Lemelin 2001

Methods	Purpose: to compare the effect of facilitators using 7 intervention strategies to encourage 8 recommended and discourage 5 not recommended preventive care manoeuvres, compared to no intervention Design: RCT, practices as unit of randomisation Duration of study: 18 months Interval between intervention and when outcome was measured: 18 months after last patient visit  Power computation: 40 practices needed to detect mean difference of 0.09 in preventive performance index used in this study between intervention and control groups with α = 0.05, power = 80% Statistics: "Cross tabulations using Chi2 test and Fisher's exact test were used to examine categorical data and compare groups. We used Student's t‐test for independent groups for comparisons of continuous data. To test for significant differences in end points between the intervention and control groups, we analysed end points using GLE repeated‐measures ANOVA, where end points measured at baseline and follow‐up were treated as within‐subject factors ... and the intervention group was the between‐subjects factor ... Significant interaction effects were further analysed with a least‐significant‐difference post‐hoc test to evaluate mean differences. We used a GLE ANOVA to test for differences between the study groups in preventive performance index."
Participants	Country: Canada Setting: Health Service Organisations in Ontario Eligible participants: (health status): 100 Health Service Organisations, of which 46 were recruited and 45 remained in study Age: Canadian Task Force on Preventive Care recommended ≥ 65 years Gender: 53.6% f
Interventions	Intervention: facilitators used 7 strategies (audit and ongoing feedback, consensus building, opinion leaders and networking, academic detailing and education materials, reminder systems, patient‐mediated activities, and patient education materials) to increase uptake of 8 preventive care manoeuvres recommended by the Canadian Task Force on Preventive Care and discourage 5 not recommended Control: no intervention
Outcomes	Outcome measured: % vaccinated  Time points from the study that are considered in the review or measured or reported in the study: intervention July 1997 to December 1998 % vaccinated by: 31 December 1998 E‐mail from Dr Bill Hogg: "Unfortunately the paper does not report the age break down of the participants in the intervention and control groups (only the average age) and so the information cannot be derived from the paper. I would have to go back to trial data to produce the numbers requested. I'm on sabbatical and away from home so can't manage this."
Notes	Funding: Ontario Ministry of Health
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"The primary care practice (1 to 6 doctors) was the unit of randomization and the unit of analysis." (no statement of method)
Allocation concealment (selection bias)	Unclear risk	No statement
Blinding (performance bias and detection bias) All outcomes	Low risk	"The chart auditors were blinded as to the status of the practices and assessment of outcomes."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	For the performance of preventive manoeuvres: "The concordance between auditors was 85.4% (kappa = 0.71) at baseline and 84.4% (kappa = 0.69) at follow‐up."
Selective reporting (reporting bias)	Low risk	No selective reporting