Obstructive Lung Diseases: Airways 4 |

Inhaler Training and COPD Education: A Pharmacist-Driven Approach to Lowering Readmissions in an Urban Safety-Net Hospital FREE TO VIEW

Marjan Islam, MD; Navitha Ramesh, MD; Nikki Bhogal, PharmD; Patricia Walker, MD; Joanna Mecca, MD; Mary Harris, MD
Author and Funding Information

Mount Sinai Beth Israel, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):868A. doi:10.1016/j.chest.2016.08.968
Text Size: A A A
Published online


SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: COPD affects approximately 5% of adults in the US, ranking 3rd in all-cause mortality and responsible for almost 700,000 hospital admissions annually. Since its inclusion to the Hospital Readmissions Reduction Program, there has been a renewed interest in identifying novel strategies to prevent readmissions nation-wide. While newer approaches continue to be explored, displaying proper inhaler technique and basic disease understanding remain at the foundation of effective self-management of COPD, yet is likely lacking in this patient population.

METHODS: Our institution carried out a clinical pharmacist-driven COPD management program to deliver bedside disease education and hands-on inhaler training for all patients admitted with a primary diagnosis of Acute Exacerbation of COPD (AECOPD) during a five-month period. The pharmacist was notified by the primary team and additionally, provided reconciliation of patient’s home and inpatient medications, counseling on nicotine replacement therapy, and coordination with post-acute care, including follow-up phone calls 48-hours after discharge. Patient charts were reviewed retrospectively for 30-day readmissions for all patients enrolled into the program. Patient demographics, medical comorbidities and psychosocial risk-factors were analyzed between ≤30-day and >30-day readmission groups. 30-day readmission rates were compared against our institution’s 1-year average 30-day readmission rates, prior to the launch of this program.

RESULTS: Of n=91 patients with an index admission for AECOPD enrolled, 14.29% (n=13) were readmitted within 30-days, compared to 19.46% during the year prior to the launch of our program (n=79 of 409 index admissions for AECOPD, p=0.13). Comparing patients that received pharmacy training, the ≤30-day readmissions group tended to be younger (61 years vs. 69 years, p=0.01) and with higher psychiatric comorbidity (52.38% vs. 24.29%, p=0.01) when compared to the >30-day readmissions group. The ≤30-day group also tended to be male (57.14% vs. 38.57%, p=0.13), and have higher rates of co-existing non-COPD pulmonary disease (28.57% vs. 24.29%, p=0.69), malignancy (14.29% vs. 8.57%, p=0.44), and other major comorbidity (i.e. ESRD or cirrhosis; 33.33% vs. 22.86%, p=0.33), though none of these differences reached statistical significance. The >30-day readmissions group tended to have higher rates of heart disease (45.71% vs. 33.33%, p=0.31), while substance abuse was nearly equal between both groups (38.10% vs. 37.14%, p=0.94).

CONCLUSIONS: Use of inhaler-training and disease education by a clinical pharmacist during hospitalization for AECOPD may lower 30-day readmissions rates, though a longer duration of enrollment will need to be undertaken before a clear effect can be appreciated.

CLINICAL IMPLICATIONS: Reducing COPD readmissions remains a complex and multi-faceted problem. While novel approaches continue to be explored, reinforcing basic inhaler and disease education should remain as a core tenant in self-management, and properly emphasized.

DISCLOSURE: The following authors have nothing to disclose: Marjan Islam, Navitha Ramesh, Nikki Bhogal, Patricia Walker, Joanna Mecca, Mary Harris

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543