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

Ian D Maidment, Garry Barton, Niyah Campbell, Rachel Shaw, Nichola Seare, Chris Fox, Steve Iliffe, Emma Randle, Andrea Hilton, Graeme Brown, Nigel Barnes, Jane Wilcock, Sarah Gillespie, Sarah Damery

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number157
JournalBMC Health Services Research
Volume20
Issue number1
DOIs
Publication statusPublished - 2 Mar 2020

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© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
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Funding: This paper presents independent research funded by the National
Institute for Health Research (NIHR) under its Research for Patient Benefit
(RfPB) Programme (Grant Reference Number PB-PG-0613-31071). T

Keywords

  • Behaviour that challenges
  • Dementia
  • Feasibility study
  • Psychotropics

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