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Table 7 Results from RCTs and controlled studies

From: A systematic review of integrated working between care homes and health care services

Study ID Outcome Main results at follow up (+) = positive effect, (-) = negative effect, (0) = no significant effect
Crotty 2004 RCT Appropriate prescribing (medication appropriateness index) Follow up at 3 months (NB - two control groups - one external and one within the facility (results presented for external control grp only))
   Change MAI score (+) Mean score (95% CI)Intervention 4.10 (2.11-6.10), Control 0.41 (-0.42-1.23), Difference p = 0.004
  Nursing home behaviour problem Change NHBPS (0), Mean score (95% CI)Intervention 3.9 (-2.7-10.5), Control 1.2 (-9.1-11.6), P = 0.440
  Mortality Mortality (0) No differences between groups (p = 0.304)
Goodman 2007 (non randomised controlled study) Bowel related problems Follow up at 6 months Normal bowel patterns (+) Intervention - significant increase in normal bowel patters, control grp - little change
  Medication and continence related product use Prescription of laxatives (0) Increase in both groups but no statistically significant differences between groups p = 0.159
  Dependency (Barthel index) Dependency (+) Mean change score p = 0.002 Intervention -0.02 (SD 3.1), Control -1.84 (SD 3.7)
  Bowel related hospital admission 1 admission in intervention grp, none in control (n = 120)
King 2001 (non randomised controlled study)   Follow up at 1 month. Data collected on 184 residents (75 reviewed, 109 not reviewed).
  Medication prescribed Changes in medication prescribed - mean (SD) (0) Intervention -0.35 (2.56), Control -0.03 (1.90) P = 0.37
  Medication administered Changes in medication administered - mean (SD) (0) Intervention -0.44 (2.45), Control 0.12 (1.84), P = 0.16
  Weekly Cost ($) - authors say study underpowered for this outcome Weekly cost (0) Intervention -0.29 (10.80), Control 0.43 (12.16), P = 0.75
  Mortality (adjusted for length of time in home) Mortality (0) Adjusted mortality data showed 6% of reviewed residents died compared to 15% of those not reviewed p = 0.07
Kane 2004 (controlled study) - evaluating EverCare   Follow up at 18 months 2 control groups a) other residents in same homes not enrolled in Evercare b) residents in homes in same geographical area that did not participate n Evercare Assessments at 6,12, 18 months (within 30 days)
  Mortality Mortality Evercare rate significantly less than for control-in group but was slightly higher than control-out group (non significant)
  Preventable hospitalizations Rates of preventable admissions lower in Evercare than for either control but only significant when compared to control-out. No differences in hospitalization rates overall. (0)
  Functional change No significant differences in ADLs between Evercare and either control. (0)
Llewellyn-Jones 1999 RCT Geriatric depression scale (score of ≥ 10 defined as depressed) Follow up after 9.5 months Depression Unadjusted MD (0) -0.76 (-2.09, 0.57)
   Adjusted difference in change score (+) Multiple linear regression analysis Intervention group 1.87 improvement on scale compared to control group (95% CI 0.76, 2.97) p = 0.0011
Opie 2002 RCT (poor study design) Frequency & severity of disruptive behaviours (Behaviour Assessment Graphical System and counts of certain behaviours) Follow up at one month Frequency of disruptive behaviour (0) ANOVA revealed no statistically significant changes BAGS scores (0) No significant between group differences
  Assessment of change by senior nursing home staff - rated on 4 point scale(interviewed one month after completion of trial) Assessment by staff No data reported on between group differences. Staff reported that the frequency of target behaviours had decreased in at least one behavioural category for 75% residents and that severity had decreased in at least one category for 60%.
Schmidt 1998 RCT Proportion of pts with any psychotropic drug (from lists of residents prescriptions) Follow up at 12 months Any psychotropic drug use (0) RR 0.97 (95% CI 0.92, 1.03)
Involves pharmacists Proportion of residents with two or more drug classes (polymedicine) Two or more drug classes (0) RR 1.02 (0.92, 1.13)
  Proportion of residents with therapeutic duplication (two or more drugs in same class) Two or more drugs in same class RR 0.92 (0.76, 1.10)
  Number of drugs prescribed Number of drugs prescribed (mean) 2.08% versus 2.20% Significant increase in average number of drugs prescribed in control before to after. No change in experimental homes.
  Proportion of residents with non recommended drugs (as defined by Swedish guidelines) Non recommended hypnotics (+) RR 0.45 (0.35, 0.58) Non recommended anxiolytics (0) RR 0.96 (0.79, 1.16) Non recommended antidepressant (0) RR 0.67 (0.44, 1.03) Acceptable hypnotics (+) RR 1.46 (1.13, 1.89)
  Proportion of residents with acceptable drugs (as defined by Swedish guidelines) Acceptable anxiolytics (0) RR 1.19 (0.97, 1.45) Acceptable antidepressant (-) RR 1.34 (1.07, 1.68)
Vu 2007 (Pseudo RCT) Percentage healed Follow up at 20 weeks Healed (0) - but baseline wound severity greater in intervention group Intervention 61.7%, control 52.5% p = 0.074
Involves pharmacists Mean time to healing Time to healing (mean days) (0) Intervention 82.0 (69.1-94.9), Control 101.1 (84.5-117.6), P = 0.095
  Total pain relief (Brief pain inventory) Pain relief - BPI score = 0 (+) Intervention 38.6%, control 24.4% p = 0.017
  Costs Mean treatment costs (+) Reduction in mean treatment costs of 357.7 Australian dollars when training costs included p = 0.004