Predictors of nonpharmacological and pharmacological treatments stopped and started among nursing home residents with dementia

Feasibility Testing of a Protocol to Stop Ineffective Drug and Nondrug Treatments

Ineffective treatments continue to be given to nursing home residents with dementia, and many more treatments are started than stopped. The Track and Trigger Treatment (T(3)) Protocol assists nurses to track responses to new treatments and get ineffective treatments stopped or altered. This preliminary study determined feasibility for end users and examined differences between two randomized groups in assessments, treatment changes, nurse time, and drug costs over 8 weeks. Controlling for number of medical diagnoses, 41 residents in the T(3) group had significantly more treatments stopped than 37 residents in the usual care group. Treatments were most commonly stopped because of ineffectiveness (33%), followed by the problem being resolved (29%), side effects (18%), and a change in goals of care (20%). Assessment quality was a statistically significant mediator, and drug costs were significantly less for the T(3) group. The T(3) processes were rated as useful and easy, with one caveat.

Using branching simulations in treatment fidelity plans

The purpose of this article is to present a new approach to treatment fidelity using branching simulations. Branching simulations are case scenarios that require the user to generate a series of step-by-step decisions and actions. The user is given immediate feedback on the consequences of his or her decisions and actions. Branching simulations may be a particularly useful fidelity strategy for interventions that require clinical decision making represented in terms of a flow of critical thinking and action steps. Results of fidelity testing in the current study using branching simulations revealed that 15 (22%) of 67 interventionists scored below the study's a priori 80% criterion for full retraining and retesting. Thirty (45%) interventionists needed partial retraining in using specific components of the intervention. Potential threats to internal validity posed by inadequate or erroneous adherence to multicomponent intervention protocols can be decreased through treatment fidelity using branching simulations.