Could Chinese cardiovascular chronic conditions patients gain benefits from pharmaceutical services? A multilevel meta-analysis

Abstract

AbstractBackgroundThe value of pharmaceutical services for Chinese patients with cardiovascular chronic conditions was not recognized.AimTo investigate the comprehensive value of pharmaceutical services in China and find factors influencing patient benefits.Design and settingThis was a systematic review with multilevel meta-analysis of 183 randomized control trials focusing on the benefits of pharmaceutical services for patients with cardiovascular chronic conditions in China.MethodsEnglish databases (PubMed, EMBASE, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, WanFang database) were searched from database inception to March 27, 2023 for studies focusing on the comparation of benefits between pharmaceutical services and usual care.ResultsOur analysis of 187 studies involving 23,895 patients demonstrated significant benefits of pharmaceutical services, particularly in reducing readmission (OR: 0.32; 95%CI: 0.2 to 0.52; I2=50.12%), mitigating ADR (OR: 0.28; 95%CI: 0.24 to 0.33; I2=18.07%), and improving patient adherence. However, no benefit was observed in terms of mortality rate and the cost of hospitalization and medication and the risk of bias was generally existed among the included studies.ConclusionsThis study highlights the significant benefits of pharmaceutical services for clinical outcomes and adherence among Chinese patients with cardiovascular chronic conditions. However, the benefits in terms of economic outcomes remain unclear. The influence of population-specific factors, such as disease and age, underscores the need for context-specific and disease- tailored studies to provide precise evidence regarding the advantages of pharmaceutical services. And our findings provide some new ideas for the subsequent research and design, standard formulation and policy implementation.How this fits inPrevious assessments showed clinical benefits of pharmaceutical services but were unclear about other benefits and didn’t consider patient characteristics or contexts. There is no standardized system for pharmaceutical services in China. Our meta-analysis found clear clinical benefits for patients with cardiovascular chronic conditions and showed that age negatively impacts adherence, and medication costs vary by disease type. This study is the first to analyze comprehensive benefits for Chinese patients, highlighting the importance of considering patient characteristics in pharmaceutical services.