COPD is the 3rd most common cause for hospital admission in the UK. Patients with COPD are often unable to attend specialist clinics, when factors contributing to exacerbations can be treated, due to the unstable nature of the condition and the degree of breathlessness experienced. There is also a high level of polypharmacy in this population. Domiciliary specialist pharmacy intervention may help identify and treat these issues.
Hypothesis Specialist Domiciliary Pharmacy intervention reduces exacerbation frequency and hospitalisation in patients with Severe COPD
Patients who were referred to a specialist COPD clinic between March 2015 and January 2016 were assessed. Those with polypharmacy and high exacerbation frequency or severe breathlessness (MRC grade 4–5) were identified and offered domiciliary pharmacy review. Patients who consented were visited at home with a comprehensive review of medication, the case was then discussed at an MDT level and therapeutic changes implemented. A comparator group of matched patient were identified and followed up without pharmacy intervention.
Baseline data were collected including demographics, smoking status, FEV1, MRC Grade, hospitalisation rates, exacerbation frequency and current medications. Patient records were then reviewed after a 6 month period to look at impact of intervention on hospitalisation, exacerbation frequency, antibiotic and steroid prescription in the two groups.
Results A total of 88 patients received intervention and 87 patients were followed up in a comparator group. Patients were matched in terms of sex, BMI, socioeconomic deprivation, smoking status, FEV1, MRC Grade, LTOT use and hospitalisation frequency.
Patients had an average of 3.5 visits with an average of 7.6 interventions per patient, therapeutic changes being the most frequent.
Review after 6 months of intervention demonstrated that the intervention group had a significant reduction in hospitalisation (p < 0.01) and exacerbation frequency (p < 0.01) (Figure 1) along with antibiotic and steroid use in comparison to the comparator group.
This project was a service evaluation rather than a double blinded, randomised control study. The results however suggest that specialist pharmacy intervention in a setting appropriate for a disabled population has a positive impact on exacerbation frequency and hospitalisation.
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