Can non-physician health-care workers assess and manage cardiovascular risk in primary care?
Bulletin of the World Health OrganizationPublished 1 June 2007Open access
Dele Abegunde
Citations93
SJR quartileQ1
SJR score1.79
SNIP1.89
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TL;DR
Applying the WHO Cardiovascular Risk Management Package, NPHWs can be retrained to reliably and effectively assess and manage cardiovascular risks in primary health-care settings where there are no attending physicians.
Abstract
Applying the WHO Cardiovascular Risk Management Package, NPHWs can be retrained to reliably and effectively assess and manage cardiovascular risks in primary health-care settings where there are no attending physicians. The package could be a useful tool for scaling up the management of cardiovascular diseases in primary health care.
Keywords
MedicineBusiness, Management and Accounting
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78,934 Citations1977J. Richard Landis, Gary G. Koch
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Contemporary Sociology A Journal of ReviewsDiscrete Multivariate Analysis: Theory and Practice.
5,160 Citations1975James R. Beniger, Yvonne Bishop +4 more
Journal of Hypertension2003 European Society of Hypertension???European Society of Cardiology guidelines for the management of arterial hypertension*
3,009 Citations2003Guidelines Committee
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