Practical Approach to Care Kit - PACKThe Practical Approach to Care Kit is a health systems strategy comprising 4 pillars that support the delivery of primary care:
- a guide,
- a training strategy,
- a health systems strengthening intervention and
- a monitoring and evaluation component.
The PACK guide is a comprehensive, integrated approach to adult primary care that includes 40 common symptoms and 20 chronic conditions. It aims to guide the clinician to assess a patient’s symptoms, make a diagnosis and devise a management plan, and deliver routine care for one or more chronic conditions. The content is informed by evidence sourced through the BMJ’s Best Practice, WHO guidelines and other sentinel guidelines, and is updated on an annual basis. It is designed to be practical and easy to use, with algorithms, checklists, illustrations and colour-coding.
The PACK training curriculum comprises cases that are carefully structured to explore the features of the guide and its clinical content. Using an interactive methodology, the training draws on clinicians’ existing experience and knowledge, and aims to embed the use of the guide in every day clinical practice. PACK training uses a proven implementation strategy, educational outreach, to deliver PACK to clinicians as teams in their health care facilities. The trainers are drawn from the local health system and are trained using a cascade model to facilitate the on-site sessions and then provide ongoing support for the programme.
PACK health systems intervention
The PACK guide is designed to integrate and reflect existing local policy for primary care delivery while being a comprehensive approach to the individual adult patient. The training strategy involves many of the role-players in primary care delivery and targets the primary care facility team as a unit. It thus offers the opportunity to reorganise the way care is delivered in a primary care facility – streamlining the patient journey through the facility and referrals on, task-sharing care between cadres of staff, clarifying scope of practice and prescriber levels, and addressing medication, test and equipment availability.
Monitoring and evaluation of the PACK programme can occur at several levels - the individual clinician, facility, regional and system-wide - to ensure that the programme is being implemented effectively. Indicator data is obtained from trainer and clinician logbooks and onsite training records. Assessments include pre and post-training assessments of clinical skills and self-confidence scores. Regular PACK training reports are provided to programme managers.