Comprehensive and Collaborative Pharmacist Transitions of Care Service for Underserved Patients with Chronic Obstructive Pulmonary Disease

被引:7
作者
Kim, Jennifer [1 ,2 ,3 ]
Lin, Amy [4 ]
Absher, Randy [1 ]
Makhlouf, Tanya [1 ]
Wells, Casey [3 ]
机构
[1] Cone Hlth, Greensboro, NC 27401 USA
[2] Area Hlth Educ Ctr, Greensboro, NC 27401 USA
[3] Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA
[4] Nebraska Med, Omaha, NE USA
来源
CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION | 2021年 / 8卷 / 01期
关键词
implementation science; quasi-experimental study design; chronic obstructive pulmonary disease; care transitions; interdisciplinary; 30-DAY READMISSION RATES; HOSPITAL READMISSIONS; IMPACT; PROGRAM; DISCHARGE; COPD; HOME; INTERVENTION; MANAGEMENT;
D O I
10.15326/jcopdf.2019.0175
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Mortality risk from chronic obstructive pulmonary disease (COPD) increases significantly in the first year after a 30-day hospital readmission. Objective: To evaluate a comprehensive and collaborative pharmacist transitions of care service for patients hospitalized with COPD compared to usual care. Methods: In this within-site, retrospective study, discharge counseling, medication reconciliation, medication access assistance, therapy changes, and post-discharge long-term follow-up were provided to underserved adult patients with a primary care provider at the study clinic and admitted to the affiliated hospital with a primary diagnosis of COPD exacerbation. Primary outcome was a 180-day composite of COPD-related hospitalizations and emergency department (ED) visits. Secondary outcomes were 30-, 60-, 90-, and 180-day events, costs, pharmacist interventions, time to follow-up, and pneumonia. Results: Sixty-five patients were identified with a total of 101 index admissions. The mean age was 62.5 years, approximately 55.3% were female, and 67.7% were black or African American. The primary composite was significantly lower in the pharmacist intervention group compared to usual care (mean difference 0.82, P=0.0364, 95% confidence interval [CI] 0.05-1.60), driven by lower 30-day hospitalizations in the intervention group (mean difference 0.15, P=0.0099, 95% CI 0.04-0.27). Cost associated with COPD-related hospitalizations was significantly lower in the pharmacist intervention group compared to usual care ($173,808, P=0.0330) as well as before intervention ($79,662, P=0.0233). There was no significant difference in time to follow-up or pneumonia. Conclusions: A comprehensive, collaborative pharmacist transitions of care service significantly reduced 30day COPD-related hospital readmissions, ED re-visits, and associated costs in an underserved population.
引用
收藏
页码:152 / 161
页数:10
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