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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

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

Authors

Ian D. Maidment

Garry Barton

Niyah Campbell

Rachel Shaw

Nichola Seare

Chris Fox

Steve Iliffe

Emma Randle

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

Graeme Brown

Nigel Barnes

Jane Wilcock

Sarah Gillespie

Sarah Damery



Abstract

© 2020 The Author(s). 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.

Citation

Maidment, I. D., Barton, G., Campbell, N., Shaw, R., Seare, N., Fox, C., …Damery, S. (2020). 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. BMC health services research, 20(1), Article 157. https://doi.org/10.1186/s12913-020-5014-0

Journal Article Type Article
Acceptance Date Feb 20, 2020
Online Publication Date Mar 2, 2020
Publication Date Mar 2, 2020
Deposit Date Mar 3, 2020
Publicly Available Date Mar 28, 2024
Journal BMC Health Services Research
Print ISSN 1472-6963
Electronic ISSN 1472-6963
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Issue 1
Article Number 157
DOI https://doi.org/10.1186/s12913-020-5014-0
Keywords Dementia, Feasibility study, Behaviour that challenges, Psychotropics
Public URL https://hull-repository.worktribe.com/output/3455401

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