Title: Pharmacist Led COPD Medication Recommendations During Discharge Medication Review
Authors: Bridget Arellano, Ali Diaz, Dahlia Kaiser AdventHealth Orlando, Orlando, FL
Background/Purpose: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity, with national 30-day readmission rates near 30%. To reduce rates of readmission, the Center for Medicare and Medicaid Services (CMS) implemented a Hospital Readmission Reduction Program, incentivizing improved communication and coordination for patients at discharge. Currently our COPD readmission rate is approximately 20%. To address this, our hospital initiated a pharmacist-led discharge medication reconciliation (DMR) workflow to optimize COPD therapy with a goal to maintain readmission rates below 16%. However, the clinical reach of this program and the rate of provider acceptance of these recommendations is not well established. This study aimed to evaluate physician acceptance of pharmacist-driven COPD therapy recommendations and its association with 30-day readmission rates.
Methods: This retrospective chart review included patients ≥65 years of age with COPD, discharged home from AdventHealth Orlando between January and September of 2025. Data collected included demographics, pharmacist interventions, recommendation types, provider response, and 30-day readmission outcomes. Descriptive statistics were used to evaluate intervention frequency, acceptance rates, and readmission outcomes.
Results: A total of 168 patient encounters and 119 unique patients were analyzed. Pharmacist interventions were made in 14 (8.3%) patient encounters, and the majority (n=10; 71.4%) were to recommend adding an additional agent to the patient’s current regimen. Of the 14 pharmacist interventions, 9 (64.3%) were accepted by the provider. Overall, 30-day readmissions occurred in 22 (18.5%) patients and 59 (35.1%) encounters. Out of the nine encounters with accepted interventions, 4 (44.4%) had a 30-day readmission. Due to the low intervention rate, comparative analysis between accepted and non-accepted recommendations was limited.
Conclusions: Pharmacist interventions during discharge medication reconciliation were very limited in this dataset of elderly patients with COPD. Although readmission rates in this specific population remained above goal, the low number of interventions restricts conclusions regarding the impact of recommendation acceptance on patient readmission rates. Future efforts should focus on the DMR workflow and evaluate various barriers surrounding pharmacist interventions on optimizing COPD therapy.
