Pharmacists’ interventions in chronic obstructive pulmonary disease related hospital readmissions

Abstract

Acute worsening of respiratory symptoms is associated with accelerated disease progression, often leading to hospitalisations impacting patients’ quality of life and the national healthcare system. The aim of this research was to propose a tool assisting pharmacists in identification of risk factors for COPD hospitalisations and readmissions. The objectives included the identification of risk factors contributing to exacerbation of COPD patients necessitating hospitalisation and early readmission for acute exacerbation of COPD, provision of education re-assessment for correct inhaler technique, and review of medication compliance. A data collection tool was compiled and validated by an expert panel comprising of participating respiratory consultant, respiratory resident specialist, clinical pharmacist, and community pharmacist. The study was conducted over 6 months at the acute general hospital, Mater Dei Hospital (MDH), Malta. A case-control approach was adopted consisting of 2 patient cohorts. The inpatient cohort consisted of patients admitted for COPD exacerbation under the care of the participating physician. The outpatient cohort was comprised of COPD patients reviewed at the medical outpatient clinics by the participating respiratory firm. A questionnaire-based interview was disseminated to patients who met the inclusion criteria. The questionnaire consisted of three sections. Section A dealt with general data collection incorporating patient-specific factors and COPD-specific variables, Section B consisted of an inhaler adherence assessment and Section C evaluated inhaler and nebulizer administration technique. In the study population (N=58), statistically significant differences between cohorts were observed (p < 0.05) for corticosteroid and antibiotic prescribing, side effects (irrespective of type of side effect), number of days per week patients required salbutamol, and where patients report to first when symptoms worsen. An almost statistically significant difference was observed for locality of residence (p=0.055) and involvement of respiratory physiotherapists (p=0.054). Addressing device-specific inhaler technique difficulties and misconceptions, written self-management action plans for worsening symptoms, and optimisation of comorbidities management are fundamental areas to consider in enhancing transition of care when establishing a pharmaceutical care model in respiratory.