Garcia‐Gollarte 2014.
| Methods | Cluster‐RCT (randomised by nursing home) Total study duration: 6 months |
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| Participants | Control group: 17 nursing homes and 29 doctors (372 participants). Intervention Group: 19 nursing homes and 30 doctors (344 participants) Setting: Nursing homes Age: Control mean 84.5 SD 10.4 ; intervention 84.24 mean SD 14.6 Gender: Control 72.1% female; intervention 74.0% female Country: Spain Date of study: February 2010 to February 2013 |
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| Interventions | Educational intervention delivered to 30 doctors Nursing home physician expert in drug use in older people delivered a structured educational intervention. The educational intervention included information on general aspects of prescription and drug use in geriatric patients, how to reduce the number of drugs and to perform regular reviews of medications, to avoid inappropriate drug use, to discontinue drugs that do not show benefit and to avoid under‐treatment with drugs that have shown benefit. Information also provided on adverse drug reactions in older people Educational material and references also provided to participants Educator also provided on‐demand prescription advice (via phone) for a six‐month period |
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| Outcomes | Measured at baseline and at nine months. Hospital admissions (total number of days spent in hospital) Medication appropriateness (STOPP‐START) Not used in this review: Falls Delirium Physician and nurse visit Emergency room visits Use of antipsychotics Use of delirium drugs |
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| Notes | Funded by the Ballesol group [author contacted] | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Random number tables |
| 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 | Unclear risk | Insufficient information to permit judgement |
| Blinding of outcome assessment (detection bias) Objective outcomes | Unclear risk | Outcomes not likely to be influenced by lack of blinding |
| Incomplete outcome data (attrition bias) Primary outcomes | Unclear risk | Per protocol analysis used. Dropouts were not identified by group |
| Incomplete outcome data (attrition bias) Secondary outcomes | Unclear risk | Per protocol analysis used. Dropouts were not identified by group |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information to permit judgement |
| Similar baseline outcome measurements | Low risk | Similar baseline outcome measurements for days in hospital and medication appropriateness |
| Similar baseline characteristics | Low risk | Similar baseline characteristics reported except worse functional status in intervention group; however, adjusting for this did not significantly change the results |
| Reliable primary outcome measure | Low risk | Objective measures of healthcare utilisation |
| Adequate protection against contamination | Unclear risk | Cluster design. However, it was theoretically possible that some physicians may have moved between intervention and control nursing homes [author contacted] |
| Other bias | Unclear risk | For prescribing appropriateness, a random sample of 311 from 1018 residents was used |