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Title: "Caught in a cleft stick?" : a grounded theory study of antipsychotic prescribing in dementia in community practice
Author: Almutairi, Saleh
ISNI:       0000 0004 5346 0959
Awarding Body: University of Reading
Current Institution: University of Reading
Date of Award: 2014
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Behavioural and psychological symptoms of dementia (BPSD) are common features of dementia, affecting up to 98% of patients with dementia. BPSD is a term expressing a heterogeneous group of non-cognitive symptoms that include psychosis, depression, agitation, and aggression. These symptoms are very distressing for all concerned and can also result in considerable social and economic costs. Antipsychotics are sometimes used to manage BPSD and their use has been linked to serious side-effects particularly stroke and an increased risk of death and this topic has been the subject of great controversy in recent times certainly since the publication of the government-commissioned Banerjee report into the use of antipsychotics for people with dementia was published in 2009 which revealed the problem of antipsychotic prescribing in dementia. This prompted the UK government to take a number of measures, such as introducing the National Dementia Strategy in 2009 and auditing of antipsychotics prescribed for patients with dementia. Yet despite warnings from agencies and the recommendations by the National Institute for Health and Care Excellence, inappropriate antipsychotic prescribing has not completely stopped. The reasons for this are multifactorial and health professionals' views about it are not extensively documented through research. In fact, dementia is still considered one of the biggest challenges facing society, the Dementia Challenge was launched in 2012 by the Prime Minister to deliver faster improvements in dementia care and research by 2015. I sought to explore, understand and explain the views of a range of healthcare professionals and personnel involved in the formal care of patients with dementia in relation to the prescribing of antipsychotic drugs in this patient group in formal settings. My aim was to generate a Grounded Theory about the complexities that exist in real practice that impede appropriate prescribing of antipsychotics for patients with dementia. I conducted twenty-eight qualitative semi-structured face-to-face interviews in 2012 and 2013 with health professionals from a variety of settings in one county in the UK. My research proposal was approved by the University of Reading Research Ethics Committee, and the participating NHS organisations. I developed a detailed theory, grounded in the data, outlining the complex nature of the problem which explains why anti psychotics might continue to be prescribed in dementia. I developed three thematic categories from the data and integrated these into one core category named 'Caught in a cleft stick? Difficult decisions in challenging circumstances' that accounts for instances where the prescribing of antipsychotics in dementia by GPs still takes place. BPSD is problematic, affecting patients and carers in different ways.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available