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

Overview

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.

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: June 2024

Interventions

  • Other: Benefits investigation
    • 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.

Arms, Groups and Cohorts

  • Patients Using Inhalers
    • Adult patient admitted to Vanderbilt University Medical Center (excluding surgery services) on a long acting inhaler or prescribed a long acting inhaler during admission.

Clinical Trial Outcome Measures

Primary Measures

  • Time to either hospital readmission or ER visit
    • Time Frame: 6 months
    • 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)

Secondary Measures

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

Participating in This Clinical Trial

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

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Vanderbilt University Medical Center
  • Provider of Information About this Clinical Study
    • Principal Investigator: Tate Davis, Clinical Pharmacist – Vanderbilt University Medical Center
  • Overall Official(s)
    • Kristina Niehoff, PharmD, Principal Investigator, Vanderbilt University Medical Center

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