Claesson 1998.

Methods	Cluster‐RCT (randomised by nursing home) Total study duration: 14 months
Participants	1854 residents 33 nursing homes Setting: nursing homes Age: Average 83 years Gender: Intervention 70% female; control 67% female Country: Sweden Date of study: 1994/95
Interventions	The aim of the regular multidisciplinary meetings was to discuss and improve the use of drugs in nursing homes, and to decrease the use of drugs which, according to the advice of the workshop arranged by the Swedish Medical Products Agency, could cause confusion and impaired memory. In group discussions, the physician, pharmacist, one or more of the nursing home nurses, and in many cases, one or more of the assistant nurses and nurse aides reviewed the drug use of all residents on a monthly basis over a period of one year. The length and frequency of the meetings were adjusted by the participants to local conditions. The therapy changes that were discussed were thus based on the physician’s medical knowledge, the pharmacist’s pharmaceutical knowledge, and the nurses’ and other staff’s knowledge about the patients’ social and functional status.The selected pharmacists were educated prior to and during the intervention period. This education took the form of lectures and workshops, which took place on five occasions, twice before the intervention started and three times during the intervention period, for a total of 65.5 hours. The lectures were given by recognised experts, including clinical pharmacists, geriatricians, gerontologists, nurses and two community pharmacists with experience in nursing home consulting. Topics covered were gerontology/geriatrics (12.5 hours), drug use in the elderly (23.5 hours) and basic training in collaborative methods (18.5 hours). In addition, the pharmacists worked with patient cases in small groups, covering all the areas mentioned above (11 hours). In addition to the formal education, the pharmacists formed regional networks. The networking took place locally, whenever the pharmacist felt a need to have it. In order to make the networks constructive, the whole group was instructed by an educational specialist on one occasion.
Outcomes	Medication‐related problems Not used for this review: Drug use
Notes	Supported by the National Corporation of Swedish Pharmacies and the Swedish Pharmaceutical Society
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Homes were matched in pairs then each randomised to control or intervention. [Attempted to contact author for further information but unsuccessful]
Allocation concealment (selection bias)	Low risk	Cluster design
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding not conducted
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Blinding not conducted
Blinding of outcome assessment (detection bias) Objective outcomes	Unclear risk	No objective outcomes
Incomplete outcome data (attrition bias) Primary outcomes	Unclear risk	Not measured in this study
Incomplete outcome data (attrition bias) Secondary outcomes	Low risk	Medication‐related problems described for residents receiving intervention
Selective reporting (reporting bias)	Unclear risk	Insufficient information to permit judgement
Similar baseline outcome measurements	Unclear risk	Medication‐related problems not measured at baseline
Similar baseline characteristics	Low risk	Similar baseline characteristics reported
Reliable primary outcome measure	Low risk	Drug use
Adequate protection against contamination	Unclear risk	Cluster design. [Attempted to contact author for further information but unsuccessful]
Other bias	Low risk	Appears to be free of other sources of bias