Optimizing chronic disease management through community-based pharmaceutical care for older adults in China: a systematic review and meta-analysis of randomized controlled trials.

Introduction: Chronic diseases present a critical healthcare concern amid global population aging. Community-based pharmaceutical care plays a vital role in the management of chronic diseases. Nevertheless, in China, the development of community-based pharmaceutical care remains in its early stages, and there is a lack of systematic evaluation of its effectiveness.

Aim: This study aimed to investigate the effectiveness of community-based pharmaceutical care for older adults with chronic diseases, and characterize the service models in China.

Method: A comprehensive literature search was conducted across PubMed, Embase, China National Knowledge Infrastructure, VIP China Science and Technology Journal, and, WanFang database from inception to February 7, 2025. Randomized controlled trials comparing community-based pharmaceutical care with regular follow-up were included. Reporting quality was evaluated using the Cochrane Risk of Bias Assessment Tool 2. Detailed information including study design, participants, and results was collected. Primary outcomes (medication effectiveness/safety, economic impact, quality of life, adherence, and medication knowledge) were analyzed through meta-analysis or reported descriptively. Mean differences or risk ratios with 95% confidence intervals were used for continuous and dichotomous outcomes, respectively. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Additionally, we analyzed the service models implemented across the studies.

Results: Eighteen studies with 2842 patients were included. Twelve reported that community-based pharmaceutical care improved disease control (P < 0.05). Meta-analysis of 10 studies showed that it reduced adverse drug reactions [RR = 0.37 (0.27, 0.50), P < 0.00001] and potentially inappropriate medication [RR = 0.19 (0.08, 0.44), P = 0.0001]. Four studies revealed lower medication use rate [MD =  - 1.15 (- 1.67, - 0.63), P < 0.0001] and costs [MD =  - 74.12 (- 99.47, - 48.76), P < 0.00001]. Seventeen studies assessed adherence, with meta-analysis showing higher Morisky scores [MD = 1.35 (0.81, 1.89), P < 0.00001] and adherence rate [RR = 1.30 (1.13, 1.49), P = 0.0001]. However, its impact on patients' quality of life yielded conflicting results. Additionally, most studies implemented multiple services such as prescription review, treatment monitoring, and patient education, and the service models exhibited significant difference across studies.

Conclusion: Our findings suggest that community-based pharmaceutical care in China effectively improved the clinical outcomes of older patients. However, there is a lack of a standardized service framework, and its impact on patients' quality of life needs further research.