Beck 1997

Methods	Purpose: to compare group visits of chronically ill older participants to a physician to usual care Design: RCT; individual participants randomised Duration of study: 1 year Interval between intervention and when outcome was measured: not stated  Power computation: not performed Statistics: Chi2 for dichotomous data, ANOVA for continuous data; not ITT
Participants	Country: USA Setting: 1 office of Colorado Permanente Medical Care Program, a group HMO in Denver Eligible participants: (health status) patients 65 or older with a chronic illness based on chart review (heart, lung or joint disease or diabetes) or high health utilisation in past 12 months (1 or more outpatient visits/month or 1 or more calls to nurse or physician per 2 months); 68% arthritis, 62 % hypertension, 30% heart disease, 31% liver disease, 15% cancer, 15% diabetes Age: average intervention 72, usual care 75 (P = 0.008) Gender: intervention 69%, control 64% female (ns). Baseline N: 419 contacted, of whom 300 returned questionnaires (of whom 77 said not interested, 3 termination from programme, 4 transfers to another clinic, 9 lack of transport, 3 died, 2 low utilisers, 1 home bound). Then 113 additional participants added. Randomised to (1) group visits (160, of whom 20 no shows, 19 drop‐outs, 2 no transport, 5 deaths, 1 skilled nursing facility, 1 transferred clinic), and (2) usual care (161, of whom 9 deaths, 7 belonged to Kaiser Permanente; 2 skilled nursing facility, 3 transferred clinic)
Interventions	Intervention group 1: visits to physician and nurse at clinic in groups average size 8, for (a) 15‐minute warm‐up and socialisation with information on specific disease processes; (b) 15‐minute break for socialisation, and nurse checked blood pressure, immunisation status, immediate needs and arranged visit with physician, (c) 15 minutes of questions and answers, and planned next visit, (d) 30 minutes for visit to physician Control: usual visits to physician
Outcomes	Outcome measured: % vaccinated Time points from the study that are considered in the review or measured or reported in the study: not stated % vaccinated by: date not stated
Notes	Funding: Garfield Memorial Fund, Research and Development Fund Kaiser Health Plan of Colorado data from administrative databases and chart review used to measure vaccination uptake No intended or unintended co‐interventions recorded
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	113 participants added but did not receive the baseline Senior Health Questionnaire, and not stated if randomly assigned; groups were equivalent at baseline in important characteristics related to the outcome except age (P = 0.008)
Allocation concealment (selection bias)	Unclear risk	No statement
Blinding (performance bias and detection bias) All outcomes	Low risk	However, data from administrative databases and chart review used to measure vaccination uptake
Incomplete outcome data (attrition bias) All outcomes	High risk	In intervention group participants attended average 6.62 group visits (55% of those scheduled) and no process analysis whether active involvement/participation by individual participants in group activities 48 drop‐outs from intervention group (30%) and 21 (9%) from control, not equivalent in composition: 20 no‐shows, 19 drop‐outs and 5 deaths in intervention and no‐shows or drop‐outs and 5 deaths in control
Selective reporting (reporting bias)	Low risk	No selective reporting