Improving the management of behaviour that challenges associated with dementia in care homes: protocol for pharmacy-health psychology intervention feasibility study

Ian D. Maidment, Rachel L. Shaw, Kirsty Killick, Sarah Damery, Andrea Hilton, Jane Wilcock, Nigel Barnes, Graeme Brown, Sarah Gillespie, Chris Fox, Garry Barton, Steve Iliffe, Nichola Seare

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia.

METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study.

ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

LanguageEnglish
Article numbere010279
Number of pages7
JournalBMJ Open
Volume6
Issue number3
DOIs
Publication statusPublished - 23 Mar 2016

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Behavioral Medicine
Feasibility Studies
Home Care Services
Dementia
Pharmacists
Antipsychotic Agents
Nursing Homes
Sample Size
General Practitioners
Cognition
Caregivers
Prescriptions
Economics
Quality of Life
Outcome Assessment (Health Care)
Interviews
Equipment and Supplies
Health
Research

Bibliographical note

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

Cite this

Maidment, Ian D. ; Shaw, Rachel L. ; Killick, Kirsty ; Damery, Sarah ; Hilton, Andrea ; Wilcock, Jane ; Barnes, Nigel ; Brown, Graeme ; Gillespie, Sarah ; Fox, Chris ; Barton, Garry ; Iliffe, Steve ; Seare, Nichola. / Improving the management of behaviour that challenges associated with dementia in care homes : protocol for pharmacy-health psychology intervention feasibility study. In: BMJ Open. 2016 ; Vol. 6, No. 3.
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Maidment, ID, Shaw, RL, Killick, K, Damery, S, Hilton, A, Wilcock, J, Barnes, N, Brown, G, Gillespie, S, Fox, C, Barton, G, Iliffe, S & Seare, N 2016, 'Improving the management of behaviour that challenges associated with dementia in care homes: protocol for pharmacy-health psychology intervention feasibility study' BMJ Open, vol. 6, no. 3, e010279. https://doi.org/10.1136/bmjopen-2015-010279

Improving the management of behaviour that challenges associated with dementia in care homes : protocol for pharmacy-health psychology intervention feasibility study. / Maidment, Ian D.; Shaw, Rachel L.; Killick, Kirsty; Damery, Sarah; Hilton, Andrea; Wilcock, Jane; Barnes, Nigel; Brown, Graeme; Gillespie, Sarah; Fox, Chris; Barton, Garry; Iliffe, Steve; Seare, Nichola.

In: BMJ Open, Vol. 6, No. 3, e010279, 23.03.2016.

Research output: Contribution to journalArticle

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AU - Fox, Chris

AU - Barton, Garry

AU - Iliffe, Steve

AU - Seare, Nichola

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N2 - INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia.METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study.ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

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