Effect of Pharmacy Counseling on Readmissions in Patients with Acute Exacerbations of COPD: A Randomized Controlled Trial
DOI:
https://doi.org/10.31584/jhsmr.2021806Keywords:
AECOPD, inpatients, pharmacy counseling, RCT, readmissionsAbstract
Objective: To investigate the effects of pharmacy counseling on clinical and economic outcomes in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients.
Material and Methods: The outcomes consisted of 28-day hospital readmissions related to AECOPD, direct costs, medication adherence calculated by proportion of days covered (PDC), and health-related quality of life (HRQoL) measured by chronic obstructive pulmonary disease assessment test (CAT). The data derived from the intervention group, for which pharmacy counseling was provided, was compared with that obtained from the control group provided with usual pharmaceutical care. The study also drew comparisons between the PDC and CAT scores of pre- and postintervention periods.
Results: Forty-four patients (23 intervention and 21 control) were included in the analysis. There were no significant differences in the readmission rate (13% vs 19%, p-value>0.050), nor the number of readmitted patients (3 vs 3, p-value >0.050). A decrease in direct costs did not reach statistical significance (p-value>0.050). In addition, no difference between the PDC scores was found (96.67 vs 100.00, p-value>0.050). Intervention patients obtained significantly lower CAT scores than the control patients did (9 vs 19, p-value<0.050). Compared with the pre-intervention period, PDC scores were identical; however, CAT scores measured during the post-intervention period were significantly different.
Conclusion: Pharmacy counseling for AECOPD patients could enhance HRQoL. Drug therapy and pulmonary rehabilitation may cause such improvement. Further work, which has adequate participants, is required to detect a significant difference in readmissions between the two groups.
References
Parris BA, O’Farrell HE, Fong KM, Yang IA. Chronic obstructive pulmonary disease (COPD) and lung cancer: common pathways for pathogenesis. J Thorac Dis 2019;11(Suppl 17):S2155– 72.
May SM, Li JTC. Burden of chronic obstructive pulmonary disease: healthcare costs and beyond. Allergy Asthma Proc 2015;36:4–10.
Chapman KR, Mannino DM, Soriano JB, Vermeire PA, Buist AS, Thun MJ, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006;27:188–207.
Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic burden of chronic obstructive pulmonary disease (COPD): a systematic literature review. Int J Chron Obstruct Pulmon Dis 2020;15:439–60.
Zamzam MA, Azab NY, El Wahsh RA, Ragab AZ, Allam EM. Quality of life in COPD patients. Egypt J Chest Dis Tuberc 2012;61:281–9.
King D, Iheanacho I, Zhang S, Kenny J, Rizzo M, Ismaila A. PRS101 - Impact of chronic obstructive pulmonary disease (COPD) on quality of life: findings from a systematic literature review. Value Heal 2018;21:S420–1.
Hurst JR, Skolnik N, Hansen GJ, Anzueto A, Donaldson GC, Dransfield MT, et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med 2020;73:1–6.
Niesink A, Trappenburg JCA, de Weert-van Oene GH, Lammers JWJ, Verheij TJM, Schrijvers AJP. Systematic review of the effects of chronic disease management on quality-of-life in people with chronic obstructive pulmonary disease. Respir Med 2007;101:2233–9.
Tang FW, Lee DT. A phenomenological study of hospital readmissions of Chinese older people with COPD. Gerontologist 2017;57:1113–22.
Shah T, Press VG, Huisingh-Scheetz M, White SR. COPD readmissions: addressing COPD in the era of value-based health care. Chest 2016;150:916–26.
Hakim MA, Garden FL, Jennings MD, Dobler CC. Performance of the LACE index to predict 30-day hospital readmissions in patients with chronic obstructive pulmonary disease. Clin Epidemiol 2017;10:51–9.
Braman SS. Hospital readmissions for COPD: we can meet the challenge. Chronic Obstr Pulm Dis 2015;2:4–7.
Myers LC, Faridi MK, Hasegawa K, Hanania NA, Camargo CA. The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006– 2015. Ann Am Thorac Soc 2019;17:450–6.
Khdour MR, Kidney JC, Smyth BM, McElnay JC. Clinical pharmacy-led disease and medicine management programme for patients with COPD. Br J Clin Pharmacol 2009;68:588–98.
Jarab AS, Alqudah SG, Khdour M, Shamssain M, Mukattash TL. Impact of pharmaceutical care on health outcomes in patients with COPD. Int J Clin Pharm 2012;34:53–62.
Wei L, Yang X, Li J, Liu L, Luo H, Zheng Z, et al. Effect of pharmaceutical care on medication adherence and hospital admission in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled study. J Thorac Dis 2014;6:656–62.
Nazareth I, Burton A, Shulman S, Smith P, Haines A, Timberall H. A pharmacy discharge plan for hospitalized elderly patients - A randomized controlled trial. Age Ageing 2001;30: 33–40.
Stowasser DA, Collins DM, Stowasser M. A randomised controlled trial of medication liaison services - patient outcomes. J Pharm Pract Res 2002;32:133–40.
Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 2006;166:565–71.
Laswell E, Svelund E, Harzler M, Chambers K, Chen A. Discharge medication counseling and its correlation with reducing readmissions for patients with chronic obstructive pulmonary disease exacerbations. Inov Pharm 2015;6:1-8.
Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol 2002;54:657– 64.
Eisenhower C. Impact of pharmacist-conducted medication reconciliation at discharge on readmissions of elderly patients with COPD. Ann Pharmacother 2013;48:203–8.
Phakdiphan S, Anantachoti P, Pengsuparp T, Trakunkan S. Hospital financial status and quality of care under diagnosis related groups payment machanism. Thai Pharm Heal Sci J 2014;9:213–21.
Raebel MA, Schmittdiel J, Karter AJ, Konieczny JL, Steiner JF. Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases. Med Care 2013;51(8 Suppl 3):S11–21.
Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009;34:648-54.
Prieto-Centurion V, Markos MA, Ramey NI, Gussin HA, Nyenhuis SM, Joo MJ, et al. Interventions to reduce rehospitalizations after chronic obstructive pulmonary disease exacerbations. A systematic review. Ann Am Thorac Soc 2014;11:417–24.
Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupr A, B gin R, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific selfmanagement intervention. Arch Intern Med 2003;163:585–91.
Tommelein E, Mehuys E, Van Hees T, Adriaens E, Van Bortel L, Christiaens T, et al. Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease (PHARMACOP): a randomized controlled trial. Br J Clin Pharmacol 2014;77:756–66.
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166:955–64.
Gallagher J, Byrne S, Woods N, Lynch D, McCarthy S. Costoutcome description of clinical pharmacist interventions in a university teaching hospital. BMC Health Serv Res 2014;14:177.
Montes de Oca M, Menezes A, Wehrmeister FC, Lopez Varela MV, Casas A, Ugalde L, et al. Adherence to inhaled therapies of COPD patients from seven Latin American countries: The LASSYC study. PLoS One 2017;12. doi: 10.1371/journal.pone. 0186777.
Agh T, Inotai A, Meszaros A. Factors associated with medication adherence in patients with chronic obstructive pulmonary disease. Respiration 2011;82:328–34.
Świątoniowska-Lonc N, Chabowski M, Polański J, Mazur G, Jankowska-Polańska B. Adherence to therapy in chronic obstructive pulmonary disease: a systematic review. Adv Exp Med Biol 2020;1271:37-47.
Zhang S, Thomas. Adherence to chronic obstructive pulmonary disease maintenance medication among patients with copd. Value Heal 2015;18:A177–8.
Wu AC, Butler MG, Li L, Fung V, Kharbanda EO, Larkin EK, et al. Primary adherence to controller medications for asthma is poor. Ann Am Thorac Soc 2015;12:161–6.
Bogart M, Stanford RH, Lalibert F, Germain G, Wu JW, Duh MS. Medication adherence and persistence in chronic obstructive pulmonary disease patients receiving triple therapy in a USA commercially insured population. Int J COPD 2019; 14:343–52.
Cyr MC, Beauchesne MF, Lemi re C, Blais L. Comparison of the adherence and persistence to inhaled corticosteroids among adult patients with public and private drug insurance plans. J Popul Ther Clin Pharmacol 2013;20:26–41.
Barrecheguren M, Monteagudo M, Miravitlles M. Populationbased study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care. npj Prim Care Respir Med 2018;28. doi: 10.1038/s41533- 018-0102-x.
Ferrone M, Masciantonio MG, Malus N, Stitt L, O’Callahan T, Roberts Z, et al. The impact of integrated disease management in high-risk COPD patients in primary care. npj Prim Care Respir Med 2019;29. doi: 10.1038/s41533-019-0119-9.
Khachi H, Karikari P. P78 impact of a pharmacist-led asthma and COPD reviews in general practice. Thorax 2013;68 (Suppl 3):A110-1.
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