supporting people living
with dementia and those
who care for them

Key Focus Areas

The system has been designed with four key deliverables in mind.
Person Centred

Preparing for Support is an initial assessment to establish citizen-focused conversations. The system allows for a complete feedback cycle with People Living with Dementia (PLWD) and carers in regular remote monitoring of their health, not only empowering citizens but also aiding long-term wellness.

Efficient Workflows

By streamlining case-load management and providing tools for simple and effective recording of case notes, we create consistency across the network, improve communication and reduce the time spent on admin tasks.

Better Outcomes

Visualizations of the Five Pillar model ensures that PLWD are receiving the best, most holistic care during their PDS journey and helps Link Workers tailor their approach to individual clients.

Richer Research

Contextual input of data from PLWD, carers and medical professionals allows for a more accurate portrayal of the citizen journey through unwellness. Citizens can be assigned to newly added Research Registers, Clinical Trials and Research Trials via the Admin Area.

What is Post Diagnostic Support?

Every person with a new diagnosis of dementia in Scotland is entitled to a minimum of one year of PDS from a named person who will work alongside the person living with dementia and those close to them. PDS is made up of five key aspects which help the person to:

  • ● Understand the illness and manage symptoms
  • ● Be supported to keep up community connections and make new ones
  • ● Have the chance to meet other people with dementia and their partners and families
  • ● Plan for future decision-making
  • ● Plan for future support

Features

The PDS Digital Platform enriches the citizen experience, making health journeys smooth for people living with Dementia and their carers.

Multi-site setup

The system can allow multiple service setups with each one locally administered and managed independently with their own data store protected and users with permissioned role-based access.

Virtual Engagements

Clients can be contacted remotely through video calls, reducing need for disruption to routine and freeing up time. More clients can be contacted and the most urgent of cases can be dealt with immediately.

Data Visualisation

Citizens and service providers are equipped with visual representations of a citizens’ journey of care (e.g. future care wishes), enabling population health views if collating data from services together.

What Matters To Me

Through WMTM, the client voice is heard and what is on their mind is captured which helps create person-focussed conversations by identifying and evidencing issues and concerns of people living with dementia.

Client Assessments

Approved care assessments can be routinely used to store, visualise and longitudinally assess wellness and create standardised service benchmarks as the basis for a Quality Improvement Framework (QIF).

Service Intelligence

Live data views of services on the system. Intelligence can be used to improve individual services, or as a Population Health guide to understand (un)wellness epidemiology in the local area of service provision.


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Benefits

Transformed user experience with integrated data-driven workflows
Enhances Person-focused Conversations

The National Dementia Strategy (2017-2020) emphasises the integral need of a person-centred and flexible approach to providing support at each stage of the care journey. This strategy sets out 21 commitments around work on diagnosis, including post-diagnostic support; care co-ordination; end of life and palliative care; workforce development and capability; data and information; and research.

Improving Post-diagnostic Support (PDS) is one of the commitments and the strategy proposes that all people newly diagnosed with dementia will receive appropriate support following diagnosis, with that support being either (a) the 5 Pillars Model of post-diagnostic support, or (b) care coordination, based on the 8 Pillars Model of Integrated Community Support.

The 5 Pillars Model provides a framework for people living with dementia, their families and carers with the tools, connections, resources and plans to allow them to live as well as possible with dementia and prepare for the future.

  • INCREASE CLIENT ENGAGEMENT
  • REDUCE SERVICE COST
  • IMPROVE WORKFLOW EFFICIENCY
  • CREATE RESEARCH VALUE

120

PLWD Supported

80

Link Workers

50

Carers Championed

6

Regions Covered

Testimonials

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