Impact of Pharmacist Inhaler Prescribing at Discharge for Chronic Obstructive Pulmonary Disease on Readmission Rates.

Background: Acute exacerbation of COPD (AECOPD) is one of the six conditions in the Hospital Readmissions Reduction Program for which institutions are penalized for high 30-day readmission rates. This institution's Transitions of Care (TOC) pharmacists have prescribing authority to optimize guideline-directed medical therapy (GDMT), defined as discharging on rescue plus triple therapy inhalers under an approved protocol. While several studies evaluate the impact of pharmacist-led interventions on COPD readmission rates, there is a lack of literature with respect to pharmacists prescribing inhalers under an approved protocol. This study aims to evaluate all-cause 30-day COPD readmission rates.

Methods: This was an IRB-approved, single-center, retrospective evaluation conducted between May 2021 and August 2023. Patients were included if they met criteria under the CMS HRRP COPD model. Patients in the pre-implementation group received usual care, with post-discharge nurse follow-up while patients in the post-implementation group received TOC pharmacy services. The primary outcome was all-cause 30-day readmission rates. Secondary outcomes included readmission reason and proportion of patients discharged on GDMT.

Results: A total of 279 patients were included, with 187 patients in the pre-implementation group and 92 patients in the post-implementation group. All-cause 30-day readmission rates in the pre- and post-implementation groups were 26% and 14%, respectively (p=0.02). The proportion of patients discharged on GDMT was 26% in the pre-implementation group and 100% in the post-implementation group (p<0.001).

Conclusion: Utilizing a TOC pharmacy service may be associated with a reduction in all-cause 30-day readmission rates for patients with COPD.