Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases.
Task-shifting for cardiovascular risk factor management: lessons from the Global Alliance for Chronic Diseases.
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DOI：
10.1136/bmjgh-2018-001092
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发表时间：
2018
影响因子：
8.1
通讯作者：
Yeates KE
中科院分区：
文献类型：
--
作者：
Joshi R;Thrift AG;Smith C;Praveen D;Vedanthan R;Gyamfi J;Schwalm JD;Limbani F;Rubinstein A;Parker G;Ogedegbe O;Plange-Rhule J;Riddell MA;Thankappan KR;Thorogood M;Goudge J;Yeates KE
将任务转移给非医生卫生工作者（NPHW）是管理传染病和改善孕产妇和儿童健康的有效模式。没有足够的证据表明NPHW管理心血管疾病（CVD）的有效性。2012年，全球慢性病联盟资助了8项研究，重点是将任务转移到NPHW以管理高血压。我们报告从实地吸取的教训。从每项研究中，我们获得了有关转移任务类型、转移任务的专业水平、提供的培训和面临的挑战的信息。此外，我们还收集了关于整个实施过程中“吸取的教训”以及每个项目中出现的“从设计到实施”的变化的更详细的数据。转移到NPHW的任务包括个人筛查，转介医生进行诊断和管理，改善生活方式的患者教育，跟踪和提醒服药依从性和预约。在四项研究中，任务从医生转移到NPHWs，在四项研究中，两个不同级别的NPHWs之间共享任务。培训方案为期3至7天，并定期进行复习培训。两项研究使用了临床决策支持工具和移动的健康组件。所面临的挑战包括系统层面的障碍，如无法开药、非公共卫生工作者的技能组合不同、工作量大和工作人员流动率高。随着低收入和中等收入国家（LMIC）卫生人力的严重短缺，实现更好的预防和控制心血管疾病的健康结果是一项重大挑战。任务转移或分担为中低收入国家的心血管疾病管理提供了一个切实可行的模式。
Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on ‘lessons learnt ’ throughout the implementation process and ‘design to implementation’ changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.
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影响因子：
4.5
作者：
Iwelunmor J;Gyamfi J;Plange-Rhule J;Blackstone S;Quakyi NK;Ntim M;Zizi F;Yeboah-Awudzi K;Nang-Belfubah A;Ogedegbe G
通讯作者：
Ogedegbe G
影响因子：
4.5
作者：
Gilmore B;McAuliffe E
通讯作者：
McAuliffe E
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影响因子：
2.5
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Vedanthan R;Kamano JH;Naanyu V;Delong AK;Were MC;Finkelstein EA;Menya D;Akwanalo CO;Bloomfield GS;Binanay CA;Velazquez EJ;Hogan JW;Horowitz CR;Inui TS;Kimaiyo S;Fuster V
通讯作者：
Fuster V
影响因子：
4.5
作者：
Scott K;Beckham SW;Gross M;Pariyo G;Rao KD;Cometto G;Perry HB
通讯作者：
Perry HB
影响因子：
2.5
作者：
Thorogood M;Goudge J;Bertram M;Chirwa T;Eldridge S;Gómez-Olivé FX;Limbani F;Musenge E;Myakayaka N;Tollman S;Twine R
通讯作者：
Twine R