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

Shaw, Rachel L; Maidment, Ian D; 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

Authors

Rachel L Shaw

Ian D Maidment

Ian D. Maidment

Rachel L. Shaw

Kirsty Killick

Sarah Damery

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

Jane Wilcock

Nigel Barnes

Graeme Brown

Sarah Gillespie

Chris Fox

Garry Barton

Steve Iliffe

Nichola Seare

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.

Publication Date 2016-03
Journal BMJ open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 3
Article Number ARTN e010279
Pages e010279
Institution Citation Maidment, I. D., Shaw, R. L., Killick, K., Damery, S., Hilton, A., Wilcock, J., …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, 6(3), e010279. https://doi.org/10.1136/bmjopen-2015-010279
DOI https://doi.org/10.1136/bmjopen-2015-010279
Keywords Dementia, Care homes, Psychotropics, Pharmacists
Publisher URL http://bmjopen.bmj.com/content/6/3/e010279
Copyright Statement 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/
Additional Information Copy of article first published in: BMJ open, 2016, v.6, issue 3, e010279.

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Copyright Statement
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/




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