 For instance, pharmacy-led medication reconciliation interventions effectively reduce medication discrepancies.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] Some studies have found that interventions led by hospital pharmacists can improve patient outcomes. [1][2][3]11,12 For instance, pharmacy-led medication reconciliation interventions effectively reduce medication discrepancies. 3. Overall, hospital pharmacists can play a pivotal role in optimizing patient discharges; however, an understanding of their perception of the discharge process is largely missing from the literature.…”

Section: Introductionmentioning

confidence: 99%

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Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process

Ladhar

Dahri²,

Inglis³

et al. 2023

Innov Pharm

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Background: Transitions of care represent a vulnerable time for patients where unintended therapeutic changes are common and inadequate communication of information frequently results in medication errors. Pharmacists have a large impact on the success of patients during these care transitions; however, their role and experiences are largely absent from the literature. Objectives: The purpose of this study was to gain a greater understanding of British Columbian hospital pharmacists’ perceptions of the hospital discharge process and their role in it. Methods: A qualitative study utilizing focus groups and key informant interviews of British Columbian hospital pharmacists was conducted from April to May 2021. Questions asked during interviews were developed following a detailed literature search and included questions regarding the use of frequently studied interventions. Interview sessions were transcribed and then thematically analyzed using both NVivo software and manual coding. Results: Three focus groups with a total of 20 participants and one key informant interview were conducted. Six themes were identified through data analysis: (1) overall perspectives; (2) important roles of pharmacists in discharges; (3) patient education; (4) barriers to optimal discharges; (5) solutions to current barriers; and (6) prioritization. Conclusions and Relevance: Pharmacists play a vital role in patient discharges but due to limited resources and inadequate staffing models they are often unable to be optimally involved. Understanding the thoughts and perceptions of pharmacists on the discharge process can help us better allocate limited resources to ensure patients receive optimal care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process

Ladhar

Dahri²,

Inglis³

et al. 2023

Innov Pharm

View full text Add to dashboard Cite

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“…24 Similarly, Makari and colleagues showed that pharmacist involvement in discharge care, providing medication reconciliation, comprehensive discharge counseling, and post-discharge follow-up calls for patients admitted with a COPD exacerbation significantly reduced readmissions within 30 days of discharge but not emergency department visits. 13 25 Literature focusing on pharmacist-to-pharmacist collaboration in transitions of care is scant, but many healthcare systems, including the one in this study, are actively exploring this collaboration and opportunity to improve patient care and reduce hospital readmissions.…”

Section: Inhaler Therapy Recommendationsmentioning

confidence: 99%

“…Interventions included pharmacist-assessed clinical appropriateness as well as inhaler compatibility with insurance formulary restrictions. [11][12][13][14] Recently, a single-center retrospective chart review evaluating a pharmacy-driven COPD transitions of care service identified that up to 30% of admitted patients were recommended to have a change in inhaler therapy prior to discharge based on access barriers or current guidelines. 14 However, this study did not report the reasons for recommending an inhaler change, what medications were included, or what recommendations were made, and focused on admitted patients with COPD alone.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma

Parrott,

Wallace,

Niehoff

et al. 2023

J Am Coll Clin Pharm

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Patients with asthma and chronic obstructive pulmonary disease rely on inhaler therapy to reduce disease progression and exacerbation risk. Patients admitted to the hospital are at an increased risk for exacerbations and readmission if their inhaler therapy upon discharge is not aligned with current guidelines and/or affordable. The objective of this study was to assess the appropriateness of the chronic inhaler regimen for patients admitted to the hospital based on clinical practice guidelines and insurance coverage. A sub‐study was designed to analyze a cohort of a single‐center, pragmatic, prospective randomized controlled trial at a large academic medical center. Patients admitted to a medicine service with a pharmacist and prescribed a long‐acting inhaler were included. Participants randomized to a pharmacist‐led intervention were assessed for inhaler appropriateness based on clinical guidelines and patient insurance. The objective of this sub‐study is to assess the number of inhalers identified as inappropriate based on the pharmacist's review. A patient was considered to have an inappropriate inhaler regimen if any of their inhalers were inconsistent with guideline recommendations or not covered by insurance. Descriptive statistics were used to characterize appropriate inhaler use. The study pharmacist reviewed 552 unique inhalers for 348 patients. Overall, 42% of inhalers were inappropriate, affecting 50.3% of participants; 20% of inhalers were inappropriate based on insurance, 26% were inappropriate based on guidelines, and 7% were inappropriate based on both criteria. Recommendations were placed via a pharmacy consult for 198 patients (57%), most recommending an inhaler initiation (55%), followed by inhaler discontinuation (38%). A pharmacist‐led review of chronic inhaler therapy for patients admitted to the hospital identified the need for a change in therapy based on financial or clinical guidelines in over half of the patients reviewed. Interventions to increase the appropriateness of prescribed inhalers are needed to reduce disease progression and disease exacerbation.

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Transforming respiratory diseases management: a CMO-based hospital pharmaceutical care model

Zarate-Tamames,

Garin,

Calvin-Lamas

et al. 2024

Front. Pharmacol.

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IntroductionRespiratory diseases encompass a diverse range of conditions that significantly impact global morbidity and mortality. While common diseases like asthma and COPD exhibit moderate symptoms, less prevalent conditions such as pulmonary hypertension and cystic fibrosis profoundly affect quality of life and mortality. The prevalence of these diseases has surged by approximately 40% over the past 3 decades. Despite advancements in pharmacotherapy, challenges in drug administration, adherence, and adverse effects persist. This study aimed to develop and perform an interim validation of a Capacity-Motivation-Opportunity (CMO) model tailored for respiratory outpatients to enhance pharmaceutical care, which is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life, and overall wellbeing.MethodologyThis cross-sectional, multicenter study was conducted from March 2022 to March 2023. It comprised four phases: 1) forming an expert panel of 15 hospital pharmacists, 2) selecting respiratory pathologies based on prevalence and severity, 3) developing the CMO model’s pillars, and 4) integrating and conducting an interim validation of the model. The Capacity pillar focused on patient stratification and personalized care; the Motivation pillar aligned therapeutic goals through motivational interviewing; and the Opportunity pillar promoted the use of information and communication technologies (ICTs) for telemedicine.ResultsThe model included eight respiratory diseases based on expert assessment. For the Capacity pillar, 22 variables were defined for patient stratification, leading to three priority levels for personalized pharmaceutical care. In a preliminary test involving 201 patients across six hospitals, the stratification tool effectively classified patients according to their needs. The Motivation pillar adapted motivational interviewing techniques to support patient adherence and behavior change. The Opportunity pillar established teleconsultation protocols and ICT tools to enhance patient monitoring and care coordination.ConclusionThe CMO model, tailored for respiratory patients, provides a comprehensive framework for improving pharmaceutical care. By focusing on patient-centered care, aligning therapeutic goals, and leveraging technology, this model addresses the multifaceted needs of individuals with respiratory conditions. Future studies are necessary to validate this model in other healthcare systems and ensure its broad applicability.

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Hospital pharmacist discharge care is independently associated with reduced risk of readmissions for patients with chronic obstructive pulmonary disease: A propensity-matched cohort study

Cited by 3 publications

References 13 publications

Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process

Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process

Pharmacist review of chronic inhaler therapy appropriateness for hospitalized patients with COPD or asthma

Transforming respiratory diseases management: a CMO-based hospital pharmaceutical care model

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