Karuza 1995

Methods	Purpose: to compare focus groups of physicians discussing adoption of influenza guideline for participants ≥ 65 to focus groups of physicians about an unrelated topic Design: RCT, practices as the unit of randomisation Duration of study: 4 months Interval between intervention and when outcome was measured: 4 months Power computation: not performed Statistics: ANOVA for differences in uptake between study arms
Participants	Country: USA Setting: Health Maintenance Organisation in Buffalo, NY Eligible participants: (health status) 13 practices in prepaid Health Maintenance Organisation in Buffalo, NY; all physicians volunteered to participate; 8 physicians dropped out due to sickness or reassignment, and 6 physicians were omitted as they did not have 5 eligible participants Age: participants were > 65, not institutionalised Gender: 63.5% f
Interventions	Intervention 1: focus group of physicians with expert presenting guideline of Immunisation practices of the Advisory Committee of the Centers for Disease Control and Prevention, with discussion with facilitator, with a plan that intervention practices would develop their own methods such as reminder letters to participants or reminders on charts Intervention 2: focus group on non‐influenza topic (steroid use and GI bleeding) Control: none
Outcomes	Outcome measured: % influenza vaccination Time points from the study that are considered in the review or measured or reported in the study: pre‐intervention base uptake measured 1 October 1990 through 31 January 1991; intervention uptake measured during vaccination season 1 October 1991 to 31 January 1992 % vaccinated by 31 January 1992
Notes	Funding: US Bureau of Health Professions, US Health Resources and Services Administration, and Agency for Health Care Policy and Research, US Public Health Service
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Thirteen group practices and their primary care physicians (mean size, 5) were assigned randomly to intervention or control arms."
Allocation concealment (selection bias)	Low risk	"The vaccination data were obtained through prechart and postchart reviews conducted at these sites by trained outside reviewers."
Blinding (performance bias and detection bias) All outcomes	Low risk	"The vaccination data were obtained through prechart and postchart reviews conducted at these sites by trained outside reviewers."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	"Active participants who were not seen during the influenza vaccination season were counted as not receiving the vaccine." "...10% of the charts were reviewed again by a different reviewer. For the key measures the inter‐judge reliability of the chart review was better than 98% agreement." "Because of expected patient attrition (e.g. mortality, moving out of town, and changing physicians) and clerical error, an average of 11% of the charts was unavailable at the post chart review per physician."
Selective reporting (reporting bias)	Low risk	No selective reporting