2025 Southeastern Residency Conference

Impact of Pharmacist-Led Intervention on Maintenance Inhaler Appropriateness in COPD Exacerbations  
Kaysey Gilchrist, Emily Cooley, Taylor Wells, Danielle McGlynn, Michael Pitt
Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbations are associated with worsening outcomes, including repeat hospital admissions. The Centers for Medicare and Medicaid created a Hospital Readmissions Reductions Program, which financially penalizes hospitals for excessive 30-day readmission rates of certain conditions, including COPD. Previous literature has indicated that pharmacists are uniquely positioned to identify interventions for COPD therapy optimization based on knowledge of clinical guidelines and insurance formularies. However, this study did not describe the implementation of pharmacist led transitions of care initiatives for patients with COPD. The purpose of this study was to identify the impact of pharmacist-led interventions in COPD patients prior to discharge on 30-day hospital readmission rates for COPD by evaluating appropriate maintenance inhaler therapy.
Methods: In July 2024, a new transitions of care service was implemented at Cape Fear Valley Medical Center (CFVMC) which enabled pharmacists to review patients admitted for a COPD exacerbation and send recommendations to the attending provider for optimization of maintenance inhaler regimens before discharge. Adult patients admitted to CFVMC between March 1, 2024 – June 30, 2024 (pre-intervention) and October 1, 2024 – January 31, 2025 (post-intervention) with a primary diagnosis of COPD exacerbation identified by ICD 10 and DRG diagnosis codes were retrospectively reviewed in this single-center study. The primary endpoint was to compare the percentage of patients admitted for COPD exacerbation who are discharged on appropriate maintenance inhaler therapy regimens pre- and post-pharmacist-led intervention. 
Results: A total of 146 hospital encounters were included in the study with 59 hospital encounters in the pre-intervention group and 87 hospital encounters in the post-intervention group. Of the 146 hospital encounters included in the study, 32 regimens (54%) were appropriate at discharged in the pre-intervention phase compared to 67 (77%) in the post-intervention phase (P=0.004). The rate of 30-day hospital readmissions was lower in the post-intervention group compared to the pre-intervention group (19.5% vs 37.3%; P = 0.02).
Conclusions reached to date: This study provides further evidence to confirm the positive impact of pharmacist-led interventions on the provision of guideline-directed maintenance inhaler therapy in patients with COPD prior to discharge from a community teaching hospital.