Comparing ASHP and PQA Frameworks for Identifying Medication Therapy Problems in Older Adults with COPD Discharged to Home Health Care: A Cross-Sectional Study.

Abstract

Background Almost 900,000 patients in the United States living with chronic obstructive pulmonary disease (COPD) require home health care each year. Pharmacists are integral members of the home health care team, especially for older adults living with COPD, because of their expertise in identifying and resolving medication therapy problems (MTPs) during transitions of care. Objective To identify, characterize, and compare the quantities and categories of MTPs in older adults living with COPD who require home health care following hospital discharge. Methods This cross-sectional study involved adults aged 65 years and older living with COPD who were discharged from an academic medical center between June 1, 2023, and November 30, 2023. MTPs were classified using two frameworks: the American Society of Health-System Pharmacists (ASHP) and the Pharmacy Quality Alliance (PQA). Results During the study period, 535 older adults were prescribed home health care, 15 of whom had a hospitalization discharge diagnosis of COPD and were screened for inclusion. Among the 13 patients eligible for inclusion, 92.3% experienced one or more MTPs. Almost 80% of the identified MTPs involved issues related to medication indication: 50% of this cross-sectional cohort were not prescribed medications when clinically indicated, and up to 40% of patients were prescribed medications without apparent indications. The ASHP framework identified more than twice the number of MTPs compared to the PQA framework. Conclusion The ASHP framework may identify more MTPs than the PQA framework in older adults living with COPD who require home health care upon discharge. Further research evaluating pharmacist interventions related to MTPs would be beneficial across diverse settings and patient populations.