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Table 7 Using PACK Child to make a transition from acute symptom to chronic illness management.

From: Addressing the quality and scope of paediatric primary care in South Africa: evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

In a Phase 3 facility a four-year-old girl reports to the clinic with a cough, recurrent wheeze and at the beginning of the consultation the mother reports that the child has asthma. The child was nebulised before the consultation, and no wheeze is heard on auscultation by the nurse. The expected route through the PACK Child guide would be to start with the routine care page for every visit, then refer to the wheeze symptoms page to manage acute symptoms, finishing with the asthma routine care in the long-term health condition section.

The clinical nurse practitioner initially refers to the cough page in the PACK Child guide and then navigates to the recurrent wheeze page. She diagnoses the child with allergic rhinitis and prescribes a nasal spray and cetirizine. The mother reports having enough “pumps” but the nurse doesn’t clarify what this includes and prescribes budesonide metered dose inhaler, advising the caregiver that it needs to be taken twice a day and Ventolin (salbutamol) used when necessary. The nurse only briefly refers to the asthma routine care page and does not ask the caregiver about the child’s history of exacerbations or hospitalisations. However, following use of  PACK Child the nurse advises the caregiver to book a review appointment in 3 months.

 

Nurse/caregiver talk

(…) unclear talk

Use of PACK Child guide

CG

She is asthmatic, she comes here for oxygen. I do put her on the nebulizer at home, but it doesn’t actually help, because she was coughing all week. I had her on the nebulizer last night, but then this morning I told her it would be better if I bring her for the oxygen. They did examine her, they gave her a dosage. So they gave her one this morning. Like the cough just didn’t want to go away

 
 

(…)

 

N

Okay, the mom is complaining of a cough, so I go to the contents page.

 

CG

(…) She’s forever chesty (...).

 

N

The child with breathing problems may have noisy breathing, wheeze. Did she have a wheeze this morning, before they nebulized her?

Checking PACK Child cough page

CG

Last night they nebulized her.

 

N

And this morning I saw that they gave her a nebulizer?

 

CG

Umm no, no::t this morning. Probably they gave her oxygen, yes.

 

N

But it’s a nebulizer.

 

CG

Okay