The inappropriate use of anti-psychotics in people with dementia for behaviour that challenges is associated with an estimated 1,800 deaths annually. However, solely focusing on anti-psychotics 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.
Six 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 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. Pre- 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.
The project has received a favourable opinion from 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.
Strengths and Limitations:
This is the first study to assess the feasibility of an inter-disciplinary intervention involving a medication review and a behavioural intervention. The study uses a mixed methods approach and will also collect health economic data. The feasibility study is conducted in a single location; a future planned cluster RCT will be extended to cover other areas.