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A4967 - COPD Pharmacy Program
Author Block: S. Patel1, K. Gafoor1, H. M. Belete1, M. Oron1, V. Shah1, E. L. Altschul1, G. Dunsky2, B. A. Mina1; 1Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, United States, 2Pharmacy, Lenox Hill Hospital - Northwell Health, New York, NY, United States.
Introduction: In 2014 the Centers for Medicare and Medicaid Services (CMS) expanded their Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). This new policy stated 30-day-all-cause unplanned readmission rates after hospitalization for acute exacerbation of COPD (AECOPD) will be penalized with reduced reimbursement. Decreasing rates of readmission could lead to considerable hospital savings. Medication non-compliance and inappropriate use are common preventable causes for an exacerbation. We implemented a pharmacy program for patients admitted with an AECOPD to provide education and adjustments to COPD treatment based on the GOLD 2017 guidelines. Methods: We implemented our program on March 15th 2017 at our community hospital. Patients admitted with a diagnosis of AECOPD were included. The pulmonary service would provide expert consultation for optimal management which included medication adjustments. The pharmacist educated the patient on COPD, demonstrated proper use of their prescribed inhaler(s), counseled them on dose, frequency, potential adverse effects and what to do in case of a missed dose. The patient would then demonstrate the use of the inhaler back to the pharmacist. Compliance was measured by 1 week post-discharge office visits by history and further education if needed. Results: 40 patients were admitted with AECOPD over a 5 month period. 30 (75%) of the patients were female with an average age of 72.2 years. The average modified medical research council dyspnea score (mMRC) was 2.2. There were 3 (7.5%) 30-day readmissions. 13 (33%) of patients were non-compliant with their home medications. On admission 45% of patients were on long acting beta agonist (LABA), long acting muscarinic agonist (LAMA)and inhaled corticosteroid (ICS), 23% were on LABA/ICS, 10% on LAMA alone and 2% on LABA/LAMA combination. On discharge 46% left on LABA/LAMA/ICS and 44% on LABA/LAMA combination. 39 patients followed-up post-discharge reporting compliance with their inhalers. Conclusion: Implementing a pharmacy program for patients admitted with AECOPD may reduce 30-day hospital re-admissions (7.5%); nationally 30-day readmission rates vary from 10% to 20%. Patients on triple therapy with LABA/LAMA/ICS were kept on the same regimen on discharge; we saw a significant increase in prescribing LABA/LAMA combination inhalers. Of the 3 re-admissions, 1 was for endocarditis, 1 did not follow-up and admitted for AECOPD, the other had end-stage COPD requiring hospice care. This suggests that there will inevitably be some unavoidable 30-day readmissions. Short-term medication compliance can be tackled with education and early follow-up, long term compliance is still a challenge.