Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
Population Health Research Institute, Hamilton, Ontario, Canada.
Glob Heart. 2018 Jun;13(2):93-100.e1. doi: 10.1016/j.gheart.2017.11.002. Epub 2018 Jan 10.
Cardiovascular disease (CVD) is the leading cause of death worldwide. The need to address CVD is greatest in low- and middle-income countries where there is a shortage of trained health workers in CVD detection, prevention, and control.
Based on the growing evidence that many elements of chronic disease management can be shifted to nonphysician health care workers (NPHW), the HOPE-4 (Heart Outcomes Prevention and Evaluation Program) aimed to develop, test, and implement a training curriculum on CVD prevention and control in Colombia, Malaysia, and low-resource settings in Canada.
Curriculum development followed an iterative and phased approach where evidence-based guidelines, revised blood pressure treatment algorithms, and culturally relevant risk factor counseling were incorporated. Through a pilot-training process with high school students in Canada, the curriculum was further refined. Implementation of the curriculum in Colombia, Malaysia, and Canada occurred through partner organizations as the HOPE-4 team coordinated the program from Hamilton, Ontario, Canada. In addition to content on the burden of disease, cardiovascular system pathophysiology, and CVD risk factors, the curriculum also included evaluations such as module tests, in-class exercises, and observed structured clinical examinations, which were administered by the local partner organizations. These evaluations served as indicators of adequate uptake of curriculum content as well as readiness to work as an NPHW in the field.
Overall, 51 NPHW successfully completed the training curriculum with an average score of 93.19% on module tests and 84.76% on the observed structured clinical examinations. Since implementation, the curriculum has also been adapted to the World Health Organization's HEARTS Technical Package, which was launched in 2016 to improve management of CVD in primary health care.
The robust curriculum development, testing, and implementation process described affirm that NPHW in diverse settings can be trained in implementing measures for CVD prevention and control.
心血管疾病（CVD）是全球范围内的主要死因。在中低收入国家，由于心血管疾病的检测、预防和控制方面缺乏训练有素的卫生工作者，因此对心血管疾病的干预需求最大。
基于越来越多的证据表明，许多慢性病管理的要素可以转移到非医师卫生保健工作者（NPHW）身上，HOPE-4（心脏结局预防和评估计划）旨在开发、测试和实施针对心血管疾病预防和控制的培训课程，该课程在哥伦比亚、马来西亚和加拿大资源匮乏地区进行。
课程开发遵循迭代和分阶段的方法，其中纳入了基于证据的指南、修订后的血压治疗算法和具有文化相关性的风险因素咨询。通过在加拿大高中生中进行的试点培训过程，对课程进行了进一步的改进。该课程在哥伦比亚、马来西亚和加拿大的实施是通过合作伙伴组织进行的，而 HOPE-4 团队则从加拿大安大略省汉密尔顿协调该计划。除了有关疾病负担、心血管系统病理生理学和 CVD 风险因素的内容外，该课程还包括模块测试、课堂练习和观察性结构化临床检查等评估，这些评估由当地合作伙伴组织进行。这些评估既是对课程内容充分吸收的指标，也是作为 NPHW 在该领域工作的准备程度的指标。
总体而言，有 51 名 NPHW 成功完成了培训课程，模块测试的平均得分为 93.19%，观察性结构化临床检查的平均得分为 84.76%。自实施以来，该课程也已适应世界卫生组织的 HEARTS 技术包，该技术包于 2016 年推出，旨在改善初级卫生保健中心的 CVD 管理。
所描述的稳健的课程开发、测试和实施过程证实，不同环境中的 NPHW 可以接受培训，以实施 CVD 预防和控制措施。
