{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T03:16:03Z","timestamp":1789960563257,"version":"4.0.1"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Japan\u2019s 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n FPS use and nonuse.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n FPS users and nonusers each included 22\u202f557 patients (total 45\u202f114; mean [SD] age, 82.8 [5.2] years; 32\u202f254 [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]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.60398","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T16:30:30Z","timestamp":1771864230000},"page":"e2560398","source":"Crossref","is-referenced-by-count":1,"title":["Family Pharmacist System for Patients With Chronic Cardiovascular or Endocrine Disease"],"prefix":"10.1001","volume":"9","author":[{"given":"Ryo","family":"Iketani","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology, Showa Medical University Graduate School of Pharmacy, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinobu","family":"Imai","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology, Showa Medical University Graduate School of Pharmacy, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"issue":"5","key":"zoi251616r1","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.sapharm.2025.01.015","article-title":"The outcomes of pharmacist-led pharmaceutical care within community pharmacies: an overview of systematic reviews.","volume":"21","author":"Fares","year":"2025","journal-title":"Res Social Adm Pharm"},{"issue":"1","key":"zoi251616r2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1136\/ejhpharm-2019-002111","article-title":"Prevalence of drug interactions in hospitalised elderly patients: a systematic review.","volume":"28","author":"de Oliveira","year":"2021","journal-title":"Eur J Hosp Pharm"},{"issue":"4","key":"zoi251616r3","doi-asserted-by":"publisher","first-page":"339","DOI":"10.29252\/beat-070401","article-title":"Drug related hospital admissions; a systematic review of the recent literatures.","volume":"7","author":"Ayalew","year":"2019","journal-title":"Bull Emerg Trauma"},{"issue":"9","key":"zoi251616r4","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1007\/s40266-016-0395-9","article-title":"Therapeutic duplicates in a cohort of hospitalized elderly patients: results from the REPOSI study.","volume":"33","author":"Pasina","year":"2016","journal-title":"Drugs Aging"},{"issue":"7557","key":"zoi251616r5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1136\/bmj.38875.675486.55","article-title":"A meta-analysis of the association between adherence to drug therapy and mortality.","volume":"333","author":"Simpson","year":"2006","journal-title":"BMJ"},{"issue":"9796","key":"zoi251616r6","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1016\/S0140-6736(11)60828-3","article-title":"Japanese universal health coverage: evolution, achievements, and challenges.","volume":"378","author":"Ikegami","year":"2011","journal-title":"Lancet"},{"issue":"11","key":"zoi251616r7","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1345\/aph.1H221","article-title":"Current state of community pharmacy in Japan: practice, research, and future opportunities or challenges.","volume":"40","author":"Yamamura","year":"2006","journal-title":"Ann Pharmacother"},{"issue":"4","key":"zoi251616r8","doi-asserted-by":"publisher","first-page":"313","DOI":"10.15406\/ppij.2018.06.00194","article-title":"Evaluation of new reimbursement fee for care of pharmacists in Japan.","volume":"6","author":"Nakai","year":"2018","journal-title":"Pharm Pharmacol Int J"},{"issue":"1","key":"zoi251616r9","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1186\/s12913-022-08093-0","article-title":"Identification of individuals benefiting from the kakaritsuke-yakuzaishi (family pharmacist) system in Japan: a retrospective cohort study using an employment-based health insurance claims database.","volume":"22","author":"Iketani","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"zoi251616r10","doi-asserted-by":"publisher","first-page":"618","DOI":"10.2188\/jea.JE20220165","article-title":"Dispensing by family pharmacists as a potential factor in pharmacist-initiated prescription change: a retrospective observational study.","volume":"33","author":"Nishikawa","year":"2023","journal-title":"J Epidemiol"},{"issue":"8","key":"zoi251616r11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-030515","article-title":"Prevalence of hospitalisation caused by adverse drug reactions at an internal medicine ward of a single centre in Japan: a cross-sectional study.","volume":"9","author":"Komagamine","year":"2019","journal-title":"BMJ Open"},{"issue":"6","key":"zoi251616r12","doi-asserted-by":"publisher","first-page":"632","DOI":"10.5582\/bst.2017.01256","article-title":"Effects of lifestyle advice provided by pharmacists on blood pressure: the COMmunity Pharmacists ASSist for Blood Pressure (COMPASS-BP) randomized trial.","volume":"11","author":"Okada","year":"2018","journal-title":"Biosci Trends"},{"issue":"1","key":"zoi251616r13","doi-asserted-by":"publisher","first-page":"21897","DOI":"10.1038\/s41598-021-01394-0","article-title":"Pharmacists\u2019 interventions improve health-related quality of life of rural older person on warfarin: a randomized controlled trial.","volume":"11","author":"Falamic","year":"2021","journal-title":"Sci Rep"},{"issue":"6","key":"zoi251616r14","doi-asserted-by":"publisher","first-page":"3156","DOI":"10.3390\/ijerph19063156","article-title":"Impact of pharmacists-led interventions in primary care for adults with type 2 diabetes on HbA1c levels: a systematic review and meta-analysis.","volume":"19","author":"Coutureau","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"zoi251616r15","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.sapharm.2016.08.005","article-title":"Pharmacist-led medication review in community settings: an overview of systematic reviews.","volume":"13","author":"Jokanovic","year":"2017","journal-title":"Res Social Adm Pharm"},{"issue":"2","key":"zoi251616r16","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s11096-006-9003-0","article-title":"A pharmacotherapy follow-up program in patients with type-2 diabetes in community pharmacies in Spain.","volume":"28","author":"Fornos","year":"2006","journal-title":"Pharm World Sci"},{"issue":"7","key":"zoi251616r17","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/j.sapharm.2019.09.059","article-title":"The impact of a community pharmacy service on patients\u2019 medication adherence and ambulatory sensitive hospitalizations.","volume":"16","author":"Milosavljevic","year":"2020","journal-title":"Res Social Adm Pharm"},{"issue":"1","key":"zoi251616r18","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1001\/jamainternmed.2014.5841","article-title":"Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.","volume":"175","author":"Viswanathan","year":"2015","journal-title":"JAMA Intern Med"},{"issue":"2","key":"zoi251616r19","first-page":"190","article-title":"Prevalence of noncommunicable diseases in Japan using a newly developed administrative claims database covering young, middle-aged, and elderly people.","volume":"5","author":"Okada","year":"2022","journal-title":"JMA J"},{"issue":"2","key":"zoi251616r20","doi-asserted-by":"publisher","first-page":"46","DOI":"10.37737\/ace.25006","article-title":"DeSC database.","volume":"7","author":"Yasunaga","year":"2025","journal-title":"Ann Clin Epidemiol"},{"issue":"4","key":"zoi251616r21","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/pds.4107","article-title":"Prevalent new-user cohort designs for comparative drug effect studies by time-conditional propensity scores.","volume":"26","author":"Suissa","year":"2017","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"5","key":"zoi251616r22","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1097\/EDE.0000000000001628","article-title":"The prevalent new-user design for studies with no active comparator: the example of statins and cancer.","volume":"34","author":"Suissa","year":"2023","journal-title":"Epidemiology"},{"issue":"4","key":"zoi251616r23","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1097\/EDE.0000000000001358","article-title":"An aggregated comorbidity measure based on history of filled drug prescriptions: development and evaluation in two separate cohorts.","volume":"32","author":"Gedeborg","year":"2021","journal-title":"Epidemiology"},{"issue":"3","key":"zoi251616r24","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies.","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"issue":"1","key":"zoi251616r25","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/EDE.0000000000000409","article-title":"Selection bias due to loss to follow up in cohort studies.","volume":"27","author":"Howe","year":"2016","journal-title":"Epidemiology"},{"issue":"8","key":"zoi251616r26","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1093\/aje\/kwy049","article-title":"Relative performance of propensity score matching strategies for subgroup analyses.","volume":"187","author":"Wang","year":"2018","journal-title":"Am J Epidemiol"},{"issue":"3","key":"zoi251616r27","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.annepidem.2006.10.009","article-title":"Test for additive interaction in proportional hazards models.","volume":"17","author":"Li","year":"2007","journal-title":"Ann Epidemiol"},{"issue":"1","key":"zoi251616r28","doi-asserted-by":"publisher","DOI":"10.1515\/em-2013-0005","article-title":"A tutorial on interaction.","volume":"3","author":"VanderWeele","year":"2014","journal-title":"Epidemiol Methods"},{"issue":"8","key":"zoi251616r29","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.2105\/AJPH.92.8.1278","article-title":"Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.","volume":"92","author":"Baker","year":"2002","journal-title":"Am J Public Health"},{"issue":"14","key":"zoi251616r30","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1001\/archinte.167.14.1503","article-title":"Health literacy and mortality among elderly persons.","volume":"167","author":"Baker","year":"2007","journal-title":"Arch Intern Med"},{"issue":"1","key":"zoi251616r31","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1136\/bmjqs-2019-009545","article-title":"Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study.","volume":"29","author":"Lapointe-Shaw","year":"2020","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"zoi251616r32","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1093\/ageing\/aft169","article-title":"Pharmacist-led interventions to reduce unplanned admissions for older people: a systematic review and meta-analysis of randomised controlled trials.","volume":"43","author":"Thomas","year":"2014","journal-title":"Age Ageing"},{"issue":"1","key":"zoi251616r33","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/s11096-013-9889-2","article-title":"Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure.","volume":"36","author":"Lowrie","year":"2014","journal-title":"Int J Clin Pharm"},{"issue":"6","key":"zoi251616r34","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1503\/cmaj.080484","article-title":"The \u201cnumber needed to treat\u201d turns 20\u2013and continues to be used and misused.","volume":"179","author":"McAlister","year":"2008","journal-title":"CMAJ"},{"issue":"10","key":"zoi251616r35","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1016\/j.apmr.2004.03.025","article-title":"Using the number needed to treat in clinical practice.","volume":"85","author":"Weeks","year":"2004","journal-title":"Arch Phys Med Rehabil"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2845335\/iketani_2026_oi_251616_1772647207.13332.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:30:13Z","timestamp":1772649013000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2845335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.60398","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]}}}