Barclay T Stewart1, Adam Gyedu2, Christos Giannou3, Brijesh Mishra4, Norman Rich5, Sherry M Wren6, Charles Mock7, Adam L Kushner8. 1. 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. Electronic address: stewarb@uw.edu. 2. 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. 3. International Health and Management of Health Crises, National and Kapodistrian University, Athens, Greece. 4. Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India. 5. Department of Surgery, Uniformed Services University, Bethesda, Md. 6. Center for Global Health and Innovation, Stanford University, Palo Alto, Calif. 7. Harborview Injury Prevention & Research Center, Department of Surgery, and Department of Global Health, University of Washington, Seattle, Wash. 8. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Surgeons OverSeas (SOS), New York, and the Department of Surgery, Columbia University, New York, NY.
Abstract
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.
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.
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