目标:挑战行为(BtC)反映了痴呆症最昂贵和最繁重的方面,其中非药物干预而非抗精神病药物被推荐为一线方法十多年来(NICE2006)。本文概述了专业人士对痴呆症NICE指南97(2018)和英国心理学会的应用的看法,临床心理学部(BPS-DCP)关于抗精神病药物替代品的简报(2013年)。
方法:混合方法34项电子调查,关于使用NICE指南97(2018)和BPS-DCP简报(2013)管理BtC的五个项目,进行了。参与者是通过英国的多学科专业痴呆症网络招募的。对定量数据进行了描述性总结,并对开放式问题进行了主题分析。
结果:二百四十七名参与者完成了与指南相关的问题。NICE和BPS-DCP指南的“中等有用”的平均评级是跨职业和地理位置获得的,除了那些将NICE指南评为“稍微有用”的精神科医生。确定的定性主题是积极和谨慎观点的混合,与“证据基础”有关,“指南的可访问性”,\'实施问题\',和“缺乏细节和清晰度”。
结论:专业人士对BtC管理的指导持谨慎态度,但强调需要提高非药物方法使用的清晰度,以及如何在临床环境中实施这些方法的更多特异性。如果NICE痴呆症指南97(2018)的愿望为专业实践提供信息,则需要量身定制的“特定设置”工具包来更新和完善BPS-DCP(2013)。
■由于对使用精神药物治疗具有挑战性的行为(BtC)的副作用的主要担忧,有必要制定关于使用非药物替代品的国家指南。参与者认为NICE(2018)指南是可访问和明确的,但在使用非药物干预措施方面缺乏细节。这是BtC的一线治疗方法。关于“抗精神病药物的替代药物”的BPS指南(2013年)被认为在分配非药物资源方面具有良好的结构化建议,但缺乏满足个人需求的灵活性或可能适合临床服务的灵活性。研究结果表明,我们需要为BtC的非药理学循证干预措施的使用和交付提供从业人员和服务制定英国范围内的特定建议。
OBJECTIVE: Behaviours that challenge (BtC) reflect the most costly and burdensome aspects of dementia where non-pharmacological interventions rather than antipsychotic medication have been recommended as first-line approaches for over a decade (NICE 2006). This paper outlines professionals\' views about their application of the Dementia NICE
Guideline 97 (2018) and a British Psychological Society, Division of Clinical Psychology (BPS-DCP) Briefing paper (2013) on alternatives to antipsychotics.
METHODS: A mixed-methods 34-item e-survey, with five items about the use of the NICE
Guideline 97 (2018) and the BPS-DCP Briefing paper (2013) for the management of BtC, was conducted. Participants were recruited through multidisciplinary professional dementia networks across the United Kingdom. Quantitative data were descriptively summarized and thematic analysis of open-ended questions undertaken.
RESULTS: Two hundred and forty-seven participants completed the questions relating to
guidelines. Mean ratings of \'moderately useful\' for both the NICE and BPS-DCP guidance were obtained across professions and geographical locations, with the exception of psychiatrists who rated the NICE guidance as \'slightly useful\'. The qualitative themes identified were a mix of positive and cautionary perspectives, relating to \'evidence base\', the \'accessibility of the guides\', \'problems with implementation\', and \'lack of detail and clarity\'.
CONCLUSIONS: Professionals were cautiously positive regarding the guidance for BtC management, but highlighted a need for improved clarity about the use of non-pharmacological approaches, and more specificity about how these can be implemented in clinical settings. Tailored \'setting-specific\' toolkits are required to update and refine the BPS-DCP (2013) if the aspirations of the NICE Dementia
Guideline 97 (2018) are to inform professional practice.
UNASSIGNED: Owing to major concerns about the problematic side effects of using psychotropics in the treatment of behaviours that challenge (BtC), there is a need for national guidance on the use on non-drug alternatives. The NICE (2018) guidance was seen by participants as accessible and clear but lacking in detail in the use of non-pharmacological interventions, which are the first-line treatments for BtC. The BPS
Guidelines on \'Alternatives to antipsychotics\' (2013) were seen as having good structured advice for allocating non-pharmacological resources but were lacking in flexibility for meeting individual needs or what might be an acceptable fit for clinical services. The findings suggest that we need to develop UK-wide bespoke specific advice for practitioners and services for both the use and the delivery of non-pharmacological evidence-based interventions for BtC.