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BMC Health Serv Res. 2020 Mar 2;20(1):157. doi: 10.1186/s12913-020-5014-0.

MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention.

Author information

1
School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK. i.maidment@aston.ac.uk.
2
Norwich Clinical Trials Unit, University of East Anglia, Earlham Road, Norwich, Norfolk, NR4 7TJ, UK.
3
School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
4
Aston Health Research Innovation Cluster, Aston University, Birmingham, B4 7ET, UK.
5
Norwich Medical School, University of East Anglia, Earlham Road, Norwich, Norfolk, NR4 7TJ, UK.
6
Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill St, London, NW3 2PF, UK.
7
Birmingham and Solihull Mental Health NHS Foundation Trust, Research and Innovation Department, The Barberry, 25 Vincent Drive, Birmingham, B15 2FG, UK.
8
Faculty of Health Sciences, University of Hull, Hull, HU6 7RX, UK.
9
Birmingham and Solihull Mental Health NHS Foundation Trust, Unit 1, B1, 50 Summer Hill Road, Birmingham, B1 3RB, UK.
10
Department of Clinical Healthcare, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane Campus, Headington, Oxford, OX3 0FL, UK.
11
Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.

Abstract

BACKGROUND:

People living with dementia in care homes frequently exhibit "behaviour that challenges". Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs.

METHODS:

People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated.

RESULTS:

Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected).

CONCLUSIONS:

It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures.

TRIAL REGISTRATION:

ISRCTN58330068. Retrospectively registered, 15 October 2017.

KEYWORDS:

Behaviour that challenges; Dementia; Feasibility study; Psychotropics

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