Coproducing Treatment for COPD Exacerbations: The COPD Rescue Pack

Richard Balaban

Nationwide, COPD exacerbations are responsible for more than $50 billion in medical expenditures, including over 800,000 hospitalizations. At CHA, COPD exacerbations are the cause of 15% of all Medicine service hospital admissions.
For patients, COPD exacerbations have damaging medical consequences; patients’ quality of life is impaired and patients may never return to their previous pulmonary baseline after an exacerbation.
Timely outpatient treatment of COPD exacerbations can decrease the severity of exacerbations and shorten the time to recovery.

The COPD Rescue Pack consists of a 5-day course of oral prednisone and an antibiotic which patients self-administer at the onset of a self-diagnosed COPD exacerbation. Patients are empowered to make the critical decision of when to initiate medical therapy. By reducing barriers to timely treatment, the COPD Rescue Pack may prevent or diminish the severity of an exacerbation, thereby decreasing the likelihood of an ED visit or hospitalization.
The COPD Rescue Pack promotes a partnership between provider and an empowered patient, encouraging a shift from provider-controlled treatment to shared healthcare management.

A pilot implementation at a CHA primary care site demonstrated that clinical pharmacists are capable of engaging and instructing patients to properly use the COPD Rescue Pack; while patients welcome the opportunity to self-manage their disease, and use the COPD Rescue Pack wisely and with positive effect. 

Conclusions: What do we intend to do next?
Based of the successful pilot, the COPD Rescue Pack is being implemented at CHA’s ten primary care sites and three pulmonary clinics.  A quantitative analysis will determine its effectiveness in decreasing hospital and ED utilization; a qualitative analysis will define, more broadly, how to best encourage patients to coproduce positive health care outcomes.