Stewart Barclay T, Gyedu Adam, Giannou Christos, Mishra Brijesh, Rich Norman, Wren Sherry M, Mock Charles, Kushner Adam L
Department of Surgery, University of Washington, Seattle, the School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, and the Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and the Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
J Vasc Surg. 2016 Dec;64(6):1770-1779.e1. doi: 10.1016/j.jvs.2016.05.046. Epub 2016 Jul 16.
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.
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.
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.
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.
许多低收入和中等收入国家（LMICs）在应对日益沉重的血管疾病负担方面能力不足。我们旨在制定基本血管护理建议，使其在全球几乎所有环境中都可行实施，而不论国家收入情况。
采用规范德尔菲法，让27位血管护理和公共卫生多个领域的专家以及有低收入和中等收入国家医疗保健经验的专家就基本血管护理资源达成共识。通过五轮匿名、迭代的调查，进行可控反馈和统计回应，以就基本血管护理资源达成共识。
这些矩阵为大多数低收入和中等收入国家四个护理级别（包括初级卫生中心以及一级、转诊和三级医院）中的92种血管护理资源提供了建议。建议包括基本资源和理想资源，涵盖以下类别：筛查、咨询和评估；诊断；医疗护理；外科护理；设备和用品；以及药物。
所推荐的资源有可能提高低收入和中等收入国家医疗保健系统应对日益沉重的血管疾病负担的能力。通过深思熟虑的规划和组织，可以提供许多这些资源，而无需大幅增加成本。然而，这些资源必须纳入一个框架，该框架包括血管疾病监测、血管能力和护理的监测与评估、运转良好的院前和院间运输系统，以及对现有和未来医疗保健提供者进行血管培训。
