A Pharmacist-Led Intervention to Increase Inhaler Access and Reduce Hospital Readmission (PILLAR): A Randomized...

Area of Science:

• Pharmacology
• Health Services Research
• Pulmonology

Background:

• Chronic obstructive pulmonary disease (COPD) is a primary cause of hospital readmissions.
• The Centers for Medicare & Medicaid Services penalizes hospitals for avoidable readmissions under the Hospital Readmission Reduction Program.

Purpose of the Study:

• To evaluate if pharmacist-led review and recommendations for chronic inhaler therapy before hospital discharge affect the time to hospital readmission and emergency department (ED) visits.
• To assess the impact of this intervention on patients with and without COPD.

Main Methods:

• A single-center randomized controlled trial involved 914 patients on long-acting inhaler therapy.
• The intervention group received pharmacist recommendations for inhaler therapy appropriateness (clinical and financial), while the control group received usual care.
• The primary outcome was the combined time to hospital readmission or ED visit within 6 months post-discharge.

Main Results:

• Overall, no significant difference in time to readmission/ED visit was observed between the intervention and usual care groups (HR, 0.97; 95% CI, 0.79-1.18).
• Patients with COPD in the intervention group showed a significantly lower risk of readmission/ED visit at 30 days (HR, 0.63; 95% CI, 0.42-0.93) and 6 months (HR, 0.42; 95% CI, 0.28-0.64).
• Patients without COPD did not experience a significant reduction in readmission/ED visits (6-month HR, 1.5; 95% CI, 1.11-2.04).

Conclusions:

• Pharmacist-led review of inhaler therapy can reduce avoidable readmissions in patients with COPD.
• Optimizing inhaler therapy based on clinical guidelines and formulary preferences presents an opportunity for pharmacists to improve patient outcomes and reduce healthcare costs.