The Fife Dementia Strategy: 2010 – 2020 - The Knowledge Network

detailed guide to disseminating information and sharing skills with people with
dementia and their carers. Work currently being complete by Health Scotland
surrounding improving information provision in dementia care is due to be
complete in 2010 and should be used in the development of the learning
pathway for Fife.
Developing the patient and learning pathways in-line with both the generic
and dementia-specific Integrated Care Pathways will help to prevent
duplication of work, allow for integrated evaluation, and ensure learning is
taking place across all settings. Work on the Integrated Care Pathways is
ongoing, and currently in Fife there is a need to focus on the applicability of
the pathway for both health and social care providers in terms of how it will
function as a holistic tool. For Integrated Care Pathways to effectively function
ongoing work will be required in addition to current awareness raising
sessions.
4.2.2 People with dementia receive appropriate treatment and care for
their dementia and other health conditions from clinicians trained in
their prescription, delivery and review.
Advances in the understanding of the changes or disturbances resulting from
dementia have altered the management of patients with these disorders from
a conservative, symptomatic approach to a more biologically and medically
specific one. The mainstay of management is still based on the individual’s
symptoms but the future promises the development of disease-specific and
disease-modifying treatments which are currently only available in clinical
trials. Recent attention in population health studies have also highlighted the
importance of co-morbidity and frailty in the clinical picture resulting in a need
for holistic patient centred treatment.
In order to ensure people with dementia in Fife are offered the best in
treatment and care for their dementia and other health conditions a number of
treatment and review procedures will need to be established. These have
been broken down into those pertaining to dementia specifically, and those
related to other health conditions.
A. Dementia specific treatments
Symptomatic (cognition enhancing) - Cholinesterase inhibitors should be
openly available for all patients with a diagnosis of dementia and should be
prescribed according to recommendations published in the SIGN guidelines 19 ,
depending on the dementia subtype. Treatment with this type of medication
must be based on robust specialist assessment and diagnosis. Responsibility
for initial prescription should be taken by the specialist making the diagnosis
and thereafter be under joint review with primary care as advised in the Area
and Drugs Committee Shared Care Protocol for Cholinesterase Inhibitors
2008 20 .
19 SIGN (2006).
20 NHS Fife. Area and Drugs Committee Shared Care Protocol for Cholinesterase Inhibitors
2008. http://www.fifeadtc.scot.nhs.uk/interface/fife_scp/Cholinesterase%20Guidlines.pdf
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