Pharmacist-integrated collaborative outpatient care for risk factor control across the cardiovascular-kidney-metabolic spectrum: a systematic review and meta-analysis of randomized trials

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• Picked for Family Practice (top studies of the week, 6 September 2026): Pharmacist‑integrated collaborative outpatient care for cardiovascular‑kidney‑metabolic risk
• Picked for Epidemiology (top studies of the week, 6 September 2026): Systematic review of pharmacist‑integrated care

Abstract

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome requires integrated outpatient strategies that address interrelated hemodynamic and metabolic risk. Pharmacist-integrated collaborative care has emerged as a potential model to improve cardiometabolic control across CKM-relevant populations, but the magnitude and consistency of benefit remain uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized trials evaluating pharmacist-integrated collaborative outpatient care versus usual care or control care in CKM-relevant populations. Twenty-one randomized trials were included, spanning hypertension, type 2 diabetes, and mixed CKM populations, predominantly in primary care settings. Random-effects meta-analyses were performed using restricted maximum likelihood estimation with Hartung-Knapp adjustment. RESULTS: The most robust finding was for clinic systolic blood pressure. Pooling adjusted estimates from 3 trials showed that pharmacist-integrated collaborative care significantly reduced clinic systolic blood pressure compared with usual care (MD - 7.11 mm Hg, 95% CI -9.65 to -4.58; I2 = 0.0%). Continuous HbA1c also favored pharmacist-integrated care in 3 trials (MD -1.26, 95% CI -2.36 to -0.16), although heterogeneity was substantial (I2 = 89.2%). This glycemic effect was less stable in sensitivity analysis excluding the high-risk Javaid 2019 trial, after which the pooled estimate attenuated to -0.81% (95% CI -2.11 to 0.49). Exploratory target-attainment analyses were directionally favorable but imprecise and were not considered definitive. CONCLUSION: Pharmacist-integrated collaborative outpatient care was associated with a clinically meaningful reduction in clinic systolic blood pressure and may improve HbA1c across CKM-relevant populations. The blood-pressure finding was consistent and robust, whereas the glycemic evidence was more heterogeneous and sensitive to study quality. These findings suggest that pharmacist-integrated collaborative care is a promising outpatient CKM risk-reduction strategy, particularly for hemodynamic control, while underscoring the need for more standardized, high-quality trials for metabolic outcomes. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261363411, identifier CRD420261363411.

Abstract as published, via PubMed.