Furniss 2000.
| Methods | Cluster‐RCT (randomised by care home) Total study duration: 8 months |
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| Participants | 330 residents (172 control, 158 intervention); 14 homes (7 matched pairs) Setting: Nursing homes Age: Control mean 78.9 SD 13.7; intervention mean 83.5 SD 9.2 Gender: Control 115 (67%) females; intervention 125 (79%) females Country: UK Date of study: Not stated |
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| Interventions | Medication review by pharmacist Medication review by the study pharmacist in the GP’s surgery, at the nursing home or (in exceptional circumstances) over the telephone. The pharmacist collected details of current medication for each resident from the medicines administration record chart in the home, together with a brief medical history and any current problems identified by the home staff. Three weeks after the medication review, the homes were revisited, to ascertain whether there had been any immediate problems with the changes in medication and to see if the suggested changes had been implemented |
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| Outcomes | Measured at time 0 (beginning of study), time 1 at four months (beginning of intervention) and at time 2 at eight months (end of intervention): Hospital admissions ("inpatient days") Mortality Medication‐related problems (number of pharmacist recommendations, acceptance of recommendations by the GP, number of treatment changes) Medication costs (not defined, £ sterling) Not used for this review: Mini‐Mental State Examination (MMSE) Geriatric Depression Scale (GDS) Brief Assessment Schedule Depression Cards (BASDEC) Crichton‐Royal Behaviour Rating Scale (CRBRS) Number of drugs per resident Type of drugs Reason for neuroleptic use Use of primary and secondary care resources Number of accidents Falls |
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| Notes | Funded by the North West NHS Executive | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Computer‐generated pseudo random numbers used |
| Allocation concealment (selection bias) | Low risk | Homes were randomised at the start of the start of a four‐month observation phase. Cluster design |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding described |
| Blinding of outcome assessment (detection bias) Subjective outcomes | High risk | No blinding conducted |
| Blinding of outcome assessment (detection bias) Objective outcomes | Low risk | No blinding conducted, however outcomes not likely to be influenced by lack of blinding |
| Incomplete outcome data (attrition bias) Primary outcomes | Unclear risk | Insufficient reporting of attrition/exclusions to permit judgement |
| Incomplete outcome data (attrition bias) Secondary outcomes | Unclear risk | Insufficient reporting of attrition/exclusions to permit judgement |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information to permit judgement |
| Similar baseline outcome measurements | High risk | 14 (8.1%) deaths in control group versus 22 (13.9%) deaths in intervention group at baseline. No baseline measurements of other primary outcomes of this review |
| Similar baseline characteristics | High risk | Slightly fewer residents in the intervention group (158) versus control (172). In the control group, residents were younger (mean 78.9 SD 13.7 versus mean 83.5 SD 9.2) and there were fewer females (67% versus 79%) |
| Reliable primary outcome measure | Low risk | Crichton‐Royal Behaviour Rating Scale |
| Adequate protection against contamination | Low risk | Randomised by care home (which were in different geographical areas) |
| Other bias | Low risk | Appears to be free of other sources of bias |