Garcia‐Cardenas 2013.

Methods	Design: cluster‐RT Groups: intervention group (management of asthma); control group (standard care)
Participants	Pharmacies: 51 (29 intervention; 22 control) Pharmacy workers: 33 pharmacists in intervention group; 32 pharmacists in control group ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Pharmacy user: 346 patients with asthma (186 intervention; 160 control) mean age: intervention 54.3 ± 19.1 years; control 57.8 ± 19.0 years % female: intervention 57.9%; control 51.3% Setting: all pharmacies in Malaga and Madrid (urban and rural) Country: Spain
Interventions	Pharmacy worker‐directed intervention: 33 pharmacists allocated to the intervention group attended a 1‐day workshop. They were trained to provide education on asthma control, medication adherence and inhaler technique and received the Spanish Guide for Asthma Management (GEMA 2009). Delivered by: respiratory physician and a pharmacist educator/researcher Type: education materials, based on clinical practice guidelines; interactive meeting with role play, case studies Mode of delivery: group TDF: knowledge, skills, social support Duration: 1 day with regular visits to assist delivery Pharmacy worker control: received instructions by phone about study protocol and monitored through 2 visits to the pharmacy ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Pharmacy user‐directed intervention: asthma self‐management Delivered by: pharmacists Type: patients were educated using verbal instructions, physical demonstration and written information about turbuhaler use. When appropriate the type of non‐adherence (intentional or unintentional) and causes of intentional non‐adherence were explored with the Beliefs about Medicines Questionnaire and Health Beliefs Model. Several aspects of asthma control were also covered in each visit. Finally pharmacist and patient jointly agreed goals for the next visit. Mode of delivery: individual face‐to‐face TDF: knowledge, skills, beliefs about consequences, goals Duration: 3 scheduled visits over 6 months and up to 6 addition visits if needed Pharmacy user control: usual treatment
Outcomes	Pharmacy worker: Uptake: 51 of 65 pharmacies completed study ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ Pharmacy user: Clinical: asthma control via Asthma Control Questionnaire (ACQ) Psychological health: not assessed Behavioural: inhaler technique (checklist), adherence to medication (Morisky Adherence scale) Quality of life: not assessed Process: not assessed Costs: not assessed
Notes	Study/intervention name: The AFasma Study Funding Source: AstraZeneca Foundation
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated
Allocation concealment (selection bias)	Low risk	Computer generated
Baseline outcome measures similar	Low risk	Differences adjusted for in analyses
Baseline characteristics similar	Low risk	Differences adjusted for in analyses
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear how missing data were managed
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not clear if assessor blinded
Protection against contamination	Low risk	Cluster randomised
Selective reporting (reporting bias)	Low risk	All outcomes reported
Other bias	Low risk	None noted
Blinding of participants and personnel (performance bias) All outcomes	High risk	Control group pharmacies were asked not to change care, which suggests that they had knowledge of groups.