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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
Senior Lecturer 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.

Journal Article Type Article
Publication Date Mar 2, 2020
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
APA6 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), https://doi.org/10.1186/s12913-020-5014-0
DOI https://doi.org/10.1186/s12913-020-5014-0
Keywords Dementia, Feasibility study, Behaviour that challenges, Psychotropics

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Copyright Statement
© The Author(s). 2020

The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.



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