title: Improving the management of behaviour that challenges associated with dementia in care homes: protocol for pharmacy-health psychology intervention feasibility study.
abstract: BACKGROUND
  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
  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.
  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.
authors.affiliation: Department of Clinical Pharmacy, School of Life and Health Sciences, Medicines and Devices in Ageing Cluster Lead, Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK.
authors.forename: Ian D
authors.identifier: http://orcid.org/0000-0003-4152-9704
authors.initials: ID
authors.lastname: Maidment
authors.affiliation: Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Shaw
authors.affiliation: School of Life and Health Sciences, Aston University, Birmingham, UK Social Dimensions of Health Institute, University of Dundee, Dundee, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Killick
authors.affiliation: Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham.
authors.forename: Sarah
authors.initials: S
authors.lastname: Damery
authors.affiliation: Faculty of Health and Social Care, University of Hull, Hull, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hilton
authors.affiliation: Research Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Wilcock
authors.affiliation: Pharmacy, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Barnes
authors.affiliation: Pharmacy, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Clinical Healthcare, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Gillespie
authors.affiliation: Department of Clinical Psychiatry, Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Fox
authors.affiliation: Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Garry
authors.initials: G
authors.lastname: Barton
authors.affiliation: Research Department of Primary Care & Population Health, University College London, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Aston Health Research and Innovation Cluster, Aston University, Birmingham, UK.
authors.forename: Nichola
authors.initials: N
authors.lastname: Seare
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods; D001524:Behavioral Medicine / Q000592:standards*; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000451:nursing* / Q000628:therapy; D019468:Disease Management; D005240:Feasibility Studies; D006282:Health Personnel / Q000193:education*; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D010594:Pharmacies / Q000592:standards*; D011788:Quality of Life; D012107:Research Design; D012648:Self Care; D006113:United Kingdom
chemical_list: D014150:Antipsychotic Agents
keywords: MENTAL HEALTH