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Ital Heart J Suppl. 2000 Dec;1(12):1533-44.

[The ANMCO (National Association of Hospital Cardiologists) in a changing health care system. Consensus development of the Organizing Symposium of the XXXI National Congress of Cardiology--ANMCO; Florence, May 21, 2000].

[Article in Italian]
[No authors listed]


This year's symposium, while following the 30-year-old tradition of Organizational Symposia which have become a trademark of the National Association of Hospital Cardiologists (ANMCO) annual meetings, is characterized by a novel approach in terms of method and content. Prompted by the profound changes affecting the socio-cultural, organizational and economic context in which the Health Service operates, the Board of the Association decided to invite the community of hospital-based cardiologists to reflect on and make proposals concerning a number of leading topics not strictly related to the organization of hospital-based cardiology, but of a wider relevance pertaining to the whole issue of the relationship between a Scientific Society and the other components of the Health Service: national and regional institutions, other doctors, the lay public and the pharmaceutical industry, etc. The main aim of this exercise was to stimulate the Society to adapt to a changing environment and so render it more capable of effectively fulfilling its duties. Naturally the larger the consensus regarding the strategies to adopt the greater this efficacy will be. Out of the many possible subjects, four were chosen as preeminent: 1. ANMCO and research: what fields of research should be prioritized, and with what kind of internal organization, and external relations? 2. ANMCO and professional training: what should be the professional standards governing the cardiologist in a changing society, what strategies for continuing education and institutional accreditation? 3. ANMCO and the community-based Health Service: the need to establish clear and efficient organizational relations with community-based cardiology and especially with general practitioners, in order to ensure that the health service is in tune with the real world, guarantee real continuity of care and reduce unnecessary hospital admissions; 4. ANMCO and the general population: how to support the citizen-user in the imperfect health-market, how to first inform the patient and then guarantee true freedom of choice, how to respect the values of the patient, transcending ideological limits and proposing organizational solutions and a return to ethical guidelines. In order to be able to approach topics of this importance and complexity with some probability of success it is fundamental that a proper consensus is reached among the cardiological community which formulates and attempts to carry out any proposed strategy. Working hypotheses designed by a minority of the Society, even if authoritative, and "imposed" on the majority are destined to have a difficult and short life. These premises gave rise to the innovative method characterizing this Symposium: each of the four topics, once identified, was assigned to an expert member who produced a preliminary draft including some proposals. These drafts were circulated to all members of the Association some months prior to the conference, in order to allow for any new comments, proposals and criticisms. This interaction with the members allowed us to collect grass-root opinions which were then organized into their respective topics by one discussant for each topic, who acted as spokesman at the conference. During the Symposium the expert member for each topic summarized his proposals and initial thoughts (already known to all members) while the discussant represented the opinions of the members; finally each topic was open to debate. The last step of this complex procedure was a meeting of the symposium panel made up of the chairmen, speakers and discussants who drafted a consensus document representative of all the opinions discussed at the Symposium. What follows is the consensus document on the four chosen topics for the general information of all the members and for proposal to the Board of the Society who will take the executive decisions. Chapter 1. The speed with which technology is improving and medical knowledge increasing is creating a gap between biological research and clinical research and another gap between clinical research and its application in daily practice. The task any medico-scientific society must set itself is to bridge these gaps by integrating research and the diffusion of its results - i.e. training. ANMCO actively carries out both functions but lacks the organs which could produce far-reaching scientific research strategies. This document reports the aims and ways of resolving this structural problem. Chapter 2. Continuing medical education aimed at maintaining and developing the knowledge of a medical professional, represents a cultural requirement and now it has become a legislative duty also in Italy. During a symposium held on the occas

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