Evaluating a Pharmacist-Initiated Care Bundle for Patients with Chronic Obstructive Pulmonary Disease
Bibliographic record
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a cause of significant morbidity and mortality, and management of patients with this complex disease remains a challenge. Pharmacists work within an interdisciplinary health care team to coordinate services and ensure that standards of care are met. A pharmacist-initiated care bundle provided in the outpatient setting has shown promising results in improving COPD management. Objective: To evaluate, in the acute care setting, the effectiveness of a pharmacist-initiated COPD care bundle in improving compliance with health care measures known to improve outcomes in patients with COPD. Methods: This retrospective chart review included patients with acute exacerbation of COPD admitted from May 14, 2019, to February 29, 2020. Completion rates for the 6 individual components of the COPD care bundle were compared between patients who did and did not receive the pharmacist-initiated intervention. A subgroup of 22 patients received the following additional interventions: documentation of the modified Medical Research Council score, assessment of COPD medications, and vaccination review and administration. Results: A total of 106 patients were included in the analysis, 53 patients in each of the control and intervention groups. The pharmacist-initiated intervention increased completion rates for the overall COPD care bundle from 2% to 17% (p = 0.003), for provision of the COPD flare-up action plan from 4% to 79% (p < 0.001), and for provision of smoking cessation education from 0% to 36% (p = 0.04); however, there was no significant difference in assessment by a respiratory therapist. For the subgroup that received additional interventions, vaccination reviews were conducted for 21 (96%) of the 22 patients, which led to 9 (41%) receiving a guideline-recommended vaccine. Conclusions: Pharmacist involvement in initiation of the care bundle significantly increased completion rates for the activities included in the care bundle. RÉSUMÉ Contexte : La maladie pulmonaire obstructive chronique (MPOC) est une cause d’une morbidité et d’une mortalité importantes, et la prise en charge des patients atteints de cette maladie complexe demeure un défi. Les pharmaciens travaillent au sein d’une équipe interdisciplinaire de soins de santé pour coordonner les services et s’assurer du respect des normes de soins. Un ensemble de soins initié par le pharmacien en milieu ambulatoire a donné des résultats prometteurs dans l’amélioration de la prise en charge de la MPOC. Objectif : Évaluer, dans le cadre des soins aigus, l’efficacité d’un ensemble de soins pour la MPOC initié par un pharmacien pour améliorer le respect des mesures de soins de santé connues pour améliorer les résultats chez les patients atteints de MPOC. Méthodes : Cet examen rétrospectif des dossiers comprenait des patients présentant une exacerbation aiguë de la MPOC admis du 14 mai 2019 au 29 février 2020. Les taux de réussite pour les 6 composantes individuelles de l’ensemble de soins pour la MPOC ont été comparés entre les patients ayant reçu et ceux n’ayant pas reçu l’intervention initiée par le pharmacien. Un sous-groupe de 22 patients a reçu des interventions supplémentaires : documentation du score modifié du Medical Research Council (mMRC), évaluation des médicaments pour la MPOC, et examen et administration de la vaccination. Résultats : Au total, 106 patients ont été inclus dans l’analyse : 53 patients dans le groupe de contrôle et 53 dans le groupe d’intervention. L’intervention initiée par le pharmacien a augmenté les taux d’adhésion à l’ensemble de soins pour la MPOC de 2 % à 17 % (p = 0,003), de 4 % à 79 % (p < 0,001) pour l’offre du plan d’action en cas de poussée de MPOC et de 0 % à 36 % (p = 0,04) pour l’éducation au sevrage tabagique; cependant, l’évaluation par un inhalothérapeute n’a permis de déceler aucune différence significative. Dans le sous-groupe ayant reçu des interventions supplémentaires, des examens de vaccination ont été menés chez 21 (96 %) des 22 patients; 9 patients (41 %) ont ainsi reçu un vaccin recommandé par les lignes directrices. Conclusions : La participation du pharmacien à l’initiation de l’ensemble de soins a augmenté de manière significative les taux de réussite des activités incluses dans l’ensemble de soins.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.053 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".