.

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.

The team:

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.

Bulletin:

Read our bulletin for Primary Care Practitoners 


Potential benefits for primary care and people with dementia that take part in the study:

  • Support from expert secondary care pharmacists with managing BPSD.
  • Enhance practice achievement on QOF and contributes to individual revalidation / appraisal portfolios.
  • Training on up to date evidence for managing BPSD including case discussions. 
  • Formal written evidence of active engagement in research for CQC purposes.

What is involved for practices:

  • Receive training.
  • Collaborate with the medication review process.
Maidement

Dr Ian Maidment

Dr Ian Maidment is an experienced researcher, manager and clinician. Prior to joining Aston in 2012 he worked as a practising pharmacist and he has experience of community, industry, acute hospital, learning disabilities, and particularly old age and adult psychiatry. Throughout his career he has had an interest in medication safety particularly in older people with dementia. He obtained his PhD by previous publication from Aston University in 2013. His research builds on his experience and uses a mixed methods approach to understand medication management issues in the real world and develop effective interventions. More information about Dr Maidment’s research



Hilton

Dr Andrea Hilton 

Andrea is an academic at the University of Hull and a practising community pharmacist, and has experience in complex interventions, medication reviews and data collection within Primary Care. Further information.



Barton

Dr Garry Barton

Dr Garry Barton is a Reader in Health Economics and a member of the Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia.

His main area of expertise is in the application and development of the methods of economic evaluation, where he has number of funded grants. Garry is also Deputy Director of the East of England Research Design Service (RDS) and Health Economics theme lead for the Collaborations for Leadership in Health Research and Care (CLAHRC) East of England.



Damery

Dr Sarah Damery

Sarah Damery is a research fellow in the Institute of Applied Health Research at the University of Birmingham, currently working on a range of projects related to Chronic Diseases and Integrated Care as part of the West Midlands CLAHRC (Collaborations for Leadership in Applied Health Research and Care). She is a mixed methods researcher, and her role in the MEDREV project will be to undertake statistical analysis of the data arising from the feasibility study.



Steve Iliffe

Steve Iliffe

Steve Iliffe is Emeritus Professor of Primary care for Older People at University College London. An academic GP by background, he has lead NIHR funded studies on dementia diagnosis, case management for people with dementia, continence management in dementia and end of life care. He brings experience of study design and of the difficulties of implementation in the dementia domain to this project.



Wilcock

Jane Wilcock

Jane Wilcock is advising on the ouctome measures for primary care on the study. She is based within the Primary Care for Older People research unit at University College London and has experience of trials of complex interventions. She has been involved in studies around improving the diagnosis and management of dementia for families and with experiences of end of life care. Recent work has included managing the NIHR programme EVIDEM and a current study developing heuristics for good end of life care for people with dementia and their families.



Shaw

Dr Rachel Shaw

Dr Rachel Shaw is a Senior Lecturer and HPC Registered Health Psychologist with expertise in qualitative research methodology.   

Her research focuses on examining health practitioners’ and patients’ experiences of health and illness to establish how systems might change to improve their quality of life.  Rachel has worked with Heart of Birmingham teaching Primary Care Trust and Birmingham Children’s Hospital on similar projects. 

Rachel is internationally renowned for her advanced training programme in qualitative research methodology.

Excellent Different Distinctive