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Evaluation of a Clinical Pharmacist-Led Service to Facilitate Transitions of Care for COPD within an Integrated VA Healthcare System
Thursday April 24, 2025 10:10am - 10:25am EDT
Athena J
Owen C. Bradford, PharmD, MSN
Birmingham VA Health Care System
700 19th St. S - Birmingham, AL 35233
Owen.Bradford@VA.gov
 
Title:
Evaluation of a Clinical Pharmacist-Led Service to Facilitate Transitions of Care for COPD within an Integrated VA Healthcare System
 
Authors:
Owen C. Bradford
Whitney White 
Caitlin Brown
 
Background/Objective: 
Previous implementations of pharmacist-led transitions of care services have shown improvement in clinical and economic outcomes across numerous disease states. Although chronic obstructive pulmonary disease (COPD) is a progressive disease state, COPD-related morbidity is largely modifiable through optimal medication utilization and adherence. The objective of this study is to evaluate a new clinical pharmacist-led COPD transitions of care service within an integrated VA healthcare system in order to determine its impact on utilization of guideline-directed medication therapy and associated measures. 
 
Methods:
This QI study will evaluate data from hospital follow-up visits for patients admitted with a diagnosis of a COPD exacerbation. Patients will be identified based on referral before hospital discharge. Post-discharge follow-up visits will be conducted via telephone, video, or face-to-face format. 
A retrospective chart review will be performed to collect data related to completion of pharmacist interventions as well as clinical and economic outcomes. Pharmacist interventions may include successful medication reconciliation, patient education, modification of COPD pharmacotherapy, actions related to vaccination status or smoking status, etc. Clinical measures may include utilization of guideline-directed medication therapy, CAT and mMRC scores, smoking cessation status, and vaccination status. Economic measures may include formulary status of COPD therapies, total monthly cost of COPD therapies, etc. 
These measures will serve as the data source for determining primary and secondary endpoint results. The primary endpoint for this study will be the change in utilization of guideline-directed medication therapy (GDMT). Secondary endpoints will include change in CAT scores, change in mMRC scores, and change in vaccination status.
 
Results
A total of 7 patients were included during the study period (December 2024 through March 2025). All 7 patients were classified as GOLD group E based on hospitalization for exacerbation. The average time from hospital discharge to initial follow-up visit was 36 days. During these visits, pharmacists completed interventions including medication reconciliation, patient education, pharmacotherapy optimization, and actions related to smoking cessation and vaccination. Following these visits, adherence to guideline-directed medication therapy (GDMT) improved from 4/7 patients (57%) to 7/7 patients (100%). Of the 5 patients who were not up-to-date on recommended vaccinations, all were offered vaccination. 1 patient received the RSV vaccine during the visit, 1 denied all vaccinations, and 2 preferred to follow up with their primary care provider for vaccination. Four patients were identified as candidates for smoking cessation interventions. All 4 of these patients received counseling on smoking cessation, and 2 initiated or continued on nicotine replacement therapy. The average 30-day cost of pharmacotherapy increased from $48.87 to $66.28, which was attributed to the addition of guideline-driven COPD therapies. Formulary adherence remained 100% both pre- and post-visit.

Conclusion:
The implementation of this pharmacist-led transitions of care service for patients hospitalized with COPD exacerbations led to improved adherence to GDMT and enhanced delivery of preventive care. Pharmacist-led clinical interventions have the potential to positively impact long-term patient outcomes, including symptom control and reduction in hospital readmissions. While the small sample size limits broader application, this pilot demonstrates the feasibility and potential clinical and economic value of integrating pharmacists into transitions of care services for COPD management in the VA setting.
 
 
Moderators
JT
Presenters
avatar for Owen C. Bradford

Owen C. Bradford

PGY1 Pharmacy Resident, Birmingham VA Health Care System
My name is Owen Bradford, and I am a PGY1 Pharmacy Resident at the Birmingham VA Health Care System! I completed my undergraduate and graduate work at Samford University here in Birmingham, AL where I received my Doctor of Pharmacy and Master of Science in Nutrition degrees. Outside... Read More →
Evaluators
TC

Tabitha Carney

PGY1 Residency Program Director, Emory University Hospital MidtownPGY1
Thursday April 24, 2025 10:10am - 10:25am EDT
Athena J

Attendees (21)


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