Fleetwood (N.I.) Project
This project aims to answer the following questions:
1. Can an adapted US model of care (the Fleetwood model) improve psychoactive prescribing and reduce falls in nursing home residents in Northern Ireland?
2. Does healthcare resource usage (i.e. direct healthcare costs) change as a result of the implementation of the Fleetwood model?
Ethical approval for the study has been obtained from the Research Ethics Committee 2 of the Office for the Research Ethics Committees, Northern Ireland, date of approval: 15th August 2005 (reference number: 05/NIR02/112).
Cluster randomised controlled trial (12 month duration)
Primary study design
Secondary study design
Randomised controlled trial
Quality of life
Patient information sheet
This intervention aims to improve the psychoactive prescribing for residents in nursing homes. It is not disease specific.
The intervention being tested is an adapted US model of pharmaceutical care - the Fleetwood model. This care model is provided to intervention home residents by pharmacists who have received specialist training in medicines for older people. It consists of monthly visits to nursing homes and includes the following steps:
1. Assessment of residents pharmaceutical care needs
2. Medication review
3. Preparation of a pharmaceutical care plan that is shared between the relevant healthcare personnel
4. Pharmacist intervention and direct communication with the prescriber
Primary outcome measures
The primary outcomes for this trial will be a change in the prevalence of inappropriate psychoactive drug use and the number of residents who fall in the intervention homes compared to the control sites, over the 12 month study period. At three, six and 12 months, equivalent data as per baseline (excluding patient demographic data) will be collected using documentation provided by the US trial investigators and adapted for use in the present study, in addition to the number and length of pharmacist consultations (intervention group only).
Secondary outcome measures
It has been shown that patients on psychoactive medication are more likely to fall, incurring additional costs to health care systems. Therefore, a secondary outcome of this study will be to examine and quantify the changes in resource usage as a result of the implementation of the modified Fleetwood model. Direct medical (healthcare) costs for both intervention and control patients will be calculated using the framework outlined by Drummond et al. (2000). The evaluation will be performed from the perspective of the payer: direct non-medical, indirect and intangible costs will not be estimated.
Cost estimates will be calculated using data collected at baseline and throughout the intervention period (e.g. hospitalisations, number of consultations), in conjunction with national accounting statistics representative of unit costs surveyed across the United Kingdom. The cost of patient drugs will be obtained from the standard Drug Tariff. Resource use data will be collected for 12 months prior to baseline and for 365 days (to standardise calculation of unit costs) after enrolment or until death. Mean annual cost estimates for each type of resource group will be shown separately (e.g. drug cost, hospitalisations, General Practitioner visits) and compared pre- and post-enrolment and by allocation to control or intervention group.
A secondary outcome to be evaluated in this study will be professional satisfaction of intervention prescribing support pharmacists, GPs and nurses (of intervention residents) with the programme. This will be assessed using postal questionnaires.
Overall trial start date
Overall trial end date
Participant inclusion criteria
Eleven matched pairs of nursing homes were selected at random from all those in Northern Ireland with greater than 30 beds, which consented to participate in the project. Within each home, all residents aged more than 65 years were invited to participate. Where appropriate, their next-of-kin were approached for consent to participate.
Target number of participants
Participant exclusion criteria
Residents were excluded if they were terminally ill, in a coma or if no consent was obtained.
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
School of Pharmacy
Research and Development Office for the Health & Personal Social Services (UK) (reference no: EAT/2528/03)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting
Patterson SM, Hughes CM, Crealey G, Cardwell C, Lapane KL, An evaluation of an adapted U.S. model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in northern ireland (fleetwood northern ireland study)., J Am Geriatr Soc, 2010, 58, 1, 44-53, doi: 10.1111/j.1532-5415.2009.02617.x.
Patterson SM, Hughes CM, Cardwell C, Lapane KL, Murray AM, Crealey GE, A cluster randomized controlled trial of an adapted U.S. model of pharmaceutical care for nursing home residents in Northern Ireland (Fleetwood Northern Ireland study): a cost-effectiveness analysis., J Am Geriatr Soc, 2011, 59, 4, 586-593, doi: 10.1111/j.1532-5415.2011.03354.x.