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e-PC101: an electronic clinical decision support tool developed in South Africa for primary care in low-income and middle-income countries
  1. Matthew Yau1,
  2. Venessa Timmerman2,
  3. Merrick Zwarenstein3,
  4. Pat Mayers2,
  5. Ruth Vania Cornick2,
  6. Eric Bateman2,4,
  7. Lara Fairall2,4
  1. 1 University of Toronto Medical School, Toronto, Ontario, Canada
  2. 2 Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
  3. 3 Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  4. 4 Department of Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Matthew Yau; matt.yau{at}


Health technology is increasingly recognised as a feasible method of addressing health needs in low and middle-income countries (LMICs). Primary Care 101, now known as PACK (Practical Approach to Care Kit), is a printed, algorithmic, checklist-based, comprehensive clinical decision support tool. It assists clinicians with delivering evidence-based medicine for common primary care presentations and conditions. These assessment and treatment guides have been adopted widely in primary care clinics across South Africa. This paper focuses on the process of designing, developing, and implementing a digital version of the clinical decision support tool for use on a tablet computer. Lessons learnt throughout its development and pilot implementation could apply to the creation of electronic health interventions and the digitisation of clinical tools in LMICs.

  • Other diagnostic or tool
  • public Health

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  • Handling editor Seye Abimbola

  • Contributors MY performed the analysis of results and drafted the paper. VT contributed to the development of the device. PM and VT performed the field testing. MZ, LF, RVC and EDB were involved in the concept and design of the evaluation and the analysis of results. All authors contributed substantially to the drafting and revision of the manuscript and approved the final version.

  • Funding Financial support for this project was received from Medical Device Innovation Platform of the South African Medical Research Council and from the University of Cape Town Lung Institute.

  • Competing interests MY and MZ declare no competing interests. LF and RVC are employees of the University of Cape Town Lung Institute. VT is an ex-employee of the University of Cape Town Lung Institute. PM was an employee of the University of Cape Town. EDB is a part-time employee of the University of Cape Town Lung Institute, and reports personal fees from ICON, Novartis, Cipla, Vectura, Menarini, ALK, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants to his institution for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann-La Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All EDB’s fees and clinical trials are for work outside the submitted work. EDB is a member of the Global Initiative for Asthma Board and Science Committee. Since August 2015 the KTU and BMJ have been engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate licence PACK content. The KTU and BMJ cofund core positions, including a PACK Global Development Director, and receive no profits from the partnership. PACK receives no funding from the pharmaceutical industry. This paper forms part of a Collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary healthcare as envisaged in the Declaration of Alma Ata, during its 40th anniversary.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.