A Pharmacist-Led Intervention to Increase Inhaler Access and Reduce Hospital Readmissions (PILLAR)

Study Overview
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Brief Summary
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The goal of this study is to assess the impact of pharmacist-led benefits investigations and application of clinical practice guidelines on patient access to inhalers and time to hospital readmission or Emergency Department (ED) visit.

Official Title
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A Pharmacist-Led Intervention to Increase Inhaler Access and Reduce Hospital Readmissions (PILLAR)

Conditions
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COPD, Asthma

Intervention / Treatment
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* Other: Benefits investigation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patient admitted to Vanderbilt University Medical Center (VUMC) (excluding surgery services) on a long acting inhaler or prescribed a long acting inhaler during admission. Exclusion Criteria: Diagnosis of cystic fibrosis Diagnosis of graft versus host disease (GVHD) no medication insurance discharge to any post-acute care facility or inpatient hospice death during hospitalization

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients Using Inhalers<br>Adult patient admitted to Vanderbilt University Medical Center (excluding surgery services) on a long acting inhaler or prescribed a long acting inhaler during admission. | Other: Benefits investigation<br>* The study pharmacist will review the prescribed inhaler for 1) insurance coverage and 2) clinical appropriateness. The pharmacist will conduct a benefits investigation at time of hospital admission. The benefits investigation involves running test claims for inhalers to determine the most cost-effective inhaler for the patient's insurance plan. The study pharmacist will utilize clinical practice guidelines to assess appropriateness of the prescribed inhaler. Based on this review, the study pharmacist will submit a pharmacy consult to the inpatient pharmacist on the patient's healthcare team who will pend the inhaler orders (changing the patient's prescribed inhaler, if necessary) for the prescriber to send to the Meds to Beds discharge pharmacy. The Meds to Beds pharmacist will counsel the patient on inhaler use techniques prior to discharge.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to either hospital readmission or ER visit | Combined time (days) to either hospital readmission or emergency department visit after hospitalization (all outcomes measured at 6 months post-discharge with a 3 month interim analysis) | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of ED visit | number of ED visits 6 months post-discharge | 6 months | 
| frequency of hospital readmissions | number of hospital readmission 6 months post-discharge | 6 months | 
| time to 1st ED visit (days) | time until the first ED visit post-discharge | 6 months | 
| time to 1st readmission (days) | time until the first readmission post-discharge | 6 months | 
| frequency of prescribed inhaler at discharge | number of times the recommended inhaler was prescribed at discharge | 6 months | 
| frequency of short course prescription of oral steroid | number of oral steroid prescriptions in the 6 months post-discharge | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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inhaler, pharmacy