PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents

Abstract

Pioneering strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.

Keywords: child health; health systems; paediatrics; practice guidelines as topic; public health.

Figure 1

Steps in the development of the PACK Child clinical decision support tool. NICE, National Institute for Health and Care Excellence; PACK, Practical Approach to Care Kit; SIGN, Scottish Intercollegiate Guidelines Network.

Figure 2

(A) Example of a symptom-based approach page. Each symptom is arranged on its own page with a ‘red box’ prefacing a simple algorithm. The ‘red box’ identifies and directs care for the child who needs urgent attention and referral to another level of care. For the child not requiring urgent attention, an algorithm directs the health worker to a likely diagnosis and provides primary care management as well as appropriate referral prompts where a condition is complex, there has been poor response to initial treatment or there is any doubt about a diagnosis. (B) Example of a standardised approach to routine care page. Structured approach to the routine care of a child with a long-term health condition: what to ‘assess’ and when, what to ‘advise’ the carer and child, and how to ‘treat’ the condition. The page also illustrates how PACK Child promotes the recognition of possible comorbid conditions. Three tones of grey in the ‘assess’ table delineate history, examination and investigations. (C) Routine care of the child is integrated into every visit. Growth is emphasised in the routine preventive care section with step-by-step, illustrated guidance on measuring, plotting, interpreting and reacting to growth parameters. ART, antiretroviral therapy.