Zermansky 2006.
| Methods | RCT (randomised by patient) Total study duration: 6 months |
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| Participants | 661 (331 intervention, 330 control) care home residents, 65 care homes Setting: Nursing and residential homes for older people Age: Intervention mean 85.3 (IQR 81‐90); control mean 84.9 (IQR 80‐90) Gender: Intervention 75 (22.7%) male; control 79 (23.9%) male Country: UK Date of study: 2002 |
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| Interventions | Medication review by a single pharmacist A clinical medication review was conducted by the study pharmacist who held a postgraduate qualification in clinical pharmacy, within 28 days of randomisation. It comprised a review of the GP clinical record and a consultation with the resident and carer. The pharmacist formulated recommendations with the resident and carer and passed them on a written proforma to the GP for acceptance and implementation. GP acceptance was signified by ticking a box on the proforma. Control patients received usual GP care |
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| Outcomes | Measured at baseline and six months ± three weeks post‐randomisation: Hospital admissions (non‐elective) Mortality Medication‐related problems Medicine costs (cost of 28 days of repeat medicines per participant) Not used for this review: Number of changes in medicines per participant Number of medicines per participant Recorded medication reviews Falls SMMSE Barthel index Number of GP consultations |
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| Notes | Funded by The Health Foundation, 90 Long Acre, London WC2 9RA (Registered Charity Number 286967) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Patients were randomised in randomly sized blocks of 2 to 8 patients using an algorithm written in Visual Basic in Microsoft Access |
| Allocation concealment (selection bias) | Low risk | Not reported in paper. Allocation was concealed to the research pharmacist and nurse data collector by statistician [Author contacted] |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Open design, no blinding attempted |
| 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 | Low risk | Similar attrition in both groups with similar reasons for dropouts. Described as intention‐to‐treat by authors |
| Incomplete outcome data (attrition bias) Secondary outcomes | Low risk | Similar attrition in both groups with similar reasons for dropouts. Described as intention‐to‐treat by authors |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information to permit judgement |
| Similar baseline outcome measurements | Low risk | Similar baseline measurements for hospital admissions and medicine costs |
| Similar baseline characteristics | Low risk | Similar baseline characteristics reported |
| Reliable primary outcome measure | Low risk | Number of changes in medication |
| Adequate protection against contamination | High risk | Randomised by patient therefore contamination possible |
| Other bias | Unclear risk | Sample size calculation indicated that 1600 residents were required, however, only 661 residents were recruited |
IQR: Interquartile Range
MMSE: Mini‐Mental State Examination
SD: Standard Deviation
I5D: 15 Dimensional Instrument of Health‐related Quality of Life