title: Consensus recommendations for essential vascular care in low- and middle-income countries.
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.
authors.affiliation: 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.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: 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.
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.affiliation: International Health and Management of Health Crises, National and Kapodistrian University, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Giannou
authors.affiliation: Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Mishra
authors.affiliation: Department of Surgery, Uniformed Services University, Bethesda, Md.
authors.forename: Norman
authors.initials: N
authors.lastname: Rich
authors.affiliation: Center for Global Health and Innovation, Stanford University, Palo Alto, Calif.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
authors.affiliation: Harborview Injury Prevention & Research Center, Department of Surgery, and Department of Global Health, University of Washington, Seattle, Wash.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.affiliation: 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.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D003131:Combined Modality Therapy; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D003697:Delphi Technique; D003906:Developing Countries / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D010348:Patient Care Team / Q000191:economics; D011203:Poverty / Q000191:economics*; D016730:Program Development; D058996:Quality Improvement / Q000191:economics; D019984:Quality Indicators, Health Care / Q000191:economics; D014652:Vascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*