Improving the Management of Behaviour that Challenges associated with dementia in Care Homes: protocol for pharmacy-health psychology intervention feasibility study (MEDREV)
The National Dementia Strategy introduced a target of reducing the prescribing of anti-psychotics. Aston University, in conjunction with a number of other organisations, is running a research project entitled MEDREV. The study is funded by the NIHR RfPB (Research for Patient Benefit) Programme. The grant is focused on the priority area of the appropriate treatment of behaviour in dementia that challenges.
MEDREV aims to test the feasibility of staff training (for care home staff and GPs) and medication review (by specialist pharmacist) to limit the inappropriate prescribing of psychotropics for BPSD (Behavioural and Psychological Symptoms of Dementia) in people with dementia in care homes.
Staff training: The study aims to assess the feasibility of trialing an intervention involving a medication review and a behavioural intervention. 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. By training care home staff and providing them with other “tools” to help them manage BPSD we aim to reduce their reliance on medication. The input from secondary care specialists is designed to support primary care with managing this complex area.
Medication review: The review involves a specialist dementia care clinical pharmacist, in collaboration with the GP, person with dementia and carer, conducting a full clinical review of medication used to treat behaviour that challenges. The medication review includes all psychotropics for BPSD (there is increasing evidence that focussing on anti-psychotics has simply driven prescribing to other potentially inappropriate medicines). The medication review is collaborative and responsibility for implementation will continue to rest with the GP; the GP is under no obligation to implement the review.
This grant will use quantitative and qualitative methods to establish whether it is feasible to implement and measure the effectiveness of the intervention in a future clinical trial.
Ethics and governance:
The study has received a favourable ethical opinion (reference number: 15/EM/0314) from the National Research Ethics Service (East Midlands - Nottingham 1 Committee). It has the full support of the local Primary Care Research Network, the CCGs in greater Birmingham and is closely aligned to the Birmingham Dementia Strategy.
This research is conducted by an inter-disciplinary team of academics and clinicians, including GPs, Health Psychologists, Pharmacists and Psychiatrists.
The chief investigator and grant leader is Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy, at Aston University. Dr Rachel Shaw leads the development of the behavioural change intervention and Dr Nichola Seare provides project management and supports ethics and governance.
Learn more about the team and other collaborators below.