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Table 2 Description of dual-focused medication review-behavioural change intervention

From: Medication review plus person-centred care: a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia

Behaviour Change Intervention Overview
“Inside Out” – An interactive face-to-face three-hour educational person-centred care group based workshop, repeated twice at each home, for care staff facilitated by a researcher with health psychology training and experience of working in the social care sector. The main aim of the intervention was to provide staff with the knowledge to:
• Understand that behaviours that challenge may be an expression of unmet need
Within this the intervention aimed to provide care home staff with the skills and resources to:
• Investigate what the unmet need might be
• Get to know the person with dementia as an individual to help manage their behaviour
• Think creatively about how to prevent challenging behaviours by making sure individuals’ needs are met
• Understand that behaviours that challenge are not ‘bad behaviour’ and ‘bad behaviour’ does not equate to ‘a bad person’
Training consisted of:
 1. Educational elements about “behaviour that challenges”, the use of antipsychotics to manage behaviour that challenges, good practice guidelines to reduce psychotropics in favour of non-pharmacological interventions.
 2. Person-centred care training using the VIPS Model (V=Valuing personhood; I=Individual needs; P=Personal perspectives; S=Social environment), videos illustrating person-centred care practice and practical exercises [39].
 3. Information and discussion points emphasising the importance of self-care and good communication among care staff
Primary healthcare staff received modified training primarily focussing on the treatment of BPSD.
Summary of Medication Review (based on type 3 full clinical review)
 Medication reviews were conducted by two experienced clinical pharmacists (one who is a specialist dementia care pharmacist and has significant experience in the clinical area) and one, who acted as back-up and also has specialist experience in this area.
 1. The primary focus is to review psychotropics used to treat behaviours that challenge; the pharmacist will also review all other medication as per routine care.
 2. Establish therapeutic alliance with the person living with dementia and/or their personal consultee.
 3. Collect information from clinical records, care staff, GP and any personal consultee about the patient including prescribed treatment of BPSD, medication used to treat psychotropic induced adverse events and any other medication.
 4. Review medication, focussing on treatments for BPSD.
 5. The GP was informed of the recommendations in writing; an individualised clinical letter from the pharmacist based on a standard proforma. The letter detailed the recommendations and the rationale for the recommendations. This was followed up with a phone call.