Morrissey 1995

Methods	Purpose: to evaluate the effects of a free package of preventive healthcare services, including influenza vaccinations, on the health outcomes of seniors Design: RCT, patients randomised within practices Duration: 2 years Power computation: all eligible patients at the practices were evaluated for study inclusion Statistics: Chi2, analysis of covariance and regression analysis
Participants	Country: USA Setting: 10 primary care practices in 13 locations in central North Carolina Participants: 1914 patients (954 intervention, 960 control) Age: >= 65 years Gender: 61.1% women
Interventions	"The health promotion service package contained a set of procedures and nursing interventions that address important risk factors and premature mortality, institutionalization, and increased disability for older people. Health promotion sessions, in this demonstration were conducted in physician offices using an individual counseling strategy that involved the nurse/physician assistant and patient in mutual planning..." Practices were sent monthly reminders by research team to schedule intervention patients for preventive care and health promotion care services. Nurses were provided with training in administering the services. The control group received the usual preventive services offered by their practice at the usual costs
Outcomes	Medical chart audits were performed on 3 heterogeneous practices (231 intervention patients and 224 controls) to determine whether or not there was an increase in the number of preventive care procedures performed in the intervention group. The percentage of patients who received the Fluvax vaccine during the 1st year of the study increased in the intervention group as compared to the control after randomisation (72% versus 52%, P < 0.001)
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"... randomised by strata into intervention or control" (no statement about method)
Allocation concealment (selection bias)	Unclear risk	No statement
Blinding (performance bias and detection bias) All outcomes	Low risk	"Although contamination of the control group is sometimes a concern with such a design, it was not an issue here for two reasons: first, the financial intervention involved full Medicare reimbursement to physicians for preventive‐care and health promotion packages only for those patients randomised to the intervention group; and second, the office system intervention was in effect only for patients receiving the intervention group. The control group was not identified to the practice, there was no prompting, no form, and no special preventive visit for the control‐group patients" "Patients were informed of their random assignment only after they came into the practice for the interview"
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Of the 1914 patients recruited: "... it was not feasible to conduct chart reviews in every practice, so we chose three diverse groups: a three‐physician family practice.. a ten‐physician community health center, a six physician suburban internal medicine practice..." "Of 458 patients eligible for chart audit, charts were located and reviewed for 455 (231 intervention, 224 control)"
Selective reporting (reporting bias)	Low risk	No selective reporting