Influencing factors of safe medication use and optimization pathways among older adults in the Chengdu-Chongqing region: A cross-sectional study based on the KAP Model

Background Safe medication use is a critical public health priority for older adults. As one of the most rapidly aging regions in China, the Chengdu-Chongqing region represents a critical setting for this challenge. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding safe medication use among older adults in this region, to identify the determinants and structural associations within KAP, and to propose actionable optimization pathways. Methods A self-designed questionnaire based on the KAP framework was administered to older adults via a cross-sectional survey. All questionnaire items were scored according to established standards. Hierarchical multiple linear regression was employed to identify the determinants and structural associations within KAP. Results A total of 3,829 valid questionnaires were collected, with an effective response rate of 87.93%. Medication safety scores were moderate to low: knowledge (4.34 ± 2.94), attitude (6.46 ± 2.61), and practice (6.19 ± 2.30). Regression analysis revealed that rural residence and lower educational level were associated with inadequate knowledge; rural residence and lower income correlated with less positive attitudes; rural residence, lower education, and lack of pharmaceutical care were linked to inappropriate practices. Regarding the KAP structure, knowledge was strongly associated with attitudes(β' = 0.23, p  < 0.001), which in turn significantly correlated with practices (β' = 0.25, p  < 0.001), while knowledge also maintained a direct association with practices (β' = 0.18, p  < 0.001). Conclusions The data support the hypothesized sequence of the KAP model, suggesting a progressive association among knowledge, attitude, and practice. Rural older adults demonstrated significantly lower KAP outcomes compared to urban counterparts. A "high accessibility but low conversion" bottleneck was observed in pharmaceutical care. Policy efforts could focus on integrating home-based pharmaceutical care into the value-added tier of family physician contracting and refining integrated pharmaceutical service mechanisms within medical consortia. Urban medical institutions should focus on advancing precision health education and community pharmaceutical services, while rural medical institutions need to strengthen primary pharmaceutical care capacity and family support networks.