Which outcomes of pharmacist-involved services are measured well enough to support decisions? A systematic review, meta-analysis, and evidence map of 266 randomised trials in China

Objective To synthesise randomised evidence on pharmacist-involved services for cardiometabolic conditions in China, and to determine which outcomes are measured, reported, and appraised well enough to support decisions. Design Systematic review, meta-analysis, and prespecified evidence map with separate appraisal of measurement quality, reporting completeness, risk of bias, trustworthiness, and cost reporting. Data sources PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, WanFang, and SinoMed from inception to 20 July 2026. Eligibility criteria Randomised trials comparing pharmacist-involved services with usual care in Chinese patients with cardiometabolic conditions. Chinese-language reports were eligible only from three core-index journal lists, defining evidence scope rather than quality. Data extraction and synthesis Two reviewers screened and extracted data independently. Random-effects models used restricted maximum likelihood with Hartung-Knapp inference and prediction intervals; nine outcomes were rated with GRADE. Risk of bias (RoB 2), bias due to missing evidence (ROB-ME), trustworthiness (INSPECT-SR), and cost-reporting completeness (CHEERS 2022) were assessed separately. Results 266 trials with 37,066 participants contributed 1,107 estimates across 21 outcomes. Unplanned readmission decreased (RR 0.52, 95% CI 0.46 to 0.60; I2=10.0%), with 15 of 22 contributing trials and 72.6% of the weight from heart failure, myocardial infarction, or coronary disease (RR 0.57, 0.51 to 0.64). Reported adverse drug reactions decreased (RR 0.41, 0.37 to 0.45) and reported adherence increased (RR 1.37, 1.32 to 1.43; I2=80.2%). No outcome reached moderate certainty. Adherence was assessed objectively in 9 of 228 reporting trials; follow-up duration was unreported in 108 of 266; post-discharge follow-up was explicitly reported in 82 of 266; none of the 13 trials reporting expenditure recorded service-delivery inputs, a complete incremental cost, a health utility, an analytic perspective, or a price year; trustworthiness screening left governance information unresolved in 211 of 238 trials; and restricting to results at low risk of bias left 52 estimates, reducing readmission to four imprecise results (RR 0.56, 0.30 to 1.05). Conclusions Unplanned readmission after admission with heart failure or coronary disease was the one outcome consistent and objectively ascertainable enough to justify prospective evaluation. Elsewhere the limit on decision usefulness was how outcomes were measured and reported rather than how many trials existed, and further trials of the same design would not resolve it. Registration PROSPERO CRD42023414180.