Primary Care 101: Knowledge Translation Unit, University of Cape Town, South Africa

Primary Care 101 is a set of evidence-based, carefully designed guidelines that cover all the conditions likely to affect adults in primary-care clinics in South Africa. These clinics are staffed mainly by nurses who have considerable experience of treating patients with HIV infection but little training in managing patients with NCD and other conditions common in primary care. The nurses receive the guidelines to study and follow. Unlike most guidelines, these guidelines are symptom-based rather than disease-based.

The nurses also receive non-didactic, case-based training in their places of work, conducted by their own nurse managers, who have themselves been trained as educators for this purpose. This scheme represents a significant departure from the traditional model of in-service training for primary-care health workers. In that model, the training is intensive and didactic, and it is conducted off-site and hence out of context, with little attempt made to integrate it with the clinical setting.

The Knowledge Translation Unit of the University of Cape Town has already shown in a
randomised trial that this double strategy – the use of guidelines and the onsite training of nurses– can improve the care of patients with respiratory conditions.13 In a separate trial, the unit showed that when onsite non-didactic, case-based training was given to nurses who manage patients with HIV, their patients’ received improved comprehensive care.13 A third trial showed that the training approach improves the quality of HIV care in a particular context – namely, when responsibility for antiretroviral prescribing shifts from doctors to nurses; however, the training approach did not improve survival rates or accelerate initiation of antiretroviral treatment among patients on waiting lists. The approach to in-service training of frontline staff has now been adopted by the South African Department of Health; and a similar, earlier approach for addressing HIV/AIDS and TB has been rolled out to more than 17,000 health workers in 1800 clinics across the country – a third of this roll-out took place in less than one year.

The double strategy – the use of the Primary Care 101 guidelines and the onsite training – is now being tested in a randomised controlled trial in the Western Cape, to see if it can improve the care of people with NCD.