ABSTRACT
The non-physician employees in telemedicine centers (TMC) play a decisive role in the care and treatment of patients with heart failure. For this reason, a holistic profile consisting of professional and methodological as well as social and personal competences is necessary, which should be built up or promoted in corresponding training concepts. This position paper underlines the urgency of appropriate and standardized further training of non-physician employees for quality assurance in TMCs and summarizes the requirements for the additional qualification of a telemedical assistant across the board.
Subject(s)
Heart Failure , Telemedicine , HumansABSTRACT
BACKGROUND: Until now, there has not been any evaluated, disease-specific education and treatment program for patients with coronary heart disease (CHD) in Germany. It is thought that education can improve these patients' physical activity and quality of life and teach them how to lessen their risk factors, what to do in case of an emergency, and how to assess their own medical treatment. METHODS: A randomized controlled open intervention trial was carried out from February 2010 to September 2011. 196 patients were assigned to receive the intervention (patient education), while 199 were assigned to a control group. In an intention-to-treat analysis, baseline and follow-up data were compared after a mean interval of 220 days. The evaluative instruments included the Freiburg Questionnaire of Physical Activity, the MacNew Heart Disease Quality of Life Questionnaire, questionnaires regarding knowledge about CHD, ergometric performance ability, and the body-mass index. RESULTS: The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week (MET=metabolic equivalent of task), compared to 2.5 MET/week in the control group; the difference of 6.8 MET/week was statistically significant (p = 0.015). The patients in the intervention group also rated their quality of life higher than those in the control group (0.2 ± 0.56 vs. 0.09 ± 0.53 [mean ± standard deviation], p = 0.056). They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency. CONCLUSION: Persistently unhealthy lifestyle is a common problem of CHD patients; the education and treatment program presented here may be a suitable means of improving patients' lifestyle for secondary prevention. Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well.
Subject(s)
Coronary Artery Disease/prevention & control , Coronary Artery Disease/psychology , Motor Activity , Patient Education as Topic/statistics & numerical data , Patient Participation/statistics & numerical data , Risk Reduction Behavior , Adolescent , Adult , Aged , Aged, 80 and over , Coronary Artery Disease/epidemiology , Female , Germany/epidemiology , Humans , Male , Middle Aged , Patient Education as Topic/methods , Patient Participation/psychology , Prevalence , Quality of Life/psychology , Risk Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Exercise therapy has a well-established place in the primary and secondary prevention of cardiovascular disease. But its evidence-based application, or even its development, within the framework of planned disease management programs in Germany is hampered by the limitations in the structural quality of the health/fitness facilities. METHOD: Review of the literature concerning the current structure of cardiovascular exercise therapy in Germany and the USA, including current guidelines for exercise therapy in primary and secondary prevention. RESULTS: The "heart groups" represent the only organization in Germany to adhere to certain quality standards, although certain limitations in the procedural quality of their programs must be acknowledged (the evidence-based securing of the programs is relatively restricted), and their overall capacity is limited. Alternative organizations, such as fitness centers or sports clubs, do not yet offer standards of quality or safety. In the USA, in particular, there are established guidelines for exercise therapy which are edited, evidence-based, peer-reviewed and applicable to all suppliers of exercise therapy. CONCLUSION: We suggest that such standards should be brought into operation within the German context and that,as far as possible, they should be extended to include statements of mode and duration of training. The resulting guidelines, after being implemented as standards, could serve as the basis for a certification procedure applicable to all health/fitness facilities.
Subject(s)
Cardiac Rehabilitation , Exercise Therapy , Adolescent , Adult , Age Factors , Cardiovascular Diseases/prevention & control , Child , Electrocardiography , Exercise Therapy/standards , Female , Germany , Humans , Male , Middle Aged , Physical Fitness , Primary Prevention , Quality of Health Care , Risk Assessment , Risk Factors , United StatesABSTRACT
BACKGROUND: Due to encouraging results of studies investigating the effects of physical activity and training on cardiovascular diseases and due to the integration of preventive strategies into disease management programs by public health organizations, it is expected that a larger population, including cardiovascular patients, will increasingly participate in physical activity, fitness programs, and sports. However, a reduction in cardiovascular events and all-cause mortality by regular physical activity is accompanied by an increased mortality during exertion, as yet, there is no satisfactory definition of risk for all cardiovascular diseases and patient groups. RISK EVALUATION: A cost-effective preparticipation screening has to consider both the low incidence of events resulting from different diseases which requires subtle diagnostics and the intention of granting the larger population simple access to exercise programs and sports. There is a substantial difference in the risk profile for fatal events in athletes and young fitness program participants on the one hand and older (> 35 years) exercising people with a higher incidence of common cardiovascular diseases on the other. Additionally, a potential exercise-induced progression of chronic heart diseases should be excluded. New imaging techniques, laboratory markers, and genetic indicators will hopefully improve the quality of risk assessment. CONCLUSION: Establishing standards for diagnostics and risk assessment as well as different types of exercise and training programs, all of which need to be transformed into national guidelines, could help to reduce risks without limiting access to physical exercise and therapy. However, an element of risk will remain if rational cost-effectiveness ratios are to be applied.
