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Celuppi IC, Meirelles BHS, Costa VT, Pires DEPD. Practical Approach to Care Kit: inovação para a clínica do enfermeiro no manejo do HIV. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.5998.3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumo Objetivo: analisar a utilização do Practical Approach to Care Kit como uma tecnologia adotada na prática clínica dos enfermeiros no manejo do HIV na Atenção Primária à Saúde. Método: pesquisa exploratória e descritiva, ancorada no referencial metodológico da Teoria Fundamentada nos Dados Construtivista. A definição dos participantes foi realizada por amostragem inicial, com 12 enfermeiros, e amostragem teórica, com cinco gestores, totalizando 17 participantes. Os dados foram coletados por entrevistas intensivas e análise documental, e foram analisados em duas etapas: 1) codificação inicial; e 2) codificação focalizada. Resultados: os profissionais identificaram o Practical Approach to Care Kit como uma inovação tecnológica que contribuiu para a ampliação da prática clínica e empoderamento do enfermeiro no manejo clínico da infecção por HIV. Também destacaram sua importância como ferramenta para orientação das diferentes responsabilidades e atribuições no compartilhamento do cuidado, contribuindo para a prestação de práticas baseadas em evidências. Conclusão: o Practical Approach to Care Kit é uma inovação tecnológica que transformou a prática clínica do enfermeiro no manejo do HIV, ampliando seu escopo de atividades na realização do diagnóstico, avaliação da condição de saúde e aconselhamento, avaliação da adesão ao tratamento, efeitos adversos e prescrição de exames, medicamentos e imunobiológicos.
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Affiliation(s)
- Ianka Cristina Celuppi
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
| | | | | | - Denise Elvira Pires de Pires
- Universidade Federal de Santa Catarina, Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
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Celuppi IC, Meirelles BHS, Costa VT, Pires DEPD. Practical Approach to Care Kit: innovación para la clínica de enfermería en el manejo del VIH. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.5998.3719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Resumen Objetivo: analizar el uso del Practical Approach to Care Kit como tecnología adoptada en la práctica clínica de los enfermeros en el manejo del VIH en la Atención Primaria de la Salud. Método: investigación exploratoria y descriptiva, basada en el marco metodológico de la Teoría Fundamentada en los Datos Constructivistas. La definición de los participantes fue realizada por muestreo inicial, con 12 enfermeros, y muestreo teórico, con cinco gestores, fueron 17 participantes en total. Los datos fueron recolectados a través de entrevistas intensivas y análisis de documentos, y fueron analizados en dos etapas: 1) codificación inicial; y 2) codificación enfocada. Resultados: los profesionales identificaron el Practical Approach to Care Kit como una innovación tecnológica que contribuyó a la expansión de la práctica clínica y al empoderamiento de los enfermeros en el manejo clínico de la infección por VIH. También destacaron su importancia como herramienta para orientar las diferentes responsabilidades y obligaciones en la distribución de la atención de los pacientes, contribuyendo a la prestación de prácticas basadas en evidencia. Conclusión: el Practical Approach to Care Kit es una innovación tecnológica que ha transformado la práctica clínica de los enfermeros en el manejo del VIH, ampliando su radio de acción para la realización del diagnóstico, evaluación del estado de salud y asesoramiento, evaluación de la adherencia al tratamiento, efectos adversos y prescripción de exámenes, medicamentos e inmunobiológicos.
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Affiliation(s)
- Ianka Cristina Celuppi
- Universidade Federal de Santa Catarina, Brazil; Universidade Federal de Santa Catarina, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil
| | | | | | - Denise Elvira Pires de Pires
- Universidade Federal de Santa Catarina, Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
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Celuppi IC, Meirelles BHS, Costa VT, de Pires DEP. Practical Approach to Care Kit: Innovation for nurses' clinical practice in HIV management. Rev Lat Am Enfermagem 2023; 31:e3720. [PMID: 36722631 PMCID: PMC9886083 DOI: 10.1590/1518-8345.5998.3720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE to analyze the use of the Practical Approach to Care Kit as a technology adopted in nurses' clinical practice for HIV management in Primary Health Care. METHOD an exploratory and descriptive research study anchored in the methodological framework of the Constructivist Grounded Theory. The participants were defined through initial sampling, with 12 nurses, and theoretical sampling, with five managers, totaling 17 participants. The data were collected by means of intensive interviews and documentary analysis, and they were analyzed in two stages: 1) Initial coding; and 2) Focused coding. RESULTS the professionals identified the Practical Approach to Care Kit as a technological innovation that contributed to expanding the clinical practice and to empowering nurses in the clinical management of HIV infection. They also highlighted its importance as a tool for guiding the different responsibilities and duties while sharing care, contributing to the provision of evidence-based practices. CONCLUSION The Practical Approach to Care Kit is a technological innovation that has transformed nurses' clinical practice in HIV management, expanding their scope of activities in carrying out the diagnosis, assessing the health condition and counseling, evaluating adherence to the treatment, adverse effects and prescription of exams, medications, and immunobiological.
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Affiliation(s)
- Ianka Cristina Celuppi
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil., Universidade Federal de Santa Catarina, Laboratório Bridge - CTC, Florianópolis, SC, Brazil., Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil., Ianka Cristina Celuppi E-mail:
| | | | - Veridiana Tavares Costa
- Diretoria de Atenção Primária a Saúde, Secretaria de Saúde do Estado de Santa Catarina (DAPS/SES), Florianópolis, SC, Brazil
| | - Denise Elvira Pires de Pires
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil., Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
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Zeng LH, Hussain M, Syed SK, Saadullah M, Jamil Q, Alqahtani AM, Alqahtani T, Akram N, Khan IA, Parveen S, Fayyaz T, Fatima M, Shaukat S, Shabbir N, Fatima M, Kanwal A, Barkat MQ, Wu X. Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries. Front Public Health 2022; 9:757089. [PMID: 35265582 PMCID: PMC8899038 DOI: 10.3389/fpubh.2021.757089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/29/2021] [Indexed: 01/09/2023] Open
Abstract
Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion.
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Affiliation(s)
- Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Musaddique Hussain
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shahzada Khurram Syed
- Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, Pakistan
| | - Malik Saadullah
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Qurratulain Jamil
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Ali M. Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Nadia Akram
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Ahmad Khan
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajida Parveen
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Tehreem Fayyaz
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mobeen Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saira Shaukat
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Najia Shabbir
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mehwish Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Aisha Kanwal
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Ximei Wu
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
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Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, Bissell K, Bolton CE, Bush A, Celli B, Chiang CY, Cruz AA, Dinh-Xuan AT, El Sony A, Fong KM, Fujiwara PI, Gaga M, Garcia-Marcos L, Halpin DMG, Hurst JR, Jayasooriya S, Kumar A, Lopez-Varela MV, Masekela R, Mbatchou Ngahane BH, Montes de Oca M, Pearce N, Reddel HK, Salvi S, Singh SJ, Varghese C, Vogelmeier CF, Walker P, Zar HJ, Marks GB. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397:928-940. [PMID: 33631128 DOI: 10.1016/s0140-6736(21)00458-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.
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Affiliation(s)
- Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France.
| | - Alvar Agusti
- Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Innes Asher
- Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Eric D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Bissell
- Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand
| | - Charlotte E Bolton
- British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK
| | - Andrew Bush
- British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK
| | - Bartolome Celli
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Alvaro A Cruz
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Anh-Tuan Dinh-Xuan
- Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland
| | - Asma El Sony
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan
| | - Paula I Fujiwara
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Mina Gaga
- Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland
| | - Luis Garcia-Marcos
- Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain
| | - David M G Halpin
- Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John R Hurst
- British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - Ajay Kumar
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Maria V Lopez-Varela
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay
| | - Refiloe Masekela
- Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Bertrand H Mbatchou Ngahane
- Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon
| | - Maria Montes de Oca
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela
| | - Neil Pearce
- Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK
| | - Helen K Reddel
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sundeep Salvi
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India
| | - Sally J Singh
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Cherian Varghese
- Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Claus F Vogelmeier
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany
| | - Paul Walker
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK
| | - Heather J Zar
- Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Guy B Marks
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia
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Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JCD, Román-Rodríguez M, Thomas M, Kardos P, Stonham C, Khoo EM, Leather D, van der Molen T. Improving primary care management of asthma: do we know what really works? NPJ Prim Care Respir Med 2020; 30:29. [PMID: 32555169 PMCID: PMC7300034 DOI: 10.1038/s41533-020-0184-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 12/14/2022] Open
Abstract
Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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Affiliation(s)
- Monica J Fletcher
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, 59713 GH, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Andrew Cave
- Department of Family Medicine, 6-10 University Terrace, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Chi Chunhua
- Peking University First Hospital, Beijing, China
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- 33ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Miguel Román-Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Spain
| | - Mike Thomas
- Department of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, SO16 5ST, UK
| | - Peter Kardos
- Respiratory, Allergy and Sleep Unit at Red Cross Maingau Hospital, Friedberger Anlage 31-32, 60316, Frankfurt, Germany
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Alves de Carvalho VK, Godoi DF, Perini FDB, Vidor AC. Cuidado compartilhado de pessoas vivendo com HIV/AIDS na Atenção Primária. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introdução: Buscando instituir ações para prevenir e reduzir a transmissão, melhorar o acesso ao tratamento e a qualidade de vida das pessoas vivendo com HIV/AIDS (PVHIV), a rede municipal de saúde de Florianópolis implantou entre 2015 e 2016 uma nova forma de suporte em Infectologia para a Atenção Primária a Saúde (APS). Objetivo: Descrever os resultados encontrados no município no processo de descentralização e cuidado compartilhado de pessoas vivendo com HIV/AIDS (PVHIV) com a APS de Florianópolis. Métodos: Trata-se de um estudo observacional, transversal e descritivo. Os dados foram obtidos de relatórios do prontuário eletrônico local e a partir de questionário estruturado aplicado junto aos médicos da APS de Florianópolis. Resultados: Entre 2014 e 2018, o número de atendimentos na APS relacionados ao cuidado de PVHIV teve um aumento expressivo, sobretudo após 2016, acompanhado de uma redução de 45,7% na proporção de encaminhamentos para infectologia após a implantação do apoio matricial em infectologia. Aliada à redução da taxa de encaminhamento evidenciou-se a habilidade na prescrição de Terapia Antirretroviral (TARV) por 100% dos médicos da APS entrevistados. Em relação à situação de acompanhamento de PVHIV, exclusivamente sob cuidados da APS, foi encontrada diferença estatisticamente significante entre os médicos que fazem preceptoria em ensino na graduação e residência e os que são residentes ou tem formação específica em medicina de família e comunidade (MFC) em relação aos médicos sem formação específica. A proporção de médicos que se sentem seguros e confiantes em realizar esse tipo de atendimento na APS também foi significativamente maior entre os médicos que fazem preceptoria e são médicos de família e comunidade. Conclusões: A implantação do Apoio Matricial da Infectologia para a APS trouxe grande avanço para o município de Florianópolis, no que tange ao acesso e qualificação do cuidado das pessoas vivendo com HIV/AIDS. Os resultados foram mais significativos para os profissionais envolvidos com atividades de preceptoria e formação específica em MFC, o que reforça o papel da educação permanente na qualificação da coordenação do cuidado pela APS.
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Murdoch J, Curran R, Cornick R, Picken S, Bachmann M, Bateman E, Simelane ML, Fairall L. Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child). BMC Health Serv Res 2020; 20:479. [PMID: 32471431 PMCID: PMC7257217 DOI: 10.1186/s12913-020-05201-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0–13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017–2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.
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Affiliation(s)
- Jamie Murdoch
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Colney Lane, Norwich, NR4 7TJ, UK.
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Makhosazana Lungile Simelane
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, Mowbray, 7700, South Africa.,Department of Medicine, University of Cape Town, Observatory, 7925, South Africa.,King's Global Health Institute, King's College London, London, SE1 9NH, UK
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9
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Bachmann MO, Bateman ED, Stelmach R, Cruz AA, Pacheco de Andrade M, Zonta R, Zepeda J, Natal S, Cornick RV, Wattrus C, Anderson L, Georgeu-Pepper D, Lombard C, Fairall LR. Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil. BMJ Glob Health 2019; 4:e001921. [PMID: 31908865 PMCID: PMC6936566 DOI: 10.1136/bmjgh-2019-001921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction The Practical Approach to Care Kit (PACK) guide was localised for Brazil, where primary care doctors and nurses were trained to use it. Methods Twenty-four municipal clinics in Florianópolis were randomly allocated to receive outreach training and the guide, and 24 were allocated to receive only the guide. 6666 adult patients with asthma or chronic obstructive pulmonary disease (COPD) were enrolled, and trial outcomes were measured over 12 months, using electronic medical records. The primary outcomes were composite scores of treatment changes and spirometry, and new asthma and COPD diagnosis rates. Results Asthma scores in 2437 intervention group participants were higher (74.8%, 20.4% and 4.8% with scores of 0, 1 and 2, respectively) than in 2633 control group participants (80.0%, 16.8% and 3.2%) (OR for higher score 1.32, 95% CI 1.08 to 1.61, p=0.006). Adjusted for asthma scores recorded in each clinic before training started, the OR was 1.24 (95% CI 1.03 to 1.50, p=0.022). COPD scores in 1371 intervention group participants (77.7%, 17.9% and 4.3% with scores of 0, 1 and 2) did not differ from those in 1181 control group participants (80.5%, 15.8% and 3.7%) (OR 1.21, 95% CI 0.94 to 1.55, p=0.142). Rates of new asthma and COPD diagnoses, and hospital admission, and indicators of investigation, diagnosis and treatment of comorbid cardiovascular disease, diabetes and depression, and tobacco cessation did not differ between trial arms. Conclusion PACK training increased guideline-based treatment and spirometry for asthma but did not affect COPD or comorbid conditions, or diagnosis rates. Trial registration NCT02786030 (https://clinicaltrials.gov/). Portuguese (Brazil) Introdução O guia de Abordagem Prática do Kit de Cuidados em Saúde (PACK) foi adaptado para o sistema de saúde do Brasil; médicos e enfermeiros da atenção primária foram treinados para usá-lo na pratica clínica. Métodos Vinte e quatro unidades básicas de saúde (UBS) municipais de Florianópolis foram alocadas aleatoriamente para receber treinamento nas UBS utilizando o guia, e 24 foram alocadas para receber apenas o guia. Foram analisados dados de 6.666 pacientes adultos com asma ou doença pulmonar obstrutiva crônica (DPOC) e os desfechos foram medidos por doze meses, através de registros médicos eletrônicos. Os resultados principais foram escores compostos de mudança no tratamento, realização de espirometria e taxas de novos diagnósticos de asma e DPOC. Resultados os escores de asma em 2437 participantes do grupo de intervenção foram maiores (74,8%, 20,4% e 4,8% com escores de 0, 1 e 2 respectivamente) do que em 2633 participantes do grupo controle (80,0%, 16,8% e 3,2%) (odds ratio (OR) para pontuação mais alta 1,32, intervalo de confiança de 95% (IC) 1,08-1,61, p = 0,006). Ajustado para os escores de asma registrados em cada clínica antes do início do treinamento, o OR foi de 1,24 (IC 95% 1,03-1,50, p = 0,022). Os escores da DPOC em 1371 participantes do grupo de intervenção (77,7%, 17,9% e 4,3% com escores de 0, 1 e 2) não diferiram dos de 1181 participantes do grupo controle (80,5%, 15,8% e 3,7%) (OR 1,21 (IC95% 0,94-1,55, p = 0,142) As taxas de novos diagnósticos de asma e DPOC, internação hospitalar e indicadores de diagnóstico e tratamento de co-morbidades cardiovasculares, diabete, depressão e cessação do tabagismo não diferiram entre os grupos experimentais. Conclusão O treinamento com PACK aumentou o tratamento baseado em diretrizes e espirometria para asma, mas não afetou as co-morbidades em DPOC ou as taxas de diagnóstico.
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Affiliation(s)
- Max Oscar Bachmann
- Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | - Eric D Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
| | | | - Alvaro A Cruz
- ProAR, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Matheus Pacheco de Andrade
- Gerência de Integração Assistencial, Secretaria Municipal de Saúde, Florianópolis, Santa Catarina, Brazil
| | - Ronaldo Zonta
- Gerência de Integração Assistencial, Secretaria Municipal de Saúde, Florianópolis, Santa Catarina, Brazil
| | | | - Sonia Natal
- Public Health, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ruth Vania Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
| | - Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
| | - Daniella Georgeu-Pepper
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
| | - Carl Lombard
- Biostatistics Unit, Medical Research Council, Cape Town, South Africa
| | - Lara R Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, Western Cape, South Africa
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10
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Silva BP, Schons AAN. Desenvolvimento de um guia rápido para prática de atenção à saúde da população transgênero. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Problema: Os direitos fundamentais das pessoas transgênero são negados cotidianamente. Neste cenário, o preconceito age como determinante social de saúde impactando na prevalência de problemas como saúde mental e infecções sexualmente transmissíveis (ISTs). O objetivo foi o desenvolvimento de um sumário de evidências para apoiar o atendimento clínico e embasar a capacitação dos profissionais da Atenção Primária de Saúde de Florianópolis - SC, a fim de melhorar os resultados de saúde dessa população. Métodos: Baseado na ferramenta PACK – interface acessível e intuitiva no modelo pergunte, solicite, aconselhe e trate – já implementada no município de Florianópolis. O método de revisão rápida foi utilizado para busca de evidência, priorizando sumários de prática clínica e protocolos internacionais. Fontes primárias foram utilizadas quando os dados anteriores eram insuficientes ou conflitantes. As perguntas de pesquisa seguiram o acrônimo PICO e a recomendação foi classificada de acordo com a adaptação GRADE do Center of Excellence for Transegender Health. Resultados: Foi criado o Guia Rápido para Prática de Atenção à Saúde da População Transgênero aos moldes do PACK Brasil. O mesmo aguarda aprovação do PACK Brasil e do Ambulatório de Atenção Integral à População Transexual de Florianópolis para futura incorporação do material. Conclusão: Apesar da falta de evidência de qualidade e estudos voltados para a população específica, a existência de diretrizes nesse campo legitima a necessidade de atenção à saúde transgênero, além de auxiliar profissionais de saúde e formuladores de políticas sobre como atender a essas necessidades. Na perspectiva de redução de danos, devemos transpor a barreira do estigma social e institucional para produção de diretrizes consensuais em busca de equidade para população transgênero.
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11
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Amorim TS, Backes MTS, Santos EKAD, Cunha KSD, Collaço VS. Assistência obstétrica/neonatal: ampliação da prática clínica do enfermeiro na Atenção Primária. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Compreender o significado da ampliação da prática clínica do enfermeiro na atenção obstétrica e neonatal no contexto da atenção primária. Métodos Pesquisa qualitativa, com o referencial teórico filosófico do Pensamento Complexo de Edgar Morin e com o referencial metodológico da Teoria Fundamentada nos Dados. As etapas de coleta, análise e construção da teoria ocorreram em sequências alternadas, entre setembro de 2016 a setembro de 2017. A saturação teórica dos dados ocorreu com a inclusão de 11 entrevistas individuais com enfermeiras da atenção primária e com quatro observações participantes. Os dados foram organizados por meio do software NVIVO10® e analisados em três etapas: codificação aberta, axial e integração. Resultados Emergiu o fenômeno central “Provocando mudanças na atuação do enfermeiro da atenção primária” e a três categorias: Compreendendo os significados da gestão do cuidado de Enfermagem na atenção primária; lidando com o movimento antagonista e regulador que influencia a qualidade e melhorando a qualidade para promover a resolutividade da atenção primária. Conclusão Os significados do movimento de liderança em prol da ampliação da prática clínica do enfermeiro na Atenção Primária relacionam-se com: as resistências na postura de alguns profissionais, a inconstância de recursos humanos e materiais, mas, sobretudo, com a busca pela essência do cuidar.
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12
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Yau M, Timmerman V, Zwarenstein M, Mayers P, Cornick RV, Bateman E, Fairall L. e-PC101: an electronic clinical decision support tool developed in South Africa for primary care in low-income and middle-income countries. BMJ Glob Health 2019; 3:e001093. [PMID: 30899556 PMCID: PMC6407554 DOI: 10.1136/bmjgh-2018-001093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/03/2022] Open
Abstract
Health technology is increasingly recognised as a feasible method of addressing health needs in low and middle-income countries (LMICs). Primary Care 101, now known as PACK (Practical Approach to Care Kit), is a printed, algorithmic, checklist-based, comprehensive clinical decision support tool. It assists clinicians with delivering evidence-based medicine for common primary care presentations and conditions. These assessment and treatment guides have been adopted widely in primary care clinics across South Africa. This paper focuses on the process of designing, developing, and implementing a digital version of the clinical decision support tool for use on a tablet computer. Lessons learnt throughout its development and pilot implementation could apply to the creation of electronic health interventions and the digitisation of clinical tools in LMICs.
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Affiliation(s)
- Matthew Yau
- University of Toronto Medical School, Toronto, Ontario, Canada
| | - Venessa Timmerman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Pat Mayers
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ruth Vania Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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13
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Fairall L, Cornick R, Bateman E. Empowering frontline providers to deliver universal primary healthcare using the Practical and Approach to care kit. BMJ Glob Health 2018; 3:bmjgh-2018-k4451rep. [PMID: 30538824 PMCID: PMC6266967 DOI: 10.1136/bmjgh-2018-k4451rep] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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14
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Cornick R, Wattrus C, Eastman T, Ras CJ, Awotiwon A, Anderson L, Bateman E, Zepeda J, Zwarenstein M, Doherty T, Fairall L. Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries. BMJ Glob Health 2018; 3:e001088. [PMID: 30483416 PMCID: PMC6231097 DOI: 10.1136/bmjgh-2018-001088] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022] Open
Abstract
Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model's development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next-a 'learning health system' with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.
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Affiliation(s)
- Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Tracy Eastman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Christy Joy Ras
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Jorge Zepeda
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Merrick Zwarenstein
- Western University, Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Tanya Doherty
- South African Medical Research Council and Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
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15
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Fairall L, Cornick R, Bateman E. Empowering frontline providers to deliver universal primary healthcare using the Practical Approach to Care Kit. BMJ 2018; 363:k4451. [PMID: 30355721 PMCID: PMC6200083 DOI: 10.1136/bmj.k4451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, South Africa
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16
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Picken S, Hannington J, Fairall L, Doherty T, Bateman E, Richards M, Wattrus C, Cornick R. PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents. BMJ Glob Health 2018; 3:e000957. [PMID: 30397519 PMCID: PMC6203049 DOI: 10.1136/bmjgh-2018-000957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 02/03/2023] Open
Abstract
Pioneering strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.
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Affiliation(s)
- Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Juliet Hannington
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Mowbray, South Africa
| | - Tanya Doherty
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Mark Richards
- Department of Paediatrics and Child Health, Somerset Hospital, University of Cape Town, Green Point, South Africa
| | - Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Mowbray, South Africa
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17
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Awotiwon A, Sword C, Eastman T, Ras CJ, Ana P, Cornick RV, Fairall L, Bateman E, Dube A, Curran R, Udoekwere I, Essien UO, Assem O, Edu TS, Ismail HB, Olubajo OO, Ana J. Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria. BMJ Glob Health 2018; 3:e001079. [PMID: 30397520 PMCID: PMC6202991 DOI: 10.1136/bmjgh-2018-001079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 12/20/2022] Open
Abstract
Nigeria, in its quest to strengthen its primary healthcare system, is faced with a number of challenges including a shortage of clinicians and skills. Methods are being sought to better equip primary healthcare clinicians for the clinical demands that they face. Using a mentorship model between developers in South Africa and Nigerian clinicians, the Practical Approach to Care Kit (PACK) for adult patients, a health systems strengthening programme, has been localised and piloted in 51 primary healthcare facilities in three Nigerian states. Lessons learnt from this experience include the value of this remote model of localisation for rapid localisation, the importance of early, continuous stakeholder engagement, the need expressed by Nigeria's primary healthcare clinicians for clinical guidance that is user friendly and up-to-date, a preference for the tablet version of the PACK Adult guide over hard copies and the added value of WhatsApp groups to complement the programme of face-to-face continuous learning. Introduction of the PACK programme in Nigeria prompted uptake of evidence-informed recommendations within primary healthcare services.
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Affiliation(s)
- Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | | | - Tracy Eastman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- BMJ Global Health, BMJ, London, UK
| | - Christy Joy Ras
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Prince Ana
- Health Resources International West Africa, Calabar, Nigeria
| | - Ruth Vania Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Audry Dube
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | | | | | - Okorie Assem
- Health Resources International West Africa, Calabar, Nigeria
| | | | - Hajia Binta Ismail
- National Primary Health Care Agency (NPHCDA), Abuja, Federal Capital Territory, Nigeria
| | | | - Joseph Ana
- Health Resources International West Africa, Calabar, Nigeria
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18
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Cornick R, Picken S, Wattrus C, Awotiwon A, Carkeek E, Hannington J, Spiller P, Bateman E, Doherty T, Zwarenstein M, Fairall L. The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery. BMJ Glob Health 2018; 3:e000962. [PMID: 30364419 PMCID: PMC6195147 DOI: 10.1136/bmjgh-2018-000962] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Sandy Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Emma Carkeek
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Juliet Hannington
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Pearl Spiller
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Tanya Doherty
- South African Medical Research Council, Cape Town, South Africa
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
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