Garcia‐Gollarte 2014.

Study characteristics
Methods	RT
Participants	1018 residents: 516 intervention, 502 control Final sample: 59 physicians, 716 nursing home residents Intervention: 29 doctors, 372 nursing home residents Control: 30 doctors, 344 nursing home residents Diagnostic criteria: residents aged ≥ 65 years and clinically stable (no change in prescription in last 2 months) Setting: private organisation
Interventions	6 months professional intervention A nursing home physician, expert in drug use in older people, delivered a structured educational intervention. The programme included: general aspects of prescription and drug use in geriatric patients, how to reduce the number of drugs, to perform a regular review of medications, to avoid inappropriate drug use, to discontinue drugs that do not show benefits, and to avoid under‐treatment with drugs that have shown benefits. It also discussed in detail some drugs frequently related to adverse drug reactions in older people. Educational material and references were given to participants. Finally, two, 1‐h workshops reviewed practical, real life cases and promoted practice changes in participants. The educator offered further on‐demand advice on prescriptions for the next 6 months. This intervention was reinforced through a single review by the researchers, using standard appropriateness criteria, STOPP‐START. Control: physicians in the control group did not receive any intervention or information about an educational intervention delivered in other centres.
Outcomes	Outcome measures were as follows: appropriateness and quality of drug use. The STOPP‐START criteria were used to assess the drugs that were actively used by each resident at the beginning of the study and 9 months later (3 months after the intervention was finished). The number of individuals with potentially inappropriate prescriptions, duplicate class of drugs, and antipsychotic use are reported here. incidence of selected geriatric syndromes. The number of falls and the number of episodes of delirium were recorded for the 3‐month period before the intervention started, and the 3‐month period immediately after the 6‐month intervention finished. This allowed for comparing the control and the intervention group, and also for assessing time changes in both groups. Falls and delirium are systematically registered in the clinical records of all the participant nursing homes. health resource utilisation. The number of visits to physicians and nurses, the number of visits to an emergency room, and the total number of days spent in hospital were also recorded for the 3‐month period before the intervention started, and the 3‐month period after the 6‐month intervention finished. These are also regularly registered in the clinical records of all the participant nursing homes.
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation was done using random number tables.
Allocation concealment (selection bias)	Unclear risk	There was no mention made of sequence concealment.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Physicians in both groups were informed that there was a company programme aimed to improve drug prescription (to explain why data on prescriptions was collected in their centres) but were blinded to the fact that the educational intervention was being assessed. Also, participants did not know they were receiving an intervention.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	30% of participants were lost to the study, but it is unclear if there was differential attrition in intervention and control groups.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Number of emergency room visits and length of hospitalisations are objective outcomes.
Selective reporting (reporting bias)	Low risk	No evidence of selective reporting
Protection against contamination bias	High risk	Although nursing homes in the intervention and control groups were separate, some cross‐contamination because of informal contacts between physicians may have occurred.
Other bias	High risk	Short intervention period (6 months) and short follow‐up (3 months)