CP29 - Pharmacist-led ICS de-escalation in non-asthmatic adults with COPD in a primary care setting

Poster Type: Research

Category: Quality of Care and Quality Improvement

Research Objectives: Latest guidelines recommend to de-escalate inhaled corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease (COPD) patients due to possible lack of benefit and increased adverse effect risk if eosinophil blood counts (EOS) <100 cells/uL. The study’s purpose is to assess pharmacist-provided recommendations for an EOS test and the corresponding medication changes.

Study Design/Methods: This IRB-approved prospective study involved retrospective chart reviews for COPD patients 18 years or older, with no current or previous asthma diagnosis, prescribed ICS therapy, seen by a primary care provider (PCP) for COPD between 1/1/2019 – 8/31/2019, and had an upcoming PCP appointment. Lab order recommendations were sent to PCPs for patients needing updated EOS. If EOS <100 cells/uL, PCPs were recommended to order pharmacist COPD management referrals. If referrals were ordered, appointments were scheduled to assess ICS appropriateness as well as other factors affecting COPD management. Data on recommendations, completed tests, and referrals were collected from medical records.

Principal Findings and Quantitative/Qualitative Results: On initial review, 249 patients had EOS on file (including 4 patients with EOS 100 cells/uL, and 24 (39%) did not have their labs drawn. Major reasons for this include patients not presenting for PCP visits, patients not attending lab, and PCPs not ordering labs. All 5 patients with EOS <100 cells/uL were referred and scheduled with the pharmacist, but none presented for their appointment.

Conclusions on Impact on Health Centers: With majority of the recommendations being accepted by PCPs for updated EOS counts, this study does show the impact of a proactive pharmacist intervention on the uptake of new guideline recommendations for COPD management. However, since no patients presented to the pharmacist COPD appointments, we were unable to assess secondary outcomes related to medication changes. Principal findings of the research demonstrate that further education is needed for providers and patients on the importance of EOS counts and the role of pharmacists in COPD medication management.

Author(s):

Shibu Varughese, PharmD, Pharmacy Resident, Ohio State University/PrimaryOne Health

Sha-Phawn Williams, PharmD, Assistant Professor, St. John Fisher College Wegmans School of Pharmacy

Andrew Faiella, PharmD, BCACP, Clinical Pharmacist, PrimaryOne Health

Jangus Whitner, PharmD, BCACP, Clinical Pharmacist and 340B Program Manager, PrimaryOne Health

Alexa Valentino, PharmD, BCACP, Lead Clinical Pharmacist, Primary One Health