Therapeutic Patient Education: A new deal for medical education?

Abstract

Nowadays, in developed countries with an aging population, chronic diseases necessitates the largest amount of medical care and their complications represent the main causes of hospitalization and of health costs. Differently from acute conditions, whose control largely depends on the physician, chronic diseases require the patients’ compliance and their active involvement in the management of their daily life, thanks to a transfer of medical competencies. The concepts of patient’s empowerment, patient–physician partnership and therapeutic alliance, which are more and more frequently discussed in the medical literature, are directly linked to this new attribution of roles and responsibilities within the frame of chronic diseases. Since the pioneering study of Miller & Goldstein (1972), who showed that the education of young diabetics in the Los Angeles County Hospital results in an important reduction of admissions and costs, Therapeutic Patient Education (TPE) has been recognized by World Health Organization (WHO 1998) as a major component of the treatment and long-term follow-up of many long-term diseases. At present, a large number of TPE programs are routinely held for several chronic diseases (diabetes, asthma, chronic heart failure, rheumatoid arthritis, obesity, etc.) in different settings (hospital, community health, etc.), evaluated by an increasing amount of meta-analyses and randomized control trials (Albano et al. 2009). WHO defines TPE as a process enabling the chronic patient and his family ‘‘to manage his treatment and prevent avoidable complications while maintaining or improving his quality of life’’. TPE programs are planned, run and evaluated by multiprofessional teams of health care providers, trained in the methodology of patient education. Even if modern medical curricula (Dent & Harden 2009) pay considerable attention to the patient–physician communication and expose the students to some educational methodologies (learning how to learn, peer-teaching, lifelong learning, etc.), this might be insufficient to prepare the future physician to teach efficiently the patient and/or to manage a