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

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