FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes.
FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes.
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DOI：
10.1080/13607863.2015.1063102
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发表时间：
2016-07
影响因子：
3.4
通讯作者：
Pickett J
中科院分区：
文献类型：
--
作者：
Brooker DJ;Latham I;Evans SC;Jacobson N;Perry W;Bray J;Ballard C;Fossey J;Pickett J
目的：本文报告了“重点干预培训和支持”实践计划的可接受性和有效性。这种干预是从早期的集群随机对照试验中扩展出来的，该试验已被证明成功地显著减少了养老院的抗精神病药物处方。方法：在为期3个月的时间里，进行为期10天的以人为本的深度教育课程，随后进行6次监督。参与者是被指定为痴呆症护理教练（DCCs）的养老院工作人员，负责在1或2个养老院实施干预措施。该课程和监督由称为痴呆症实践发展教练（dpdc）的教育工作者提供。有效性数据包括监测抗精神病药物处方、目标达成情况、知识、态度和实施问卷。定性数据包括案例研究和说明执行问题的反思期刊。结果：在招募的100名dcc中，66名dcc完成了该计划。事后的问卷调查显示，人们对痴呆症的认识和信心有所提高，对痴呆症的态度也有所改善。20%的居民在基线时服用抗精神病药物，这一数字减少到14%（减少31%），据报道，在改善个性化目标实现的同时，还减少了额外的剂量。fit实施成功的关键是分配和保护发展协调委员会参加培训和监督以及在其现有工作作用之外执行执行任务的时间。评价数据显示，这是在少数家庭实施的一个重大障碍。讨论和结论：FITS进入实践方案得到了很好的评价，减少了不适当的抗精神病药物处方。建议对干预措施进行修订，以最大限度地成功实施。
Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.