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
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.
Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.
BMJ Open. 2016 Mar 23;6(3):e010279. doi: 10.1136/bmjopen-2015-010279.
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.
在患有痴呆症且有行为障碍的人群中，抗精神病药物的不当使用估计每年导致1800人死亡。然而，仅关注抗精神病药物可能会导致处方转向其他同样危险的精神药物。关于药剂师在用于治疗行为障碍的精神药物管理中的作用，人们知之甚少。本研究旨在确定实施并衡量一种联合药房 - 健康心理学干预措施的有效性是否可行，该干预措施包括药物审查和员工培训包，以限制用于管理痴呆症护理院居民行为障碍的精神药物处方。
方法/分析：将招募西米德兰兹郡的6家护理院。对于正在接受治疗行为障碍药物的痴呆症患者或其个人顾问，将邀请他们参与。药剂师将与全科医生（GP）、痴呆症患者及其护理人员合作，审查用于治疗行为障碍的药物。行为干预包括为护理院工作人员和全科医生提供的培训包，促进以患者为中心的护理，并将行为障碍视为未满足需求的一种表现来进行治疗。主要结局指标是神经精神科问卷 - 护理院版（NPI - NH）。其他结局包括生活质量（EQ - 5D和DEMQoL）、认知（简易精神状态检查表[sMMSE]）、健康经济学（CSRI）以及所开药物，包括建议是否得到实施。结局数据将在6周、3个月和6个月时收集。培训前和培训后的访谈将探讨利益相关者对干预措施的期望和体验。数据将用于估计确定性研究的样本量。
伦理/传播：该项目已获得东米德兰兹研究伦理委员会（15/EM/3014）的批准。如果潜在参与者缺乏行为能力，将根据《精神能力法》咨询其个人顾问关于参与的事宜。研究结果将发表在同行评审期刊上，并在会议上展示。
