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

Research output: Contribution to journalArticle


  • Ian Maidment
  • Garry Barton
  • Niyah Campbell
  • Rachel Shaw
  • Nichola Seare
  • Chris Fox
  • Steve Iliffe
  • Emma Randle
  • Andrea Hilton
  • Graeme Brown
  • Nigel Barnes
  • Jane Wilcock
  • Sarah Gillespie

Colleges, School and Institutes

External organisations

  • Aston University
  • Norwich Clinical Trials Unit, Norwich
  • School of Life and Health Sciences, Aston University
  • University of East Anglia
  • University College London
  • National Centre for Mental Health
  • University of Hull
  • Birmingham and Solihull Mental Health Foundation NHS Trust, UK
  • Birmingham and Solihull Mental Health Foundation Trust
  • Research Department of Primary Care and Population Health, UCL, London.
  • Oxford Brookes Univ


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 on the management of 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-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use 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 NPINH 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-5 L and DEMQoL (≥88% at each of the time points where data was collected).
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. Retrospectively registered, 15 October 2017.


Original languageEnglish
Number of pages9
JournalBMC Health Services Research
Issue number157
Publication statusPublished - 2 Mar 2020


  • Dementia, Feasibility study, Behaviour that challenges, Psychotropics