Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: Effects on prescription filling and readmission

• Published in: American journal of health-system pharmacy 2015-07, Vol.72 (14), p.1204-1208
• Main Authors: BLEE, JOHN, ROUX, RYAN K, GAUTREAUX, STEFANI, SHERER, JEFFREY T, GAREY, KEVIN W
• Format: Article
• Language: English
• Subjects: Aged; Bronchodilator Agents - administration & dosage; Chronic obstructive lung disease; Dosage and administration; Drug Prescriptions; Drug therapy; Female; Hospital admission and discharge; Humans; Inhalers; Male; Medication Adherence; Methods; Middle Aged; Nebulizers and Vaporizers - trends; Patient Discharge - trends; Patient Readmission - trends; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - epidemiology; Respiratory system agents
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp140621

PURPOSEThe effects of dispensing inhalers to patients with chronic obstructive pulmonary disease (COPD) on hospital discharge were evaluated. METHODSData were collected in 2011–12 for patients with COPD who had hospital orders for the study inhalers (preintervention group) and after implementation of the multidose medication dispensing on discharge (MMDD) service (2013–14) (postintervention group). The primary objective of this study was to assess inhaler adherence and readmission rates before and after MMDD implementation. Adherence was defined as filling the discharge prescription for the multidose inhaler at a Harris Health pharmacy within three days of discharge or having at least seven days of medication left in an inhaler from a previous prescription that was filled or refilled before hospital admission. All patients in the postintervention group were considered adherent, since every patient was given the remainder of his or her multidose inhaler when discharged. RESULTSData from 620 patients (412 in the preintervention group, 208 in the postintervention group) were collected. During the preintervention time period, 88 of 412 patients were readmitted within 30 days compared with 18 of 208 patients during the postintervention period (p < 0.001). The intervention was associated with a significant reduction in 30-day readmissions (p = 0.0016) and 60-day readmissions (p = 0.0056). CONCLUSIONA targeted pharmacy program to provide COPD patients being discharged from the hospital with the multidose inhalers they had used during hospitalization was associated with improved medication adherence, as measured by prescription filling behavior, and reduced rates of 30- and 60-day hospital readmissions.