Strategies for health education in cardiology

Health education still lacks content and represents an undefined field. Nevertheless, it may be a cheap, simple and reliable tool to offer the public, thus giving them knowledge concerning the prevention and the treatment of and the rehabilitation from heart disease. Different strategies are available, but it is of paramount importance for physicians and nurses working in the field of cardiology, to change their attitude in approaching patients and to have specialized training. Numerous post-graduate courses dealing with new diagnostic and therapeutic procedures are continuously conducted in our Country. On the contrary, very little has been done to stimulate medical staff to be interested in acquiring knowledge of prevention and health education methodology and practice. Health policy should therefore be directed to this goal, and the performance of the Centres of Cardiology might be augmented with the help of volunteer organizations.     

Theoretical bases of health education in cardiology: prevention of rheumatic diseases

Today also in Italy rheumatic disease shows a reduction of its prevalence, however it is still significant present in South Italy, especially among poorer and less educated social groups. We have to research the reasons why there is not yet an effective antistreptococcus vaccine, why there is not a penicillinic prophylaxis quite accurate and capillary, moreover why there is little interest among the majority of politicians and medical personnel regarding those social and sanitary situations, which encourage the rheumatic disease in the poor. Especially in the South, in spite of diffused improvement of the economic welfare, a good health education program has not developed. It should be done by law methodically and very seriously, inside and outside the hospitals, the schools and in the communities, taking advantage of all means especially radio and television, which are now only used for advertisements, that often are only diseducative.     

Economic evaluation in the field of cardiology: Theory and practice

Economic evaluations figure largely in health care. Economic evaluation aims at offering structured information about the balance between costs and effects of a intervention in comparison to another intervention. Four basic types of economic evaluation studies exist: cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. In deciding which types of evaluation should be used in the analysis, the aim of the analysis is determinative. This article illustrates the theory of economic evaluation and concentrates on its use within cardiology. Finally, this article describes the project "Appropriate Medical Care," a project developed by the Royal Dutch Medical Association. In this project results from cost-effectiveness analysis will be taken into consideration in forming guidelines for the treatment of coronary artery diseases.     

Cost efficiency of nuclear cardiology services in the modern health care environment

More than a decade of dramatic changes in US and global health care has affected the practice of and payment for nuclear cardiology services. The clear diagnostic and prognostic power of nuclear cardiology procedures to detect coronary artery disease and predict patient outcomes has resulted in the rapid growth of these procedures in clinical practice. This has focused the attention of public and private payers on the high use of medical resources required to carry out nuclear cardiology testing. Two recent, major multicenter trials, one in the United States and another in Europe, have demonstrated the cost effectiveness of stress myocardial perfusion imaging strategies compared with coronary angiography in patients with known or suspected coronary artery disease, across the spectrum of pretest risks and both sexes. These studies, and more extensive data from more than 10 years of decision analysis, have reinforced the value of nuclear cardiology in modern cardiovascular health care. Future challenges will include assurance of provider and laboratory quality in the burgeoning outpatient imaging centers across the country, and wider acceptance by payers and expert panels of the evidence supporting the cost effectiveness of nuclear cardiology in most clinical settings.     

The current situation in training and education of assistant staff in interventional cardiology

The number of heart catheter laboratories in Germany has been increasing for years. While there are general training regulations for cardiologists, nothing comparable exists for the assistant staff in interventional cardiology. Qualification is settled within the department. Aim of this study was the determination of the demand in general training and qualification courses. All heart catheter laboratories in North Rhine-Westphalia were questioned. Assistants (227) and medical directors (43) from 48 laboratories (54.0% returns) answered. Of the assistants 59.1% were qualified nurses, 28.2% consulting room assistants, and 10.1% medical technicians. Most of them were female (85.0%); the average age was 34.3 years. Of the assistants 73.1% were not trained in their current hospital or practice. Before their occupation in cardiac catheterization, 51.8% worked in nursing and 17.6% in ECG, sonography, etc. None of the 227 assistants was still in training at the time of questioning although 68.3% of the hospitals and practices accept trainees. Nine out of ten laboratories offer inhouse qualification, mainly in radiation protection (82.1%) and medical fields (66.7%), and 85.3% of the assistants have already attended these. Of the medical directors 90.0% and 99.2% of the assistants consider general training and qualification courses to be necessary. When asked for important fields for training programs, the assistant staff mentions "medicine" (77.6%), "examination assistance" (67.0%), and "EDP" (60.4%), while the medical directors place importance on "quality management" (89.2%) and "radiation protection" (86.5%). The job market for assistants the interventional cardiology is still good: 14.3% of the laboratories plan to take on new employees, 61.9% want to keep their number of assistants. The share of part-time work is low (16.8%). The momentary qualification and training of assistant staff in interventional cardiology does not match the demand. General programs for trainees with universally applicable teaching objectives and examination regulations are necessary.