Liu Qingming, Guo Yushan, Zhang Youshuang, Zhou Xiao, Chen Wenfei, Ni Jiaqi, He Jinhan, Zhou Jing
Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu, 610041, China.
Int J Clin Pharm. 2025 Jun 23. doi: 10.1007/s11096-025-01951-x.
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.
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.
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.
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.
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.
在全球人口老龄化的背景下，慢性病成为关键的医疗保健问题。基于社区的药学服务在慢性病管理中发挥着至关重要的作用。然而，在中国，基于社区的药学服务发展仍处于早期阶段，且缺乏对其效果的系统评估。
本研究旨在调查基于社区的药学服务对患有慢性病的老年人的效果，并描述中国的服务模式。
从创刊至2025年2月7日，在PubMed、Embase、中国知网、维普中文科技期刊数据库和万方数据库中进行了全面的文献检索。纳入了比较基于社区的药学服务与常规随访的随机对照试验。使用Cochrane偏倚风险评估工具2评估报告质量。收集了包括研究设计、参与者和结果在内的详细信息。通过荟萃分析或描述性报告分析主要结局（用药效果/安全性、经济影响、生活质量、依从性和用药知识）。分别使用95%置信区间的均值差或风险比来分析连续性和二分性结局。使用推荐分级评估、制定和评价框架评估证据质量。此外，我们分析了各项研究中实施的服务模式。
纳入了18项研究，共2842例患者。12项研究报告称基于社区的药学服务改善了疾病控制（P<0.05）。对10项研究的荟萃分析表明，它降低了药物不良反应[RR = 0.37（0.27，0.50），P<0.00001]和潜在不适当用药[RR = 0.19（0.08，0.44），P = 0.0001]。4项研究显示用药使用率[MD = -1.15（-1.67，-0.63），P<0.0001]和成本[MD = -74.12（-99.47，-48.76），P<0.00001]更低。17项研究评估了依从性，荟萃分析显示更高的Morisky评分[MD = 1.35（0.81，1.89），P<0.00001]和依从率[RR = 1.30（1.13，1.49），P = 0.0001]。然而，其对患者生活质量的影响产生了相互矛盾的结果。此外，大多数研究实施了多种服务，如处方审核、治疗监测和患者教育，且服务模式在各项研究中存在显著差异。
我们的研究结果表明，中国基于社区的药学服务有效改善了老年患者的临床结局。然而，缺乏标准化的服务框架，且其对患者生活质量的影响需要进一步研究。
