Programmes

The programmes developed by the Knowledge Translation Unit aim to standardise and improve care delivered at primary level by nurses (or other non-physician clinician equivalents), doctors and lay health workers. Each programme consists of a clinical practice guideline and an implementation strategy and is underpinned by five principles:

1. The guideline aligns with policy and where feasible, is evidence-based.
2. Engagement with decision-makers and end-users improves uptake.
3. The implementation strategy of educational outreach can change practice. (1, 2, 3)
4. Training in primary care teams facilitates task-sharing. (4)
5. A cascade model of training allows for rapid scale-up.

The guidelines are designed to be concise and easy to use. A standardised format of algorithms and checklists simplifies the approach to the patient. The content is locally tailored and prioritises the care of common chronic conditions, both infectious and non-communicable. Guideline development and revision is collaborative, drawing on clinicians, patient advocacy groups, policy makers and end-users. This process invariably involves tackling policy issues like prescribing restrictions, scope of practice, discrepancies in recommendations and resource constraints.

A training strategy is more likely to result in practice change if time is limited between training and clinical decision-making, learning and practice are alternated, and training occurs over a prolonged period (5) – our educational outreach training sessions are short (1½ hours), on-site and multiple (eight sessions over 2–3 months). This minimises disruption to clinical services. Training is interactive, case-based and involves all facility staff; the team approach promoting functional integration of clinical care.

A cascade model of implementation allows for rapid scale-up and integration of the programme into the health system. The on-site training is delivered by nurses drawn from the health system (clinicians, managers, trainers) who are trained by master trainers during a facility trainers’ workshop. Workshop activities mirror an on-site training session. Facility trainers with leadership qualities and managerial support are selected as master trainers. A support programme for trainers and end-users establishes a community of practice (6) to provide a forum for problem solving and opportunities to reinforce training methodology and guideline use.

Cascade Model

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