Interventional, Quasi-Experimental Study of a Chronic Obstructive Pulmonary Disease Education Care Plan for Hospital Discharge

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity, mortality, and reduced quality of life for patients. Proper use of inhaler devices is critical for effective drug delivery and prevention of COPD progression. The primary endpoint of this study was a mean percent increase in correct steps associated with inhaler technique after pharmacist education. The co-primary endpoint was a 25% increase in the proportion of patients correctly identifying the appropriate use of short-acting versus long-acting inhaler types. This was an interventional quasi-experimental study of patients hospitalized at a 491-bed tertiary academic medical center with a COPD exacerbation to assess a pharmacist-led COPD care plan. Eligible patients included general floor, adult patients admitted with a primary diagnosis of COPD exacerbation. The primary investigator recorded initial inhaler technique scores through a paper checklist, and provided education about device types and usage. Patients were reassessed within 48 h to determine if pharmacist education improved inhaler knowledge. A total of 67 patients received the COPD care plan before hospital discharge. At baseline, patients scored a median of 81.8% (67.5–97.0) of steps correct across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% (90.9–100.0) (p < 0.0001). The proportion of patients correctly identifying when to use short-acting versus long-acting inhalers increased from 73.1% to 98.5% (p < 0.0001). Implementation of a pharmacist-led care plan for patients admitted for COPD exacerbation was associated with an increase in correct steps for appropriate inhaler technique and understanding of inhaler device types after pharmacist education.

Implementation of a pharmacist‐driven chronic obstructive pulmonary disease transitions of care service at a large academic medical center

“…Other studies involved pharmacists focusing on fewer aspects of the care bundle, for example, smoking cessation, 21 educating nurses, 10 inhaler technique education, 16,22 developing standardized education tools, 11 medication reconciliation at discharge, 14 preparing discharge medication packages, 9 or a combination of these 6,12,13 In a meta-analysis including eight studies with over 1800 participants, inhaler technique education showed a significant reduction in exacerbations (pooled risk ratio = 0.71; 95% confidence interval, 0.59-0.86; p < 0.001). 24 A study by Warunek and colleagues 16 found that patient education by pharmacists improved patient inhaler technique and knowledge. This study emphasizes that inhaler technique education by a pharmacist leads to improved, accurate use after 48 h. Increased adherence and using the appropriate inhalers at the correct time can contribute to improved symptoms and decreased exacerbations.…”

“…Compared to other studies looking at COPD care bundles, this is the first study that has expanded the role of the pharmacist in the inpatient setting to provide a more comprehensive approach to patient care. Other studies involved pharmacists focusing on fewer aspects of the care bundle, for example, smoking cessation, 21 educating nurses, 10 inhaler technique education, 16,22 developing standardized education tools, 11 medication reconciliation at discharge, 14 preparing discharge medication packages, 9 or a combination of these 6,12,13 with varying results. The single pharmacist in this study was able to intervene and contribute to patient care in a variety of different ways such as conducting accurate medication histories, assessing a patient's GOLD classification, recommending adjustments to COPD related therapies, providing inhaler technique education, immunization education, disease state counseling, and discharge counseling.…”

“…During this initial encounter, the pharmacist provided disease state education, inhaler technique education, smoking cessation counseling, adherence counseling, and immunization education. Assessment of inhaler technique was conducted before and after education was provided using standardized rubrics as previously reported by Warunek and colleagues 16 …”

“…Assessment of inhaler technique was conducted before and after education was provided using standardized rubrics as previously reported by Warunek and colleagues. 16 Once information was obtained from the Electronic Medical Record (EMR) and initial encounter, the pharmacist reviewed the data collected to make recommendations to providers via a secure messaging application. If recommendations were accepted, the pharmacist would then implement the changes by collaborating with outpatient pharmacies, optimizing inpatient and outpatient treatment in collaboration with providers, and arranging for immunization.…”

“…Pharmacists have been identified as key members of interdisciplinary teams with respect to COPD management. Several studies have been conducted analyzing the impact of pharmacists‐driven recommendations and TOC initiatives in reducing readmission rates in this population, but many of these interventions focus on limited aspects of COPD pharmacotherapy 6,8,12,16 . The purpose of the present study was to develop, implement, and evaluate outcomes for a pharmacist‐driven COPD TOC bundle focusing broadly on all drug related needs for these patients.…”