Background
to the CARPA-STM:
what it is for and where it comes from
History
The Central Australian Rural Practitioners Association
(CARPA) is an educational forum and support network for rural practitioners
that began in 1984. Its sphere of influence has grown over the years
to include the Central Australian regions of the Northern Territory,
Western Australia, South Australia, the Top End of the Northern Territory
and parts of Northern Queensland and Northern Western Australia. The
main activities of CARPA are twice yearly conferences, twice yearly
editions of the CARPA newsletter and production of the Standard Treatment
Manual (STM).
The
CARPA-STM has become the Territory Health Service endorsed manual
for use in remote health centres throughout the Territory. It is
also the main clinic handbook used in all Aboriginal health Services
in the Territory and surrounding Central Australian region.
Three
editions have been published and a formal evaluation was done on
the second edition. An evaluation of the third edition (1997) is
underway in May-August 2001. The 1994 evaluation confirmed the local
anecdotal reports of the manual being widely and regularly used
and having established an important role in standardizing clinical
practice and greatly helping remote staff face the challenges of
remote (mostly Aboriginal Health) work.
Need
Unfortunately,
in many remote health services there is high staff turn over with
new staff often having little specific training for their new remote
practice roles. Staff come from a wide range of backgrounds and experience.
This is particularly true of the non-aboriginal staff. Aboriginal
Health Workers, Remote Area Nurses and remote area doctors can all
benefit from clear appropriate guidelines on the management of important
conditions.
The
scope of the intended audience of the STM includes literate AHWs,
RANs and Drs. Non-literate AHWs (and all staff) also benefit from
standardization of clinical practice so the "learning by seeing
and doing" is consistent.
The
content of the STM includes
- common
conditions (such as STIs, Diabetes),
- life
threatening conditions that can benefit from emergency procedures
(eg pneumothorax)
- guidance
on common conditions that might otherwise be intimidating for
staff (such as psychotic patient)
- and
guidance on issues of public health importance relevant to clinical
practice (such as early intervention for chronic disease, and
smoking interventions, TB).
Strengths
The
STM has evolved to include what remote practitioners want, this has
happened through the collective experience of the editors, contributors,
reviewers and feedback through formal and informal evaluations. It
is essentially a manual by remote practitioners for remote practitioners.
The result is a manual that benefits the public through promoting
appropriate clinical practice and assisting practitioners to do a
job they may not have been specifically trained for. It benefits the
practitioners by offering realistic guidance that is scientifically
sound and benefits from years of collective experience.
The
STM is brief, uses plain English, is updated each 3-4 years and
is culturally appropriate for use in remote Aboriginal communities.
Because of these factors and the wide sense of "ownership"
by remote practitioners it is widely used and endorsed by most health
services in the Territory. The STM has a real capacity to improve
health care in central and Top End Australia.
The
STM brings the considerable collective experience and wisdom of
remote area practitioners and regional experts to bear on the recent
relevant literature. It delivers it in a standardised format that,
though simple, appears to be usable and very well accepted. All
the protocols are reviewed by remote practitioners (end users) for
clarity, practicality and acceptability before finalisation.
Acknowledged
limitations and compromises
The
STM has to be brief and this limits the amount of explanatory content
that can be included. For the most part it tells you what to do, not
necessarily why or how to do it. The "background document"
will explain the rationale and the CRANA procedures manual ( in press)
will explain how to do procedural things. The production of the STM
is essentially a voluntary project reliant on the good will and motivation
of practitioners. There is funding for a half time project officer
(coordinating editor) and professional formatting, artwork and editing
at the end of the project. We expect the initial printing to be more
than 5000 copies.
Themes
of style and content
"Better
is Best". An acceptable, manageable, applicable treatment is
more appropriate and will have better uptake than a more difficult
less manageable "best clinical practice". This will lead
to more net health gain (net clinical impact) than a "best practice"
that is seldom implemented.
The
style and format of the 4th edition will probably remain
very similar to the 3rd edition, pending feedback from
the evaluation currently underway.
For
more information contact members of the core group via the
contact page
|