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Spanos S, Dammery G, Pagano L, Ellis LA, Fisher G, Smith CL, Foo D, Braithwaite J. Learning health systems on the front lines to strengthen care against future pandemics and climate change: a rapid review. BMC Health Serv Res 2024; 24:829. [PMID: 39039551 PMCID: PMC11265124 DOI: 10.1186/s12913-024-11295-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to continuously improve care delivery. This rapid review aimed to understand the ways in which LHS principles have been applied to primary care and emergency departments, the extent to which LHS approaches have been adopted in these key settings, and the factors that affect their adoption. METHODS Three academic databases (Embase, Scopus, and PubMed) were searched for full text articles reporting on LHSs in primary care and/or emergency departments published in the last five years. Articles were included if they had a primary focus on LHSs in primary care settings (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency care settings. Data from included articles were catalogued and synthesised according to the modified Institute of Medicine's five-component framework for LHSs (science and informatics, patient-clinician partnerships, incentives, continuous learning culture, and structure and governance). RESULTS Thirty-seven articles were included, 32 of which reported LHSs in primary care settings and seven of which reported LHSs in emergency departments. Science and informatics was the most commonly reported LHS component, followed closely by continuous learning culture and structure and governance. Most articles (n = 30) reported on LHSs that had been adopted, and many of the included articles (n = 17) were descriptive reports of LHS approaches. CONCLUSIONS Developing LHSs at the front lines of care is essential for future-proofing against current and new threats to health system sustainability, such as pandemic- and climate change-induced events. Limited research has examined the application of LHS concepts to emergency care settings. Implementation science should be utilised to better understand the factors influencing adoption of LHS approaches on the front lines of care, so that all five LHS components can be progressed in these settings.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia.
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Lisa Pagano
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Darran Foo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- Faculty of Medicine, Health and Human Sciences, MQ Health General Practice, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
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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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Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low and middle income countries: case for change. Eur Respir J 2022; 60:2103179. [PMID: 35210321 PMCID: PMC9474897 DOI: 10.1183/13993003.03179-2021] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Asthma is the most common noncommunicable disease in children, and among the most common in adults. The great majority of people with asthma live in low and middle income countries (LMICs), which have disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality. Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1-3 times per week do not need (or benefit from) ICS. Even when ICS are prescribed, many patients manage their asthma with oral or inhaled short-acting β2-agonists (SABA) alone, owing to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries. The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death, despite the availability of highly effective therapeutic approaches, is unacceptable. A World Health Assembly Resolution on universal access to affordable and effective asthma care is needed to focus attention and investment on addressing this need.
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Affiliation(s)
- Kevin Mortimer
- Dept of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Dept of Medicine, University of Cambridge, Cambridge, UK
| | - Helen K Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - Paulo M Pitrez
- Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Eric D Bateman
- Division of Pulmonology, Dept of Medicine, University of Cape Town, Cape Town, South Africa
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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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Olbrich L, Stockdale L, Basu Roy R, Song R, Cicin-Sain L, Whittaker E, Prendergast AJ, Fletcher H, Seddon JA. Understanding the interaction between cytomegalovirus and tuberculosis in children: The way forward. PLoS Pathog 2021; 17:e1010061. [PMID: 34882748 PMCID: PMC8659711 DOI: 10.1371/journal.ppat.1010061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Over 1 million children develop tuberculosis (TB) each year, with a quarter dying. Multiple factors impact the risk of a child being exposed to Mycobacterium tuberculosis (Mtb), the risk of progressing to TB disease, and the risk of dying. However, an emerging body of evidence suggests that coinfection with cytomegalovirus (CMV), a ubiquitous herpes virus, impacts the host response to Mtb, potentially influencing the probability of disease progression, type of TB disease, performance of TB diagnostics, and disease outcome. It is also likely that infection with Mtb impacts CMV pathogenesis. Our current understanding of the burden of these 2 diseases in children, their immunological interactions, and the clinical consequence of coinfection is incomplete. It is also unclear how potential interventions might affect disease progression and outcome for TB or CMV. This article reviews the epidemiological, clinical, and immunological literature on CMV and TB in children and explores how the 2 pathogens interact, while also considering the impact of HIV on this relationship. It outlines areas of research uncertainty and makes practical suggestions as to potential studies that might address these gaps. Current research is hampered by inconsistent definitions, study designs, and laboratory practices, and more consistency and collaboration between researchers would lead to greater clarity. The ambitious targets outlined in the World Health Organization End TB Strategy will only be met through a better understanding of all aspects of child TB, including the substantial impact of coinfections.
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Affiliation(s)
- Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Lisa Stockdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- The Jenner Institute, The Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robindra Basu Roy
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Luka Cicin-Sain
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- German Centre for Infection Research (DZIF), Partner site Hannover-Braunschweig, Braunschweig, Germany
| | - Elizabeth Whittaker
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Andrew J. Prendergast
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Helen Fletcher
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - James A. Seddon
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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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: 132] [Impact Index Per Article: 44.0] [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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9
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Tesema A, Joshi R, Abimbola S, Ajisegiri WS, Narasimhan P, Peiris D. Addressing barriers to primary health-care services for noncommunicable diseases in the African Region. Bull World Health Organ 2020; 98:906-908. [PMID: 33293751 PMCID: PMC7716106 DOI: 10.2471/blt.20.271239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Azeb Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | - Whenayon Simeon Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
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Murunga VI, Oronje RN, Bates I, Tagoe N, Pulford J. Review of published evidence on knowledge translation capacity, practice and support among researchers and research institutions in low- and middle-income countries. Health Res Policy Syst 2020; 18:16. [PMID: 32039738 PMCID: PMC7011245 DOI: 10.1186/s12961-019-0524-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers' KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions. METHODS An electronic search for peer-reviewed publications focusing on LMIC researchers' KT capacity, practice and support across all academic fields, authored in English and from the earliest records available to February 2019, was conducted using PubMed and Scopus. Selected studies were appraised using the Mixed Methods Appraisal Tool, data pertaining to publication characteristics and study design extracted, and an a priori thematic analysis of reported research findings completed. RESULTS The search resulted in 334 screened articles, of which 66 met the inclusion criteria. Most (n = 43) of the articles presented original research findings, 22 were commentaries and 1 was a structured review; 47 articles reported on researchers' KT practice, 12 assessed the KT capacity of researchers or academic/research institutions and 9 reported on KT support for researchers. More than half (59%) of the articles focused on sub-Saharan Africa and the majority (91%) on health research. Most of the primary studies used the case study design (41%). The findings suggest that LMIC researchers rarely conduct KT and face a range of barriers at individual and institutional levels that limit their KT practice, including inadequate KT knowledge and skills, particularly for communicating research and interacting with research end-users, insufficient funding, and inadequate institutional guidelines, structures and incentives promoting KT practice. Furthermore, the evidence-base on effective interventions for enhancing LMIC researchers' KT practice is insufficient and largely of weak quality. CONCLUSIONS More high-quality research on researchers' KT capacity, practice and effective KT capacity strengthening interventions is needed. Study designs that extend beyond case studies and descriptive studies are recommended, including better designed evaluation studies, e.g. use of realist approaches, pragmatic trials, impact evaluations, implementation research and participatory action research.
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Affiliation(s)
- Violet Ibukayo Murunga
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3BX United Kingdom
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Rose Ndakala Oronje
- African Institute for Development Policy, 6th Floor, Block A, Westcom Point Bldg, Mahiga Mairu Ave Off Waiyaki Way, Westlands, Nairobi, Kenya
| | - Imelda Bates
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
| | - Nadia Tagoe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Office of Grants and Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Pulford
- Liverpool School of Tropical Medicine, Center for Capacity Research, Pembroke Place, Liverpool, L35QA United Kingdom
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11
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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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12
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 741] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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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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14
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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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15
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Feyissa YM, Hanlon C, Emyu S, Cornick RV, Fairall L, Gebremichael D, Teka T, Shiferaw S, Walelgne W, Mamo Y, Segni H, Ayehu T, Wale M, Eastman T, Awotiwon A, Wattrus C, Picken SC, Ras CJ, Anderson L, Doherty T, Prince MJ, Tegabu D. Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Ethiopia. BMJ Glob Health 2018; 3:e001108. [PMID: 30498596 PMCID: PMC6241984 DOI: 10.1136/bmjgh-2018-001108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022] Open
Abstract
The Federal Ministry of Health, Ethiopia, recognised the potential of the Practical Approach to Care Kit (PACK) programme to promote integrated, comprehensive and evidence-informed primary care as a means to achieving universal health coverage. Localisation of the PACK guide to become the 'Ethiopian Primary Health Care Clinical Guidelines' (PHCG) was spearheaded by a core team of Ethiopian policy and technical experts, mentored by the Knowledge Translation Unit, University of Cape Town. A research collaboration, ASSET (heAlth Systems StrEngThening in sub-Saharan Africa), has brought together policy-makers from the Ministry of Health and health systems researchers from Ethiopia (Addis Ababa University) and overseas partners for the PACK localisation process, and will develop, implement and evaluate health systems strengthening interventions needed for a successful scale-up of the Ethiopian PHCG. Localisation of PACK for Ethiopia included expanding the guide to include a wider range of infectious diseases and an expanded age range (from 5 to 15 years). Early feedback from front-line primary healthcare (PHC) workers is positive: the guide gives them greater confidence and is easy to understand and use. A training cascade has been initiated, with a view to implementing in 400 PHC facilities in phase 1, followed by scale-up to all 3724 health centres in Ethiopia during 2019. Monitoring and evaluation of the Ministry of Health implementation at scale will be complemented by indepth evaluation by ASSET in demonstration districts. Anticipated challenges include availability of essential medications and laboratory investigations and the need for additional training and supervisory support to deliver care for non-communicable diseases and mental health. The strong leadership from the Ministry of Health of Ethiopia combined with a productive collaboration with health systems research partners can help to ensure that Ethiopian PHCG achieves standardisation of clinical practice at the primary care level and quality healthcare for all.
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Affiliation(s)
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King’s College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Emyu
- Technical Assistant to the Clinical Services Directorate, Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Ruth Vania 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
| | - 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
| | | | - Telahun Teka
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubaye Walelgne
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Yoseph Mamo
- Institute of Palliative Care, Kozhikode, Kerala, India
- Tropical Health Education Trust and Jimma University Chronic Disease Project, Jimma, Ethiopia
| | | | - Temesgen Ayehu
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Meseret Wale
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Tracy Eastman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- BMJ Knowledge Centre Department, BMA House, London, UK
| | - Ajibola Awotiwon
- 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
| | - Sandy Claire Picken
- 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
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Martin James Prince
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King’s College London, London, UK
- King’s Global Health Research Institute, King’s College London, London, UK
| | - Desalegn Tegabu
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
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16
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Simelane ML, Georgeu-Pepper D, Ras CJ, Anderson L, Pascoe M, Faris G, Fairall L, Cornick R. The Practical Approach to Care Kit (PACK) training programme: scaling up and sustaining support for health workers to improve primary care. BMJ Glob Health 2018; 3:e001124. [PMID: 30498597 PMCID: PMC6242020 DOI: 10.1136/bmjgh-2018-001124] [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: 08/17/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
Abstract
There is an urgent need to depart from in-service training that relies on distance and/or intensive off-site training leading to limited staff coverage at clinical sites. This traditional approach fails to meet the challenge of improving clinical practice, especially in low-income and middle-income countries where resources are limited and disease burden high. South Africa's University of Cape Town Lung Institute Knowledge Translation Unit has developed a facility-based training strategy for implementation of its Practical Approach to Care Kit (PACK) primary care programme. The training has been taken to scale in primary care facilities throughout South Africa and has shown improvements in quality of care indicators and health outcomes along with end-user satisfaction. PACK training uses a unique approach to address the needs of frontline health workers and the health system by embedding a health intervention into everyday clinical practice at facility level. This paper describes the features of the PACK training strategy: PACK training is scaled up using a cascade model of training using educational outreach to deliver PACK to clinical teams in their health facilities in short, regular sessions. Drawing on adult education principles, PACK training empowers clinicians by using experiential and interactive learning methodologies to draw on existing clinical knowledge and experience. Learning is alternated with practice to improve the likelihood of embedding the programme into everyday clinical care delivery.
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Affiliation(s)
| | | | - Christy-Joy Ras
- 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
| | - Michelle Pascoe
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Gill Faris
- Purposeful People Development, Cape Town, South Africa
| | - Lara Fairall
- 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
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17
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Prince MJ. Back to the future with PACK. BMJ Glob Health 2018; 3:e001231. [PMID: 30483417 PMCID: PMC6231110 DOI: 10.1136/bmjgh-2018-001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Martin James Prince
- Health Service and Population Research Department, King's College London, London, UK
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18
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Wattrus C, Zepeda J, Cornick RV, Zonta R, Pacheco de Andrade M, Fairall L, Georgeu-Pepper D, Anderson L, Eastman T, Bateman ED, CRUZ AA, Bachmann MO, Natal S, Doherty T, Stelmach R. Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Brazil. BMJ Glob Health 2018; 3:e001016. [PMID: 30483415 PMCID: PMC6231100 DOI: 10.1136/bmjgh-2018-001016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 11/04/2022] Open
Abstract
Brazil's Sistema Único de Saúde, or Unified Health System policy, has delivered major improvements in health coverage and outcomes, but challenges remain, including the rise of non-communicable diseases (NCDs) and variations in quality of care across the country. Some of these challenges may be met through the adaptation and implementation of a South African primary care strategy, the Practical Approach to Care Kit (PACK). Developed by the University of Cape Town's Knowledge Translation Unit (KTU), PACK is intended for in-country adaptation by employing a mentorship model. Using this approach, the PACK Adult guide and training materials were localised for use in Florianópolis, Santa Catarina, Brazil, as part of an initiative to reform primary care, expand care for NCDs and make services more accessible and equitable. The value of the collaboration between the KTU and Florianópolis municipality is the transfer of skills and avoidance of duplication of effort involved in de-novo guide development, while ensuring that materials are locally acceptable and applicable. The collaboration has informed the development of the KTU's PACK mentorship package and led to a relationship between the groups of developers, ensuring ongoing learning and research, with the potential of assisting the further scale-up of PACK in Brazil.
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Affiliation(s)
- Camilla Wattrus
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | | | - Ruth Vania Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | | | | | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | - Daniella Georgeu-Pepper
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | - Tracy Eastman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
- BMJ Publishing Group, Knowledge Centre, London, UK
| | - Eric D Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
| | | | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sonia Natal
- Federal University of Santa Catarina, Florianópolis, Brazil
| | - Tanya Doherty
- South African Medical Research Council, Cape Town, South Africa
| | - Rafael Stelmach
- Pulmonary Division - Heart Institute (iCor), University of São Paulo Medical School, Sao Paulo, Brazil
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19
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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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20
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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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21
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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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