Grant underpins roll-out of health care guidelines for nurses

27 April 2009

The Knowledge Translation Unit (KTU) in the UCT Lung Institute has received R8.9 million to roll out their successful diagnostic and treatment PALSA PLUS Guidelines for primary health care workers in three more provinces: KwaZulu-Natal, the Eastern Cape, and Gauteng.

Adapted and tailored to local conditions and national protocols and policies by the KTU, the programme is based on the World Health Organisation's PAL strategy. This has been designed to improve the case detection rate of TB and the management of other common respiratory conditions.

The symptom-based guidelines use clinical algorithms and key messages to guide the practitioner to diagnose and manage their clients appropriately. The first edition, PALSA, was expanded to include HIV care and sexually transmitted infections, counselling and testing for HIV, routine care for HIV clients before and once on ART, prevention of TB and other opportunistic infections, and the prevention and treatment of sexually transmitted infections.

The PALSA PLUS Guidelines have been available to nurses in the Western Cape and Free State provinces for some years. They've been highly effective in providing nurses with a symptom-based approach to respiratory diseases including TB, HIV/AIDS, and sexually transmitted infections.

The guidelines contain key messages that promote the diagnosis of these conditions, further assisting nurses to integrate the care of patients who present with more than one condition, as is often the case with HIV/AIDS.

"In many primary health care centres there are no doctors. Nurses are seeing very sick patients with HIV and TB and are required to make some complex clinical decisions," said KTU head, Dr Lara Fairall.

With a paucity of doctors to service rural healthcare centres, primary health care in South Africa will become increasingly nurse-driven.

"Cape Town is an exceptional place as most primary care is delivered by doctors. But this is not the case in the rest of South Africa," said Fairall.

The KTU was formed in 2005 to put evidence into practice, and so improve the primary care management of priority diseases such as TB and HIV/AIDS.

Guideline developer Dr Ruth Cornick keeps the information in step with policy changes.

The KTU is also looking to extend the PALSA PLUS Guidelines to include chronic diseases such as hypertension and diabetes.

This new roll-out of PALSA PLUS to other provinces has been funded by the Belgian Technical Corporation, working through the South African National Department of Health's TB Control and Management Cluster.

Dr Bev Draper, who is managing the project that extends the implementation of the guidelines, said that the KTU "uniquely" offers the training methodology required by the Department of Health in their tender for this project.

"The KTU breaks the mould of didactic 'in-the-class' training," she added. "Nurses are trained to use the guidelines while on site, building on their existing knowledge.

"We don't take nurses out of the facilities for training," said Draper.

Theirs is not a knock-and-drop approach, either. The KTU wants the project to be sustainable from the beginning. Part of the plan is to develop master trainers in each province who will continue the project after the KTU withdraws.

In the Western Cape, 2 600 nurses and 94 trainers have already been taught how to use the Guidelines, and the team will train an additional 4 865 nurses and 521 facilitators in the three additional provinces over the next year.

"The KTU wishes to contribute to the quality of care being offered to patients," said Draper. "These evidence-based guidelines standardise and strengthen this quality of care."

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