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Appendices

Appendix 1. Electronic database search strategies

MEDLINE OvidSP 1 January 2012 ‐ 14 May 2015

1

polypharmacy/

2628

2

polypharm*.ti,ab.

3944

3

((multi‐drug* or multidrug*) adj2 (therapy or therapies or prescribing or treatment or regime*)).ti,ab.

3371

4

(beer* adj1 criter*).ti,ab.

304

5

inappropriate prescribing/

1037

6

((appropriate or optim* or inappropriat* or suboptim* or sub‐optim* or unnecessary or incorrect* or in‐correct* or excessive or multiple or concurrent*) adj2 (medicine? or medication? or prescription* or drug*)).ti,ab.

21359

7

((over adj1 prescript*) or (overprescrib* or overprescript*)).ti,ab.

751

8

((under adj prescript*) or (underprescrib* or underprescript*)).ti,ab.

276

9

medication appropriateness index.ti,ab.

72

10

(quality adj (prescribing or prescription? or medication?)).ti,ab.

85

11

(improv* adj (prescrib* or prescription? or pharmaco*)).ti,ab.

2066

12

case conferencing.ti,ab.

47

13

medication therapy management/

790

14

(medication? management or medication? therapy management or medication? strategy or medication? strategies or (medication? adj2 review*)).ti,ab.

3596

15

drug regimen review*.ti,ab.

54

16

drug utilization review/

3215

17

(drug adj utili?ation adj2 (review* or evaluat*)).ti,ab.

413

18

drug related problem?.ti,ab.

941

19

((prescribing or prescription?) adj2 pattern?).ti,ab.

2948

20

assessing care of vulnerable elders.ti,ab.

56

21

acove.ti,ab.

46

22

stopp.ti,ab.

132

23

start screening tool.ti,ab.

18

24

screening tool of older person's prescriptions.ti,ab.

30

25

screening tool to alert doctors to right treatment.ti,ab.

29

26

medication errors/

10732

27

(pharmaceutical? or pharmacist? or prescrib*).ti,ab.

185124

28

pharmaceutical preparations/

43774

29

pharmacists/

11288

30

pharmacists' aides/

532

31

prescription drugs/

3360

32

drug prescriptions/

22654

33

prescriptions/

2033

34

pharmaceutical services/

4377

35

drug toxicity/

22441

36

pharmacotherap*.ti,ab.

24486

37

drug therapy/

28413

38

drug monitoring/

15022

39

or/1‐38

345099

40

homes for the aged/ or "homes for the aged".tw.

11571

41

exp nursing homes/ or nursing home?.tw.

40611

42

(aged adj2 (care or nursing or healthcare or residential) adj2 (facility or facilities or home?)).ti,ab.

708

43

((geriatric or elderly) adj2 (facility or facilities or care home?)).ti,ab.

354

44

hospitals, veterans/

5928

45

or/40‐44

50940

46

((care or convalescent) adj (home? or center? or centre? or facility or facilities)).ti,ab.

35311

47

((skilled or intermediate) adj (nursing facility or nursing facilities)).ti,ab.

1609

48

(resident* adj2 (care or facility or facilities)).ti,ab.

6401

49

((nursing or group or residential) adj home?).ti,ab.

24170

50

long‐term care/

22277

51

((longterm or long term) adj3 (care or facility or facilities)).ti,ab.

18133

52

(healthcare adj2 (facility or facilities)).ti,ab.

2669

53

residential facilities/

4759

54

assisted living facilities/

968

55

assisted living.ti,ab.

1455

56

halfway houses/

1025

57

or/46‐56

94250

58

exp aged/

2433322

59

geriatrics/

26942

60

(gerontol* or ageing or aging or elder* or geriatric* or seniors or old age or older or late* life).ti,ab.

583360

61

(older adj (person* or people or adult* or patient* or inpatient* or outpatient*)).ti,ab.

85641

62

veterans/

10381

63

veteran*.ti,ab.

23572

64

or/58‐63

2740961

65

exp randomized controlled trial/

394909

66

controlled clinical trial.pt.

89435

67

randomi#ed.ti,ab.

408930

68

placebo.ab.

162358

69

drug therapy.fs.

1771119

70

randomly.ti,ab.

231035

71

trial.ab.

331228

72

groups.ab.

1449417

73

or/65‐72

3543651

74

exp animals/ not humans/

4037906

75

73 not 74

3046430

76

39 and 45

2952

77

39 and 57 and 64

2794

78

or/76‐77

4142

79

75 and 78

1720

80

limit 79 to yr="2012 ‐Current"

393

Embase OvidSP 1 January 2012 ‐ 14 May 2015

1

polypharmacy/

8098

2

polypharm*.ti,ab.

5772

3

((multi‐drug* or multidrug*) adj2 (therapy or therapies or prescribing or treatment or regime*)).ti,ab.

3393

4

(beer* adj1 criter*).ti,ab.

550

5

inappropriate prescribing/

1682

6

((appropriate or optim* or inappropriat* or suboptim* or sub‐optim* or unnecessary or incorrect* or in‐correct* or excessive or multiple or concurrent* or adverse) adj2 (medicine? or medication? or prescription* or prescrib* or drug*)).ti,ab.

50332

7

((over adj1 prescript*) or (over adj1 prescrib*) or (overprescrib* or overprescript*)).ti,ab.

1348

8

((under adj prescript*) or (under adj prescrib*) or (underprescrib* or underprescript*)).ti,ab.

563

9

medication appropriateness index/ or medication appropriateness index.ti,ab.

113

10

(quality adj (prescribing or prescription? or medication?)).ti,ab.

128

11

(improv* adj (prescrib* or prescription? or pharmaco*)).ti,ab.

2583

12

case conferencing.ti,ab.

57

13

medication therapy management/

4106

14

(medication? management or medication? therapy management or drug therapy management or medication? strategy or medication? strategies or (medication? adj2 review*)).ti,ab.

6098

15

drug regimen review*.ti,ab.

61

16

(drug adj utili?ation adj2 (review* or evaluat*)).ti,ab.

441

17

drug utilization/

14141

18

((drug or medication) adj related problem?).ti,ab.

1973

19

((prescribing or prescription?) adj2 pattern?).ti,ab.

4150

20

assessing care of vulnerable elders.ti,ab.

72

21

assessing care of vulnerable elders.mp.

74

22

"assessing care of vulnerable elders"/

2

23

acove.ti,ab.

89

24

stopp.ti,ab.

349

25

start screening tool.ti,ab.

46

26

screening tool of older person's prescriptions.ti,ab.

63

27

screening tool to alert doctors to right treatment.ti,ab.

56

28

medication error/

11886

29

(pharmaceutical? or pharmacist? or prescrib*).ti,ab.

264124

30

drug/

19225

31

pharmacist/ or pharmacy technician/

45126

32

prescription drug/

4573

33

prescription/

106402

34

pharmacy/

45688

35

pharmacotherap*.ti,ab.

31782

36

exp drug therapy/

1368324

37

drug monitoring/

26385

38

drug toxicity/

6318

39

"drug use"/

72662

40

or/1‐39

1750098

41

home for the aged/ or "home? for the aged".ti,ab.

5316

42

((care or convalescent) adj (home? or center? or centre? or facility or facilities)).ti,ab.

39224

43

public hospital/

21393

44

exp nursing homes/

26353

45

((skilled or intermediate) adj (nursing facility or nursing facilities*)).ti,ab.

1724

46

((aged or geriatric or elderly) adj2 (care home? or facility or facilities or residential)).ti,ab.

1272

47

or/41‐46

86634

48

(resident* adj2 (care or facilit*)).ti,ab.

6772

49

((nursing or group or residential) adj home*).ti,ab.

21258

50

long term care/

83653

51

((longterm or long term) adj3 (care or facilit*)).ti,ab.

17973

52

residential home/

3955

53

residential home*.ti,ab.

707

54

assisted living facility/

1431

55

assisted living.ti,ab.

1711

56

(life care cent* or continued care cent* or extended care facilit*).ti,ab.

283

57

halfway house/

351

58

or/48‐57

118205

59

exp aged/

1646752

60

geriatrics/

15941

61

(aged or elder* or geriatric* or seniors or old age or older or late* life).ti,ab.

799481

62

(old* adj (person* or people or adult* or patient* or inpatient* or outpatient*)).ti,ab.

126453

63

veteran/

11947

64

veteran*.ti,ab.

22983

65

or/59‐64

2164247

66

clinical trial/

696973

67

randomized controlled trial/

324874

68

randomization/

57914

69

single blind procedure/

18802

70

double blind procedure/

96148

71

crossover procedure/

38442

72

randomi?ed controlled trial*.ti,ab.

112095

73

rct.tw.

16460

74

random allocation.ti,ab.

1121

75

randomly allocated.ti,ab.

18340

76

allocated randomly.ti,ab.

1382

77

(allocated adj2 random).ti,ab.

292

78

single blind*.ti,ab.

12471

79

double blind*.ti,ab.

109011

80

((treble or triple) adj2 blind*).ti,ab.

426

81

prospective study/

267926

82

or/66‐81

1145782

83

exp animal/ not human/

2195026

84

82 not 83

1107995

85

40 and 47

13171

86

40 and 58 and 65

10550

87

or/85‐86

20859

88

84 and 87

4153

89

limit 88 to yr="2012 ‐Current"

989

Cochrane Central Register of Controlled Trials (CENTRAL) Wiley 1 January 2012 ‐ 14 May 2015

#1

[mh ^polypharmacy]

101

#2

(polypharm*):ti,ab,kw

273

#3

(multi‐drug* or multidrug*) near/2 (therapy or therapies or prescribing or treatment or regime*):ti,ab,kw

331

#4

(beer near/2 criter*):ti,ab,kw

3

#5

[mh ^"inappropriate prescribing"]

49

#6

(appropriate or optim* or inappropriat* or suboptim* or sub‐optim* or unnecessary or incorrect* or in‐correct* or excessive or multiple or concurrent*) near/2 (medicine* or medication* or prescription* or drug*):ti,ab,kw

2588

#7

(over near/1 prescript*) or (overprescrib* or overprescript*):ti,ab,kw

62

#8

(under near/1 prescript*) or (underprescrib* or underprescript*):ti,ab,kw

16

#9

medication appropriateness index:ti,ab,kw

20

#10

(quality near/1 (prescribing or prescription* or medication*)):ti,ab,kw

59

#11

(improv* near/1 (prescrib* or prescription* or pharmaco*)):ti,ab,kw

189

#12

case conferencing:ti,ab,kw

12

#13

[mh ^"medication therapy management"]

53

#14

medication* management:ti,ab,kw or "medication* therapy management":ti,ab,kw or "medication* strategy":ti,ab,kw or "medication* strategies":ti,ab,kw or (medication* near/2 review*):ti,ab,kw

611

#15

drug regimen review*:ti,ab,kw or (drug near/1 utili?ation near/2 (review* or evaluat*)):ti,ab,kw

153

#16

[mh ^"drug utilization review"]

123

#17

drug related problem*:ti,ab,kw or (prescription* near/2 pattern*):ti,ab,kw or "assessing care of vulnerable elders":ti,ab,kw or (acove):ti,ab,kw or (stopp):ti,ab,kw

194

#18

start screening tool:ti,ab,kw or "screening tool of older person's prescriptions":ti,ab,kw or "screening tool to alert doctors to right treatment":ti,ab,kw

3

#19

[mh ^"medication errors"]

230

#20

(pharmaceutical* or pharmacist* or prescrib*):ti,ab,kw

15159

#21

[mh ^"pharmaceutical preparations"]

229

#22

[mh ^pharmacists]

452

#23

[mh ^"pharmacists' aides"]

8

#24

[mh ^"prescription drugs"]

92

#25

[mh ^"drug prescriptions"]

471

#26

[mh ^prescriptions]

91

#27

[mh ^"pharmaceutical services"]

133

#28

[mh ^"drug toxicity"]

780

#29

(pharmacotherap*):ti,ab,kw

5106

#30

[mh ^"drug therapy"]

434

#31

[mh ^"drug monitoring"]

1129

#32

{or #1‐#31}

25427

#33

[mh "homes for the aged"]

498

#34

home* for the aged:ti,ab,kw or (aged near/2 (care or nursing or healthcare or residential) near/2 (facility or facilities or home*)):ti,ab,kw or (geriatric or elderly) near/2 (facility or facilities or care home*):ti,ab,kw

990

#35

[mh "nursing homes"]

1057

#36

[mh ^"hospitals, veterans"]

293

#37

{or #33‐#36}

1826

#38

(care or convalescent) next (home or homes or center* or centre* or facility or facilities):ti,ab,kw

3372

#39

((skilled or intermediate) near/2 (nursing facility or nursing facilities)):ti,ab,kw

108

#40

(resident* near/2 (care or facility or facilities)):ti,ab,kw

678

#41

(nursing or group or residential) next (home or homes):ti,ab,kw

2301

#42

(longterm or long term) near/3 (care or facility or facilities):ti,ab,kw

3110

#43

[mh ^"long‐term care"]

1115

#44

[mh ^"residential facilities"]

148

#45

(assisted living):ti,ab,kw

315

#46

[mh ^"halfway houses"]

18

#47

{or #38‐#46}

8636

#48

[mh aged]

997

#49

[mh ^geriatrics]

202

#50

(gerontol* or ageing or aging or elder* or geriatric* or seniors or old age or older or late* life):ti,ab,kw

44963

#51

(older next (person* or people or adult* or patient* or inpatient* or outpatient*)):ti,ab,kw

7601

#52

[mh veterans]

488

#53

(veteran*):ti,ab,kw

2478

#54

{or #48‐#53}

47508

#55

#47 and #54

2330

#56

#32 and (#37 or #55) Publication Year from 2012 to 2015

83

CINAHL EbscoHost 1 January 2012 ‐ 14 May 2015

S1

MH polypharmacy

1,698

S2

polypharmacy

2,183

S3

beer* n1 criter*

150

S4

((appropriate or optim* or inappropriat* or suboptim* or sub‐optim* or unnecessary or incorrect* or in‐correct* or excessive or multiple or concurrent*) n2 (medicine? or medication? or prescription* or drug*))

6,010

S5

(over n2 prescript*) or overprescrib* or overprescript*

420

S6

"under prescript*" or underprescrib* or underprescript

54

S7

"medication appropriateness index*"

24

S8

quality n2 (prescri* or medication*)

424

S9

improv* n2 (prescri* or pharmaco*)

959

S10

"assessing care of vulnerable elders"

37

S11

acove

24

S12

((multi‐drug* or multidrug*) n3 (therapy or therapies or prescribing or treatment or regime*))

587

S13

MH medication errors

8,551

S14

MH inappropriate prescribing

353

S15

pharmaceutical* or prescribing

25,134

S16

MH pharmacists

4,753

S17

MH "pharmacy technicians"

205

S18

MH "drugs, prescription"

10,395

S19

MH "prescriptions, drug”

4,242

S20

MH "pharmacy service") or (MH "pharmaceutical care")

2,710

S21

pharmacist*

7,487

S22

(MH "medication management (iowa nic)") or (MH "medication managements (iowa nic) (non‐cinahl)")

2

S23

MH drug toxicity

3,066

S24

stopp or start screening tool

46

S25

"screening tool of older person's prescriptions"

7

S26

"screening tool to alert doctors to right treatment"

8

S27

(medication* n2 (management or review* or strateg*))

2,550

S28

pharmacotherap*

3,689

S29

(MH "drug therapy")

6,126

S30

(MH "drug utilization")

3,823

S31

"drug utili*ation" n2 (review* or evaluat*)

216

S32

MH drug monitoring

3,766

S33

"drug regimen review*"

11

S34

"case conferencing"

21

S35

S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34

74,621

S36

"homes for the aged" or MH housing for the elderly

1,945

S37

MH nursing homes+ or mw nursing home

33,249

S38

(aged n2 ("care facilit*" or "care home*" or "nursing facilit*" or "residential facilit*")) or "aged nursing home*" or (aged n1 "healthcare facilit*")

472

S39

"aged residential home*" or (geriatric n2 facilit*) or (geriatric* n1 "care home*") or (elderly n2 (facilit* or "care home*"))

284

S40

(MH "hospitals, veterans")

3,243

S41

S36 OR S37 OR S38 OR S39 OR S40

38,021

S42

((care or convalescent) w1 (home* or center* or centre* or facilit*))

21,905

S43

((skilled or intermediate) w1 "nursing facilit*")

2,493

S44

(resident* n2 (care or facilit*))

10,260

S45

((nursing or group or residential) n1 home*)

36,410

S46

((longterm or long term or long‐term) n3 (care or facilit*))

22,339

S47

MH residential facilities or MH long term care

19,412

S48

"residential home*" or healthcare n2 facilit*

1,436

S49

MH assisted living

2,010

S50

"assisted living"

2,521

S51

"life care cent*" or "continued care cent*" or "extended care facilit*"

152

S52

(MH "halfway houses")

97

S53

S42 OR S43 OR S44 OR S45 OR S46 OR S47 OR S48 OR S49 OR S50 OR S51 OR S52

75,485

S54

(MH "aged+")

355,481

S55

MH geriatrics

2,639

S56

ageing or aging or gerontol* or elder* or geriatric* or seniors or "old age" or "late* life"

142,501

S57

old* n1 (person* or people or adult* or patient* or inpatient* or outpatient*)

47,396

S58

MH veterans

7,376

S59

veterans

13,892

S60

S54 OR S55 OR S56 OR S57 OR S58 OR S59

408,165

S61

(MH "clinical trials")

81,870

S62

PT clinical trial

52,097

S63

TX clinic* n1 trial*

121,846

S64

TX ((singl* or doubl* or tripl* or trebl*) n1 (blind* or mask*))

640,410

S65

TX "randomi* control* trial*"

52,249

S66

MH random assignment

32,044

S67

TX "random* allocat*"

2,772

S68

MH quantitative studies

10,797

S69

TX "allocat* random*"

135

S70

S61 OR S62 OR S63 OR S64 OR S65 OR S66 OR S67 OR S68 OR S69

767,987

S71

(MH "animals+") not MH human

28,052

S72

s70 not s71

764,290

S73

S35 AND S41

1,524

S74

S35 AND S53 AND S60

1,530

S75

S73 OR S74

2,131

S76

S72 AND S75

543

S77

s76 Limiters ‐ Published Date: 20120101‐20151231

133

Appendix 2. Trial registry search strategies

ClinicalTrials.gov, US National Institutes of Health (NIH) searched 18 May 2015

( residential homes OR nursing homes ) AND ( medicine OR medication OR prescription OR drug ) AND ( elderly OR old OR aged ) AND ( randomly OR random OR randomised OR randomized OR RCT )

78

International Clinical Trials Registry Platform (ICTRP), World Health Organization (WHO)

Number of results: 11 

Each term 1 was searched with each possible combination of the other terms (2‐4). Terms were combined using AND

Term 1

Term 2

Term 3

Term 4

Randomised

Nursinghomes

elderly

drugs

Randomized

Residentialhomes

old

medication

RCT

pharmacy

Randomly

polypharmacy

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Interventions to optimise prescribing compared with usual GP care for care home residents

Patient or population: older people (aged 65 years or older) living in care homes

Settings: Institutionalised care facilities in Australia, Finland, Israel, Netherlands, New Zealand, Spain, Sweden, United Kingdom, and USA and Canada

Intervention: Intervention to optimise prescribing (single or multicomponent intervention)

Comparison: Usual care by general practitioner

Outcomes

Impact

No of Participants
(studies)

Quality of the evidence
(GRADE)

Adverse drug events

There was no evidence of an effect on adverse drug events

1228 in 87 care homes (2 studies)

⊕⊕⊝⊝
low

Hospital admissions

It is uncertain whether medication review reduces hospital admissions

7606 in 309 care homes (8 studies)

⊕⊕⊝⊝
low

Mortality

There was no evidence of an effect on mortality

6805 in 188 care homes (6 studies)

⊕⊕⊝⊝
low

Quality of life

It is uncertain whether medication review improves quality of life

586 in 21 care homes (2 studies)

⊕⊕⊝⊝
low

Medication‐related problems

Medication review may lead to the identification and resolution of medication‐related problems

6640 in 251 care homes (7 studies)

⊕⊕⊝⊝
low

Medication appropriateness

Medication review may lead to an improvement in medication appropriateness

1566 in 152 care homes (5 studies)

⊕⊕⊝⊝
low

Medicine costs

It is uncertain whether medication review decreases medication costs

4734 in 142 care homes (5 studies)

⊕⊝⊝⊝
very low

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Quality assessment of evidence for each outcome was based on study design, risk of bias, inconsistency, indirectness and imprecision. The evidence was downgraded from high to low for adverse drug events (Crotty 2004b; Gurwitz 2008) due to a serious risk of bias and imprecision. The evidence was downgraded from high to low for hospital admissions (Furniss 2000; Roberts 2001; Crotty 2004b; Zermansky 2006; Frankenthal 2014; Garcia‐Gollarte 2014; Pitkala 2014; Connolly 2015), mortality (Furniss 2000; Roberts 2001; Zermansky 2006; Frankenthal 2014; Pitkala 2014; Connolly 2015), quality of life (Frankenthal 2014; Pitkala 2014) and medication appropriateness (Crotty 2004a; Crotty 2004b; Frankenthal 2014; Garcia‐Gollarte 2014; Pitkala 2014) due to a serious risk of bias and inconsistency. The evidence for medicines costs (Furniss 2000; Roberts 2001; Crotty 2004a; Zermansky 2006; Frankenthal 2014 was downgraded from high to very low due to a serious risk of bias, inconsistency and imprecision. The evidence for medicine‐related problems (Strikwerda 1994; Claesson 1998; Furniss 2000; Roberts 2001; Crotty 2004b; Zermansky 2006; Frankenthal 2014 was reduced from high to low due to design, risk of bias and imprecision.

Figuras y tablas -
Table 1. Summary of study characteristics

Study,Country, Design

Participants

Intervention

Outcome measures

Duration

Claesson 1998

Sweden

Cluster‐RCT

1854 residents in 33 nursing homes

Multidisciplinary meetings with physician, pharmacist and nurse(s)

Medication‐related problems

14 months

Connolly 2015

Australia

Cluster‐RCT

1998 residents in 36 nursing homes

Multidisciplinary meetings with study geriatrician, a GP, a pharmacist and a nurse manager. Education of nurses and care‐givers

Hospital admissions

Mortality

14 months

Crotty 2004a

Australia

Cluster‐RCT

154 residents in 10 nursing homes

Multidisciplinary case conferencing with GP, a geriatrician, a pharmacist, residential care staff and an Alzheimer's Association representative

Medication Appropriateness Index

3 months

Crotty 2004b

Australia

Patient‐RCT

110 patients discharged to 85 long‐term care facilities

Pharmacist transition co‐ordinator. Transfer of medicines information to nursing staff, family physician and community pharmacist plus medication review and case conferencing

Adverse drug events

Hospital admissions

Medication‐related problems

Medication Appropriateness Index

8 weeks

Frankenthal 2014

Israel

Patient‐RCT

359 residents in 1 chronic care geriatric facility

Medication review by the study pharmacist

Hospital admissions

Mortality

Quality of life

Medication appropriateness (STOPP‐START)

Medication‐related problems

Medicine costs

12 months

Furniss 2000

UK

Cluster‐RCT

330 residents in 14 nursing homes

Medication review by a single pharmacist

Hospital admissions

Mortality

Medication‐related problems

Medicine costs

8 months

Garcia‐Gollarte 2014

Spain

Cluster‐RCT

716 residents in 36 nursing homes

Physician educational programme followed by on‐demand support (prescription advice) by phone

Hospital admissions (total number of days spent in hospital)

Medication appropriateness (STOPP‐START)

6 months

Gurwitz 2008

USA/Canada

Cluster‐RCT

1118 residents in 29 units in 2 long‐term care facilities

Computerised provider order entry with clinical decision support

Adverse drug events

12 months

Pitkala 2014

Finland

Cluster‐RCT

227 residents in 20 assisted living facilities

Nurse training and education

Hospital admissions

Mortality

Health‐related Quality of Life

Medication appropriateness (Beer's criteria plus others)

12 months

Roberts 2001

Australia

Cluster‐RCT

3230 residents in 52 nursing homes

Introduction of new professional role, nurse education and medication review by pharmacists

Hospital admissions

Mortality

Medication‐related problems

Medicine costs

24 months

Strikwerda 1994

Netherlands

Cluster‐RCT

196 residents in 1 nursing home

Feedback on GP prescribing from community pharmacist

Medication‐related problems

6 weeks

Zermansky 2006

UK

Patient‐RCT

661 residents in 65 care homes

Medication review by a single pharmacist

Hospital admissions

Mortality

Medication‐related problems

Medicine costs

6 months

Figuras y tablas -
Table 1. Summary of study characteristics