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Table 1 COME-ON intervention components

From: Process evaluation of a complex intervention to optimize quality of prescribing in nursing homes (COME-ON study)

Intervention componentDescriptionObjectivesParticipants involvedMoment and frequencyIncentives
1. Blended training
 1a. Training—e-learningModule 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 periodAccreditation for GPs and pharmacists; certificate of attendance for nurses
 1b. Training—interdisciplinary workshopsInterdisciplinary 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 2Accreditation 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 teamPharmacistsAt month 2Accreditation for pharmacists
Specific training for nurses, provided by the coordinating physician and/or pharmacist:
▪ Detection of adverse drug events by nurses
▪ Drug administration
(a) to strengthen the competencies of the nursesNursesTwice or more during the study period at the discretion of the CPCertificate of attendance
2. Local interdisciplinary meetingsInterdisciplinary 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 studyRemuneration for all HCPs involved in the COME-ON study
3. Interdisciplinary case conferencesInterdisciplinary face-to-face medication reviews of all medications for each included NHRTo perform a medication review of all medications taken by the resident and to plan / evaluate interventions to optimize medication usePhysicians
Nurses
Pharmacists
Once every 4  months (i.e., three time over study period) for a duration of approximately 20  minutes/ICC/NHRRemuneration for all HCPs