Association of pharmacist-led care with medication safety and clinical outcomes in older adults with chronic diseases: a retrospective cohort study in an integrated medical-nursing care institution

This retrospective cohort study aimed to evaluate the association between structured, pharmacist-led pharmaceutical care and medication safety and clinical outcomes among older adults with chronic diseases residing in an integrated medical-nursing care institution. Data were collected from October 2022 to October 2024. Patients receiving structured pharmaceutical care constituted the intervention group ( n = 99), while propensity score-matched patients receiving usual care served as controls ( n = 99). Primary outcomes included the prevalence of drug-related problems (DRPs) and potentially inappropriate medications (PIMs), and medication adherence. Secondary outcomes encompassed blood pressure, glycemic and lipid control, and hospitalization rates. The intervention group had lower prevalence of DRPs (39.4% vs. 73.7%, p < 0.001) and PIMs (36.4% vs. 57.6%, p = 0.003), along with higher medication adherence ( p < 0.001). Blood pressure target attainment (82.6% vs. 65.9%, p = 0.013) and LDL-C target attainment (55.6% vs. 39.4%, p = 0.023) were also higher in the intervention group. The intervention was associated with greater blood pressure stability, primarily reflected by lower SBP variability, and with fewer hypoglycemic events. Hospitalization rates were lower in the intervention group (35.4% vs. 49.5%, p = 0.045). Pharmacist-led pharmaceutical care was associated with more favorable medication safety and clinical outcomes in older adults with chronic diseases in the integrated care setting.