may feel that deprescribing is ‘giving up’, or a signal that they are no longer worth treating; • The cost implications of deprescribing may include reduced medication costs, reduced costs of treating adverse drug effects, and an uncertain benefit or cost if there is a change in function that increases or decreases health service utilisation. These findings were also published in the Medical Journal of Australia (Reeve et al. Med J Aust. 210(4): 174-179). Funding: NHMRC and ARC (administered by University of Sydney).
Evaluating the effectiveness and cost-effectiveness of DCM to enable person centred care training: A cluster randomised trial CHeBA staff: Lynn Chenoweth. Other investigators: Professor Claire Surr (Leeds Beckett University, UK), Professor Clive Ballard (King’s College London, UK), Professor Murna Downs (University of Bradford, UK), Dr Anne Corbett (King’s College London,UK), Sue Fortescue (Alzheimer’s Society Research Network), Kirsty Nash (Oxford Health NHS Foundation Trust), Professor Louise Robinson (University of Newcastle, UK), Professor Graham Stokes (Bupa Care Services, Leeds, UK), Professor Amanda Farrin (University of Leeds, UK), Alison Ferguson (University of Leeds, UK), Dr Jane Fossey (University of Oxford, UK), Lucy Garrod (Oxford Health NHS Foundation Trust), Ms Liz Graham (University of Leeds, UK), Dr Alys Griffiths (University of Bradford, UK), Madeline Harms (University of Leeds, UK), Ivana Holloway (University of Leeds, UK), Steph Jones (University of Bradford, UK), Amanda Lilley-Kelly (University of Leeds, UK), Dr Najma Siddiqi (University of Leeds, UK), Dr Daphne Wallace (University of Bradford, UK). Aims: • Evaluate the clinical and cost-effectiveness of Dementia Care Mapping (DCM) in supporting the implementation of person-centred care training (PCCT); • Evaluate its effectiveness as a process for improving care quality and quality outcomes for people with dementia, compared with usual dementia care; • DCM-EPIC was conducted as a pragmatic, cluster randomised controlled trial with costeffectiveness analysis. Follow-up at 6- and 16-months. Stratified randomisation of 50 care homes to intervention (n=31) or control (n=19). Care home eligibility included recruitment of ≥10 residents; not subject to improvement notices; not used DCM. At baseline and 16-months, 726 and 261 residents were recruited, respectively. Resident eligibility included: 84
permanent residence; diagnosis of dementia/ probable dementia; not at end-of-life. Clusters were not blinded to allocation. Three DCM cycles delivered by two trained care home staff were scheduled; cycle one supported by a DCM expert. Agitation (CohenMansfield Agitation Inventory (CMAI)) at 16-months was the primary outcome. Findings: • DCM was not superior to control on any outcomes (n=675 residents: 287 control, 388 intervention). The adjusted mean CMAI score difference intervention versus control was -2.11 points) (95% CI -4.66 to 0.44, p = 0.104, adjusted ICC control=0, intervention 0.001). Sensitivity analyses supported the primary analysis. Intervention adherence was problematic. Incremental cost per unit improvement in CMAI and QALYs (intervention versus control) for baseline recruited residents (n=726, 418 intervention, 308 control) was £289 and £60,627 respectively. The main trial results and substudy results were presented at 2018 international conferences, including the AAIC. Funding: National Institute for Health Research, UK (administered by Leeds Beckett University; contract between CHeBA, UNSW and Leeds Beckett University, UK. for L. Chenoweth’s contribution). Publications: • Surr CA, Holloway I, Walwyn RE, Griffiths AW, Meads D, Kelley R, Martin A, McLellan V, Ballard C, Fossey J, Burnley N, Chenoweth L, Creese B, Downs M, Garrod L, Graham EH, Lilley-Kelley A, McDermid J, Millard H, Perfect D, Robinson L, Robinson O, Shoesmith E, Siddiqi N, Stokes G, Wallace D, Farrin AJ. Dementia Care Mapping (DCM™) to reduce agitation in care home residents with dementia: The DCM™ EPIC cluster RCT. Monograph. National Institute for Health Research - Health Technology Assessment (NIHR-HTA) Repository. 2019: UK; • Griffiths AW, Surr CA, Creese B, Garrod L, Chenoweth L. The development and use of the Assessment of Dementia Awareness and Personcentred Care Training (ADAPT) tool in long-term care. Dementia (London). 2019 Oct-Nov; 18(78):3059-3070. DOI: 10.1177/1471301218768165. PMID: 29631493; • Surr C, Griffiths A, Kelley R, Holloway I, Walwyn R, Martin A, McDermid J, Chenoweth L, Farrin AJ. The implementation of Dementia Care MappingTM in a randomised controlled trial in long-term care: results of a process evaluation. Am J Alzheimers Dis Other Demen. 2019 Sep; 34(6):390-398. DOI: 10.1177/1533317519845725. PMID: 31056923 / PMCID: PMC6676338; • Surr C, Woodward-Carlton B, Griffiths AW, the DCM-EPIC team. Does DCM Improve Care in Care Homes? The EPIC trial. Journal of Dementia Care. 2019; 27(5): 24-27.
