Background: Delivering evidence-based primary care is complex, particularly in low-income countries. Evidence is usually generated in high-income countries; medical evidence databases designed as point-of-care tools cater for these settings. Increasingly evidence-aligned, WHO guidelines target low-resource settings, but their single-disease focus hampers use in growing multi-morbidity. The Practical Approach to Care Kit (PACK) is a clinical decision support tool underpinning a health systems intervention adopted throughout South Africa and elsewhere that improves outcomes and quality of primary care. Evidence and WHO aligned and adaptable to local policy, it has been described by a nurse as ‘A tool for every day, for every patient’.
Objectives: To describe PACK tool features that make evidence actionable in a primary care setting.
Methods:We examined end-user need - patients have multiple symptoms and conditions (often undiagnosed) and require screening, assessment and routine care - and defined core PACK principles: comprehensiveness, integration, feasibility and usability. Iterative development drew on local stakeholder feedback on 15 annual editions, along with content alignment to policy, latest evidence sourced through BMJ’s Best Practice and WHO guidelines.
Results: PACK is a 120-page guide to over 500 symptoms, syndromes and conditions. Clinical, written and physical design features realise the PACK principles: a symptom-based approach makes explicit clinical decision-making processes; content is standardised into an algorithm and checklist format; language is simple and concise; comprehensiveness enables clinical integration and prompts to screen and diagnose; aligning evidence-based content to policy ensures feasibility. Development, updating and localisation work led to system improvements to prescribing, practice scope, referral pathways and policy consolidation, in turn enabling PACK implementation.
Conclusions: Lessons from our 15-year, multi-country experience are that to make evidence actionable interventions must cater to end-user need and that the process of development, update and localisation of content are integral to implementation.