Family Pharmacist System for Patients With Chronic Cardiovascular or Endocrine Disease.

Importance: Japan's family pharmacist system (FPS) has helped to prevent therapeutic duplication and drug interactions and to improve leftover drug adjustments. However, its association with lower risk of death or hospitalization remains unclear. Objective: To examine the risk of death or hospitalization from any cause among older patients with chronic cardiovascular or endocrine disease among users of an FPS. Design, Setting, and Participants: This cohort study used administrative claims data in the DeSC Health Insurance Database from April 2015 to March 2024, with a 2-year follow-up period. A prevalent new-user design was adopted to compare patients who initiated FPS use with those receiving standard pharmaceutical care. Patients 75 years of age or older with a history of visiting a pharmacy at least twice for treating hypertension, type 2 diabetes, hyperlipidemia, heart failure, angina, nonvalvular atrial fibrillation, or other arrhythmias were included. Exposure: FPS use and nonuse. Main Outcomes and Measures: The primary outcome was death or hospitalization from any cause, assessed in a time-to-first-event analysis, with each component analyzed individually as a secondary outcome. Cox proportional hazards regression with robust variance estimators was used to estimate hazard ratios (HRs) and the 95% CIs. Results: FPS users and nonusers each included 22 557 patients (total 45 114; mean [SD] age, 82.8 [5.2] years; 32 254 [71.5%] female) after time-conditional propensity score matching. The risk of death or hospitalization from any cause did not differ significantly between groups (HR, 1.00 [95% CI, 0.97-1.04]). For individual end points, the risk of death from any cause was slightly but significantly lower among users than nonusers (33.9 [95% CI, 32.0-35.9] vs 37.0 [95% CI, 35.0-39.1] deaths per 1000 person-years), with an HR of 0.91 (95% CI, 0.85-0.99). However, no significant difference in risk was observed between FPS users and nonusers for hospitalization from any cause (HR, 1.01 [95% CI, 0.98-1.05]). Conclusions and Relevance: This large-scale cohort study found that the use of an FPS was not associated with lower risk of death or hospitalization from any cause. However, the results generated a clinically important hypothesis that FPS use may be associated with slightly lower risk of death among older patients with chronic cardiovascular or endocrine disease.