Therapeutic Patient Education (TPE) and health education in spa centers in France

Abstract

Therapeutic Patient Education (TPE) aims to help patients manage their lives better with chronic illness Spa centers are good places for the TPE for many reasons: groups of homogeneous and motivated patients, sufficient duration of the stay and presence of competent health professionals to ensure therapeutic education In France TPE programs are governed by an opposable regulation and an obligation of evaluation. The stakeholders must have a specific training of at least 40 hours. Programs are licensed for 4 years by regional health agencies (RHA). A TPE program consists of: 1°) an individual session of elaboration of the educational diagnosis or its updating to identify the needs and expectations of the patient, formulate with him the skills to be acquired and the learning priorities, and define a personalized action program, 2°) collective or individual therapeutic or alternating therapeutic education sessions for the acquisition of self-care skills and the mobilization or acquisition of adaptive skills and their maintenance, 3°) an individual assessment session of skills acquired, changes implemented by the patient in his daily life and the progress of the individualized program, 4°) a coordination of health professionals involved in the management of chronic disease around and with the patient TPE programs in French spa centers are proposed in addition to the classic spa treatment In 2018 in France TPE programs have been authorized by the RHA for several spa centers for the following twelve indications: fibromyalgia, lower limb osteoarthritis, rheumatoid arthritis, overweight and metabolic syndrome, post-bariatric surgery, type 2 diabetes, venous insufficiency, lymphoedema, psoriasis, eczema, asthma and post breast cancer Some of these TPE programs have been the subject of evaluation studies by AFRETH (Association Francaise pour la Recherche Thermale) One of the main problems of TPE programs is its cost, which is entirely the patient's responsibility because it is not reimbursed by the health system Beside the labeled “TPE programs” authorized by RHA, many other simpler health education programs, not labeled TPE and not requiring authorization from RHA, are organized in French spa centers: stopping smoking, benzodiazepine withdrawal, chronic low back pain education, prevention of falls, Parkinson‘disease, support for patients with Alzheimer's disease and their caregivers, etc. In conclusion more and more TPE programs and health education are developing in French spa centers. The value of these programs must continue to be evaluated.