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A Pharmacist-Led Intervention to Increase Inhaler Access and Reduce Hospital Readmission (PILLAR): A Randomized
Tate D Parrott1, Matthew D Wallace1, Sarah H Eble2
1Vanderbilt University Medical Center, Nashville, TN.
Background:
COPD is a leading diagnosis for hospital readmissions and a focus of the Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program, which penalizes hospitals for avoidable readmissions.
Research Question:
Does a pharmacist-led evaluation and recommendation of chronic inhaler therapy before hospital discharge impact time to hospital readmission and emergency department (ED) visit?
Study Design And Methods:
A single-center randomized controlled trial at a large academic medical center enrolled admitted patients prescribed a long-acting inhaler. Patients received usual care or the intervention wherein a pharmacist reviewed inhaler therapy and provided recommendations for those with inappropriate therapy based on insurance formulary preference or clinical guidelines before discharge. The primary outcome was the combined time (days) to either hospital readmission or ED visit after hospitalization measured 6 months postdischarge. Similar analyses were performed for patients with and without COPD.
Results:
The study included 914 patients on long-acting inhaler therapy (56% with COPD and 33% with asthma). Fifty percent of patients were identified to have inappropriate inhaler therapy. The mean time to readmission/ED visit ± SD was 121 ± 71 days for the intervention arm and 117 ± 73 days for the usual care arm (hazard ratio [HR], 0.97; 95% CI, 0.79-1.18). Patients with COPD in the intervention arm had a lower risk of readmission/ED visit at both 30 days (HR, 0.63; 95% CI, 0.42-0.93) and 6 months (HR, 0.42; 95% CI, 0.28-0.64) compared with usual care; however, no difference was seen for patients without COPD at 30 days (HR, 1.18; 95% CI, 0.75-1.86; P = .468) and 6 months (HR, 1.5; 95% CI, 1.11-2.04; P = .009).
Interpretation:
In a group of patients receiving long-acting inhaler therapy for various indications, a significant reduction in risk of time to readmission/ED visit was not seen between the intervention and usual care groups. However, a significant reduction in risk of time to readmission/ED visit was observed for patients with COPD in the intervention group, suggesting an opportunity for pharmacist inhaler therapy review for financial and clinical appropriateness to reduce avoidable readmissions.
Clinical Trial Registration:
ClinicalTrials.gov; No.NCT03927820; URL: www.clinicaltrials.gov.
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