Achieving Quality and Effectiveness in Dementia Using Crisis Teams (AQUEDUCT): a randomised controlled trial evaluating the impact of a best practice Resource Kit used by teams managing crisis in dementia

Abstract

People with dementia frequently experience mental health crisis requiring psychiatric hospital admission. In the UK, Teams Managing Crisis in Dementia (TMCDs) vary in structure and practice due to the absence of a standardized model. A pragmatic, randomised controlled trial (RCT) was designed to evaluate the AQUEDUCT Best Practice Tool and online Resource Kit (RK). Twenty-three TMCDs across England were randomised 1:1 To receive the RK plus usual care (intervention) or usual care alone (control) ( www.isrctn.com/ISRCTN42855694 ). The primary outcome was the number of psychiatric hospital admissions for people with dementia at the primary endpoint of six months. Secondary outcomes included TMCD staff mental health (GHQ-12), psychological flexibility (WAAQ), and work engagement (UWES); and for people with dementia and carers, service satisfaction (CSQ-8) and mental wellbeing (GHQ-12). There was no significant difference in number of psychiatric admissions between groups (incident rate ratio: 0.74; 95% CI: 0.37-1.48; p = 0.397) and the primary endpoint was met. No significant differences were found for the secondary outcomes across staff or service user groups. Fidelity to the intervention varied; five TMCDs met or exceeded implementation criteria, while others reported structural barriers. Limited engagement was attributed to the absence of a learning collaborative and pandemic-related service pressures. Although the RK was valued by staff for guiding quality improvement, it did not significantly reduce hospital admissions or improve secondary outcomes. Future studies should prioritise implementation support and explore systemic barriers to service improvement in dementia crisis care.

Fig. 1. The AQUEDUCT trial consort flow diagram.

Fig. 1, the consort flow diagram illustrates the flow of participants through the multi-site, randomised controlled trial of the online AQUEDUCT Best Practice Tool and Online Resource Kit to support Teams Managing Crisis in Dementia (TMCDs). The Screening panels show the total number of crisis teams assessed for eligibility (n = 53), with exclusions noted due to service difficulties or lack of research capability (n = 30), resulting in enrolment of 23 TMCDs. The Allocation panels group shows the randomisation of eligible crisis teams into the intervention arm (n = 11) or control arm (n = 12), plus the recruitment of individual team members into the intervention (n = 116) and control arms (n = 122). The panels below also show the outcome measures completed, and the recruitment of service users (carers and people with dementia). The Follow up panel shows the withdrawal rate for TCMDs, and the completion rates for the team and service user measures at follow up at 26 weeks.