Clinical effectiveness of telepharmacy services in patients with non-communicable diseases in ambulatory care...

Non-communicable diseases (NCDs), such as hypertension, diabetes, and asthma, require continuous medication management. However, medication adherence remains suboptimal. Telepharmacy-defined as pharmacist-led care delivered remotely via telephone, video, or digital platforms-may improve adherence and clinical outcomes while addressing access barriers, but uncertainty remains regarding clinical effectiveness and generalisability. A systematic review is warranted to assess whether telepharmacy improves medication adherence, safety, and other key outcomes compared with usual care.

To assess the clinical effectiveness of telepharmacy services, compared with usual care, on medication adherence and clinical outcomes in patients with NCDs in ambulatory care settings.

We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, and two trial registries up to 15 December 2025. We also assessed the reference lists of included studies and relevant reviews, conducted citation searching, and contacted study authors to clarify information and identify additional data. No language or publication status restrictions were applied.

We included individually randomised controlled trials (RCTs) and cluster-RCTs comparing pharmacist-led telepharmacy with usual care for people with NCDs (e.g. cardiovascular disease, diabetes, and cancer) in ambulatory care settings.

Critical outcomes were medication adherence, patients' satisfaction, and drug-related problems (DRPs). Important outcomes included mortality rate, worsening of NCDs, clinical measurements, laboratory values, patients' quality of life, healthcare use, and economic outcomes. We included seven outcomes in the summary of findings table.

We assessed the risk of bias for the seven outcomes in the summary of findings table using the Cochrane RoB 2 tool, incorporating both individually RCTs and cluster-RCTs.

We conducted synthesis analyses using random-effects models, calculating summary risk ratios or mean differences (MDs)/standardised mean differences (SMDs) with 95% confidence intervals (CIs). For cluster-RCTs, we used adjusted estimates or applied design effect corrections. Where meta-analysis was not feasible, we used narrative synthesis. We assessed the certainty of the evidence using GRADE.

We included 21 trials (17 individually RCTs and 4 cluster-RCTs) involving a total of 5440 participants with NCDs. Sample sizes ranged from 20 to 1400 participants. Studies were conducted in high-, upper-middle-, and lower-middle-income countries, across hospital, clinic, pharmacy, or insurer-based settings. Interventions targeted conditions such as diabetes, hypertension, and asthma. Telepharmacy interventions varied in delivery modes (e.g. telephone, video, and app), intensity, and components (e.g. adherence support, monitoring, and education). Follow-up durations ranged from one to 18 months, with most studies lasting 12 months or less.

Telepharmacy interventions may improve medication adherence compared with usual care (SMD 0.32, 95% CI 0.10 to 0.55; 10 studies, 2978 participants; low-certainty evidence). For patients' satisfaction, the evidence is very uncertain about the effect of telepharmacy interventions compared with usual care (SMD 0.37, 95% CI -0.11 to 0.85; 3 studies, 422 participants; very low-certainty evidence). One additional study using a 5-point Likert scale reported little to no difference between groups (96.5% versus 97.5%; P = 0.68). Another study lacked a comparator group, and we excluded it from the synthesis. We did not pool the evidence for DRPs due to clinical and methodological heterogeneity. Narrative findings from individual studies showed that one study reported increased detection of DRPs. Other studies reported fewer adverse events, suggesting prevention of DRPs, while the remaining studies found no clear differences. The certainty of the evidence was low. Regarding important outcomes, two studies reported worsening of NCDs. Due to clinical heterogeneity, we did not pool the results and presented them narratively. The effect of telepharmacy on worsening of NCDs remains uncertain. For asthma control, no clear difference was observed (SMD 0.23, 95% CI -0.34 to 0.80; 2 studies, 318 participants). Telepharmacy interventions may reduce systolic blood pressure (SBP) (MD -6.82 mmHg, 95% CI -12.16 to -1.48; 5 studies, 1254 participants; low-certainty evidence) and may reduce diastolic blood pressure (DBP) (MD -2.50 mmHg, 95% CI -4.80 to -0.20; 5 studies, 1254 participants; low-certainty evidence) compared to usual care. Two additional studies reporting clinical measurements found more pain relief with telepharmacy in one study, and no clear difference in thromboembolic events in the other. For glycated haemoglobin (HbA1c), telepharmacy interventions probably have little or no effect (MD -0.10%, 95% CI -0.25 to 0.05; 5 studies, 1771 participants; moderate-certainty evidence). For LDL cholesterol, a meta-analysis of two studies showed no clear difference between the groups (MD -0.84 mg/dL, 95% CI -4.70 to 3.02; 2 studies, 444 participants). One study reported better prothrombin time-international normalised ratio (INR) control in the intervention group. Three studies assessed quality of life using different tools, but did not show consistent evidence of benefit. Hospital admissions and emergency department visits showed no clear differences between groups. Two studies evaluated economic outcomes, with one reporting cost savings and the other showing no difference in total or disease-related costs. No included studies reported data on mortality rate or adverse events attributable to telepharmacy, so potential harms remain uncertain.

Low-certainty evidence suggests that telepharmacy interventions may improve medication adherence, and may reduce both SBP and DBP in patients with NCDs in ambulatory care settings compared to usual care. Moderate-certainty evidence indicates telepharmacy interventions probably have little or no effect on HbA1c. The evidence is very uncertain about the effect of telepharmacy interventions on patients' satisfaction. The evidence base is limited by short follow-up periods, variation in interventions and outcome measures, and lack of equity-related data. Telepharmacy appears promising for ambulatory care, but further high-quality trials with standardised adherence measures and longer follow-up are needed to clarify effectiveness, implementation potential, and equity impacts.

Takeshi Hasegawa and Hisashi Noma were supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant numbers: JP24K06239 and JP23K24811).

Protocol (2023): DOI 10.1002/14651858.CD015136.