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A2769 - Optimization of COPD Management Among Inpatients with Acute Exacerbations of COPD
Author Block: I. Wirth1, E. D. Penz2, D. D. Marciniuk2; 1Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada, 2Respirology, Critical Care, and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
RATIONALE: Optimal management of COPD includes non-pharmacologic interventions—vaccination, smoking cessation, patient education / case management, and pulmonary rehabilitation—in addition to appropriate pharmacologic therapy. In addition to reducing symptoms and improving health-related quality of life, many of these interventions have also been demonstrated to decrease the risk of future exacerbations. In-hospital management of an acute exacerbation of COPD (AECOPD) is also an opportunity to ensure that all elements of patients’ COPD management are optimized. Accordingly, the purpose of this study was to examine the proportion of inpatients with AECOPD in our health region who were receiving guideline-adherent pharmacologic and non-pharmacologic therapy at the time of discharge. METHODS: This retrospective review contained all patients with a discharge diagnosis of AECOPD who were admitted to either of two Saskatoon hospitals from January 1, 2016 - December 31, 2016. 222 admissions were included in the study. Patients’ pharmacologic therapy at discharge was compared to both the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Canadian Thoracic Society (CTS) guidelines. RESULTS: Overall, 86% of patients were discharged on medications consistent with at least one of these guidelines (85% met the GOLD guidelines; 57% met the CTS guidelines). 10% of the study population were discharged without any inhaled maintenance therapy, and the remaining 4% were prescribed a regimen inconsistent with these guidelines. At discharge, only 14% of patients were documented to be vaccinated against pneumococcus, and 24% against influenza. 3% received the pneumococcal vaccine in hospital, while 6% received the influenza vaccine. Additionally, only 48% of current smokers were offered nicotine replacement therapy in hospital to assist with cessation. COPD Nurse-Clinicians were consulted in 75% of all admissions. Involvement of a Respirologist in the patient’s care and use of a COPD-specific admission order set were both associated with Nurse-Clinician consultation (p=0.01 and 0.001, respectively). Lastly, 8% of patients were referred to pulmonary rehabilitation upon discharge, while 3% were already participating at the time of admission to hospital. CONCLUSIONS: The results indicate that there is room for significant improvement in both the pharmacologic and non-pharmacologic aspects of in-hospital COPD management. The proportion of patients discharged without any maintenance therapy and the low rates of vaccination and pulmonary rehabilitation referral were particularly evident deficiencies that must be addressed. Effective quality improvement initiatives are warranted to ensure that all patients are able to benefit from optimal, evidence-based COPD treatment.