The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery
The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery
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DOI：
10.1136/bmjgh-2018-000962
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发表时间：
2018-10-01
影响因子：
8.1
通讯作者：
Fairall, Lara
中科院分区：
文献类型：
--
作者：
Cornick, Ruth;Picken, Sandy;Fairall, Lara
对于低/中等收入国家 (LMIC) 环境中的初级卫生工作者来说，提供优质初级保健具有挑战性。由于临床指南过时、不一致，并且以高收入国家的证据为依据，忽视了中低收入国家的资源限制和疾病负担，这往往使情况变得复杂。开普敦大学肺脏研究所的知识翻译部门 (KTU) 在南非制定、实施和评估了卫生系统干预措施，并将其本地化到博茨瓦纳、尼日利亚、埃塞俄比亚和巴西，简化和标准化初级卫生工作者提供的护理，同时加强他们工作的系统。这项干预措施的核心称为实用护理方法套件 (PACK)，它是一种临床决策支持工具，即 PACK 指南。本文描述了该指南在 18 年期间的发展历程，并解释了其设计特点，这些特点满足了患者、临床医生和卫生系统对临床指导的需求，并用南非初级保健护士的话来说，使其成为“每位患者每天的工具”。它描述了 KTU 在开发过程中吸取的经验教训，现在将其应用于指南的进一步开发、维护和国内本地化：首先根据具体情况开发临床决策支持，让当地利益相关者参与所有阶段，利用其他人的证据数据库保持最新状态，并确保内容开发、更新和本地化与实施相结合。
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, 'A tool for every day for every patient'. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others' evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.