Περίληψη:
Objective Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. Methods The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. Results The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. Conclusions The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers. © 2016 Society for Vascular Surgery
Συγγραφείς:
Stewart, B.T.
Gyedu, A.
Giannou, C.
Mishra, B.
Rich, N.
Wren, S.M.
Mock, C.
Kushner, A.L.
Stewart, B.T.
Gyedu, A.
Alexander, P.
Amponsah-Manu, F.
Dardik, A.
Darko, N.-D.
Elster, E.
Giannou, C.
Harris, M.J.
Johnston, L.
Junkins, S.
Kokuro, C.
Kuwayama, D.
Labi-Addo, W.
Mishra, B.
Morna, M.
Oppong-Nketia, V.
Orgoi, S.
Quiroga, E.
Remick, K.
Tai, N.
Veller, M.
Yangi-Angate, H.
Rich, N.
Mock, C.
Kushner, A.L.
Λέξεις-κλειδιά:
acetylsalicylic acid; beta adrenergic receptor blocking agent; calcium channel blocking agent; coumarin; dipeptidyl carboxypeptidase inhibitor; glucose; heparin; hydroxymethylglutaryl coenzyme A reductase inhibitor; ivermectin; low molecular weight heparin; protamine; vitamin K group; warfarin, anticoagulant therapy; Article; cardiovascular system examination; cerebrovascular accident; clinical evaluation; compartment syndrome; consensus; counseling; deep vein thrombosis; Delphi study; doppler device; health care planning; health care survey; human; Human immunodeficiency virus infection; low income country; major clinical study; medical care; middle income country; patient referral; portable equipment; preventive medicine; priority journal; screening; sphygmomanometer; tertiary care center; tourniquet; vascular disease; consensus; developing country; economics; health care cost; health care quality; integrated health care system; multimodality cancer therapy; patient care; poverty; practice guideline; program development; total quality management; Vascular Diseases, Combined Modality Therapy; Consensus; Delivery of Health Care, Integrated; Delphi Technique; Developing Countries; Health Care Costs; Humans; Patient Care Team; Poverty; Program Development; Quality Improvement; Quality Indicators, Health Care; Vascular Diseases
