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ToolsMaidment, 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 and Damery, Sarah (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. ISSN 1472-6963
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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 in psychosocial interventions for 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-/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resourceuse 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-5L and DEMQoL (≥88% at each of the time points where data was collected). The pharmacist made recommendations in 21 participants (72.4%); 63 15 of which involved antidepressants (71.4%). The intervention cost approximately £100 per review, with training costs of £270 per participant. The NPI-NH total score increased by 0.9 points over 3 months in the group whose medication changed, compared with an increase of 22.8 points in the group whose medication was not changed (p=0.03). 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
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