months of the study and beyond. The time spent by trained staff on DCM-related
activities was estimated.
The PCC training manual [11] was employed to provide PCC education for PCC site
staff by one author (JS-P). This consisted of a two-day training session for two staff
from each of the five PCC sites. In addition, PCC resource materials and two
supervision field visits were provided at each site (over a two week period). Ongoing
support by telephone and email was supplied and documented by JS-P. Once on-site
training and supervision were completed, the trained staff in each site took on
responsibility for the continued implementation of PCC.
Resident-level pharmaceutical use was collected at baseline, immediately following
the intervention (at three months) and four months following the end of the
intervention. Information was collected about the use of antidepressant, anti-
psychotic, anxiolytic and other psychotropic medications as these are commonly
prescribed to reduce the incidence and severity of BPSDs. The data collection detailed
the product used, dosage and regularity of use. Pharmaceutical Benefit Schedule
(PBS) codes were assigned to each instance of usage and multiplied by the regularity
to provide a cost per patient per day. Since brand names were not recorded, it was
assumed that all usage was of generic products when available. This assumption is
unlikely to affect the relative results of the three intervention arms as there is no
reason to believe that prescribing behaviour in this particular dimension is affected by
training. Differences in the average expenditure per resident both over time and
between intervention arms were estimated.
The primary study outcome, agitation (and related behavioural and psychological
symptoms of dementia), was assessed using the Cohen-Mansfield Agitation Inventory
(CMAI) (Cohen-Mansfield & Werner 1998) which has been used widely in dementia
care. [12, 13] The CMAI is a 29-item tool, which assesses the level of agitation and
related BPSDs, such as anxiety and anger responses, over the preceding seven days.
Each item is scored between 1 (never) and 7 (several times per hour), making the
range of scores vary from 29 to 203.
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