Table 1 COME-ON intervention components
Intervention component | Description | Objectives | Participants involved | Moment and frequency | Incentives |
|---|---|---|---|---|---|
1. Blended training | |||||
 1a. Training—e-learning | Module 1: Pharmacotherapy in older people; potentially inappropriate medications and tools used to measure it Module 2: What is a medication review? How can HCP contribute? Module 3: How to perform an interdisciplinary medication review? Module 4: Teamwork | (a) to provide the key messages about the pharmacotherapy in older people (b) to explain how to conduct an interdisciplinary medication review + provide tools | Physicians Nurses Pharmacists | To be done preferentially over months 1 and 2, but available during whole study period | Accreditation for GPs and pharmacists; certificate of attendance for nurses |
 1b. Training—interdisciplinary workshops | Interdisciplinary workshops, provided by the research team. Problem-based learning using clinical vignettes: How to conduct an interdisciplinary medication review? What is the contribution of each HCP? How to classify DRPs? | (a) to explain how to conduct an interdisciplinary medication review + provide tools (b) to initiate teamwork and communication between HCPs of the same NH | Physicians Nurses Pharmacists | At month 2 | Accreditation for GPs and pharmacists; certificate of attendance for nurses |
Specific training for pharmacists, provided by the research team: How to prepare a medication review? How to make a suggestion? Where to find relevant information about medications? | (a) to support pharmacists to take up their role in the interdisciplinary team | Pharmacists | At month 2 | Accreditation for pharmacists | |
Specific training for nurses, provided by the coordinating physician and/or pharmacist: â–ª Detection of adverse drug events by nurses â–ª Drug administration | (a) to strengthen the competencies of the nurses | Nurses | Twice or more during the study period at the discretion of the CP | Certificate of attendance | |
2. Local interdisciplinary meetings | Interdisciplinary discussion about the rational use of one specific class of medications at the level of the nursing home. Material was provided by the research team about the antidepressants and the lipid-lowering drugs (summary of evidence available + topics to be discussed). Possibility to invite external expert(s). | (a) to reach consensus on the appropriate use of one specific medication class within each NH and (b) to initiate teamwork and communication between HCPs of the same NH | Physicians Nurses Pharmacists | Two meetings of approximately 2  hours during the study | Remuneration for all HCPs involved in the COME-ON study |
3. Interdisciplinary case conferences | Interdisciplinary face-to-face medication reviews of all medications for each included NHR | To perform a medication review of all medications taken by the resident and to plan / evaluate interventions to optimize medication use | Physicians Nurses Pharmacists | Once every 4  months (i.e., three time over study period) for a duration of approximately 20  minutes/ICC/NHR | Remuneration for all HCPs |