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Medication review plus person-centred care: a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia

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

Authors

Ian D. Maidment

Sarah Damery

Niyah Campbell

Nichola Seare

Chris Fox

Steve Iliffe

Dr Andrea Hilton A.Hilton@hull.ac.uk
Senior Lecturer and Programme director, Non-Medical Prescribing

Graeme Brown

Nigel Barnes

Jane Wilcock

Emma Randle

Sarah Gillespie

Garry Barton

Rachel Shaw

Abstract

Background
“Behaviour that Challenges” is common in people living with dementia, resident in care homes and historically has been treated with anti-psychotics. However, such usage is associated with 1800 potentially avoidable deaths annually in the UK. This study investigated the feasibility of a full clinical trial of a specialist dementia care pharmacist medication review combined with a health psychology intervention for care staff to limit the use of psychotropics.

This paper focuses on feasibility; including recruitment and retention, implementation of medication change recommendations and the experiences and expectations of care staff.

Methods
West Midlands care homes and individuals meeting the inclusion criteria (dementia diagnosis; medication for behaviour that challenges), or their personal consultee, were approached for consent.

A specialist pharmacist reviewed medication. Care home staff received an educational behaviour change intervention in a three-hour session promoting person-centred care. Primary healthcare staff received a modified version of the training.

The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home version at 3 months. Other outcomes included quality of life, cognition, health economics and prescribed medication. A qualitative evaluation explored expectations and experiences of care staff.

Results
Five care homes and 34 of 108 eligible residents (31.5%) were recruited, against an original target of 45 residents across 6 care homes. Medication reviews were conducted for 29 study participants (85.3%) and the pharmacist recommended stopping or reviewing medication in 21 cases (72.4%). Of the recommendations made, 57.1% (12 of 21) were implemented, and implementation (discontinuation) took a mean of 98.4 days. In total, 164 care staff received training and 21 were interviewed.

Care staff reported a positive experience of the intervention and post intervention adopting a more holistic patient-centred approach.

Conclusions
The intervention contained two elements; staff training and medication review. It was feasible to implement the staff training, and the training appeared to increase the ability and confidence of care staff to manage behaviour that challenges without the need for medication. The medication review would require significant modification for full trial partly related to the relatively limited uptake of the recommendations made, and delay in implementation.

Journal Article Type Article
Publication Date Oct 19, 2018
Journal BMC Psychiatry
Print ISSN 1471-244X
Electronic ISSN 1471-244X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 18
Issue 1
Article Number 340
Institution Citation Maidment, I. D., Damery, S., Campbell, N., Seare, N., Fox, C., Iliffe, S., …Shaw, R. (2018). Medication review plus person-centred care: a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia. BMC Psychiatry, 18(1), https://doi.org/10.1186/s12888-018-1907-4
DOI https://doi.org/10.1186/s12888-018-1907-4
Keywords Psychiatry and Mental health
Publisher URL https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1907-4