Protocol for REducing Anti-Psychotic use in residential care-Huntington Disease (REAP-HD): a pilot cluster randomised controlled trial of a multifaceted intervention for health professionals.
Bottom Line: Primary outcome is the proportion of people with HD who have had a reduction in antipsychotic use 4 months after the intervention.Secondary outcome measures are (1) change in severity of behavioural symptoms, as measured by the NPI-Q at 4 months (to ensure antipsychotic reduction has not lead to worsening behavioural symptoms), and (2) proportion of people with HD who have had a reduction in antipsychotic dosage at 4 months for each strategy, compared to 4 months prior to enrolment (to capture the possibility that both arms reduced antipsychotic use).Recruitment is ongoing, as of July 2014.
Affiliation: Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia The University of Sydney, Sydney, New South Wales, Australia.Show MeSH
Related in: MedlinePlus
Mentions: REAP-HD is a multifaceted intervention designed after barrier analysis with a number of nurses experienced in behavioural management in HD, using the theoretical domain framework.19 A key feature of the programme is a clinical pathway for management of behavioural symptoms (figure 1). This clinical pathway targets skills and professional role by operationalising a strategy in delaying antipsychotic use whenever possible. It is hoped that by simplifying current behavioural management guidelines it will empower nursing staff to pursue non-pharmacological intervention and delay calling the GP for a drug order. It also incorporates a reminder to review and reduce antipsychotic dosage, as an aid to focus attention in the decision process (figure 2). In the REAP-HD programme, the intervention team will visit the RCF and deliver a 45-minute Powerpoint presentation. This focuses on antipsychotic use and the clinical pathway, rather than being just a general introduction to HD. The Director of Nursing, Deputy Director of Nursing, Nurse Educator, Nursing Unit Manager, as well as the ward nursing staff (RN, Endorsed Enrolled Nurses and Assistants in Nursing) will all be invited. The RCF will be given copies of the clinical pathway to incorporate into the resident's notes/careplan. Banner pens (figure 3) with the REAP-HD logo and an abridged clinical pathway will be given to the RCF as reminders for the trial. Our intervention team will carry out a telephone reminder/follow-up call to the responsible RN 1 month after the intervention. At that juncture the RN will be asked about usage of the clinical pathway and any practical barriers to antipsychotic reduction. The GP will be sent a letter and the clinical pathway from the HD Service, explaining how the clinical pathway could be used for behavioural management. It can be argued that a face-to-face meeting with the GP would have been more effective. However, in terms of routine application of REAP-HD in the future outside of a trial setting, a letter is the only realistic option.
Affiliation: Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia The University of Sydney, Sydney, New South Wales, Australia.