Table 5 Data collection; content of case report form (CRF)

Patient data

• patient ID*

• age*^§

• gender*^§

• pharmacist*^§

• GP*^§

• weight^#/+

• lengths^#/+

• diet⁺

• alcohol consumption⁺

• smoking habits⁺

• cognition^$

• abilities/disabilities⁺

• daily activities⁺

• former education\language⁺

• religion⁺

• home situation⁺

• home help⁺

• carer⁺

• medication aids⁺

• other relevant information (free text) ⁺

Medical data

• acute medical conditions (menu, coded with ICPC-code[31])^#

• chronic medical conditions (menu, coded with ICPC-code[31])* ^#

• current complaints or symptoms (menu, coded with ICPC-code[31]) ^#

• significant past medical conditions or procedures^#

• other relevant health information (free text) ^#

Clinical data

• laboratory values^#

• blood pressure^#

• temperature^#

• weight^#

• other relevant measured clinical data^#

available clinical data is collected from 12 months before inclusion till the end of the inclusion period.^#

Medication data

full drug history: all dispensed drugs from 12 months before inclusion till the end of the inclusion period^§, containing information on:

• chemical substance (menu, coded with ATC-code[25]) ^§

• dispensed product (extracted from pharmacy database)* ^§

• dispensed amount (extracted from pharmacy database)* ^§

• dispensing date (extracted from pharmacy database)* ^§

• prescribed dose (extracted from pharmacy database)* ^§

• over the counter (OTC) drugs^{§, +}

• vitamins, dietary or nutritional supplements^{§, +}

• other health products^{§, +}

• medical devices^{§, +}

• drug allergies^{§, +}

• intolerabilities or adverse drug events^{§, +}

Study outcomes

• hospital admissions (discharge letter as appendix)^#

• date of each admissions^#

• reason for eacht admission^#

• quality of life; EQ5D score (at t = 0* and t = 12 months)⁺

• visual analogue scale score(at t = 0* and t = 12 months) ⁺

• adverse drug events (ADE) with symptom, related drug and timing information (at t = 12 months) ^{+, #}

• severity of the ADE^{+, #}

Pharmaceutical care plan^$

• DTPs (according to the Subjective-Objective-Assessment-Plan (SOAP) notes[29])

• therapy goals

• priorities

• interventions

• clinician who is executing the action

• date of action

• date of evaluation of the action