Évaluation des effets du programme d’éducation thérapeutique Bipolis® sur le parcours de santé des participants entre mars 2009 et juillet 2017

Abstract

ObjectivesBipolis® is a therapeutic patient education program for people with bipolar disorders from healthcare institutions in the Occitania region, designed and implemented by Dr Barbara Combes. This program is based on the SARA® method (Ambulatory Recovery Assistance Internship), four independent and complementary sub-programs. This innovative therapeutic and pedagogical approach incorporates therapeutic knowledge in four areas of activity (Appropriation of the disease, Relapse, Sociality, Hygiene of Life) and invests the working postures of the patient and the specific professional ETP caregiver. It adopts original ETP techniques in “common axes of strength” in each SARA ® sub-program to understand psychic functioning, address states of stability and instability, and the fundamental problems of psychiatric pathology. A Free Enrolment Modality was used depending on the patient's desire to learn skills, self-care strategies and adaptive strategies. We explored its impact on the recurrences of bipolar disorder, the degree of patient's satisfaction and the perceived quality of life. MethodsOur work constitutes a retrospective survey of cohort exposed versus non-exposed research, whose target population is patients with bipolar disorder who participated in Bipolis® between March 2009 and July 2017, with whom we have compared a sample of controls based on gender, age, and the year of the beginning of follow-up at the counselling center who did not participate in the Bipolis® program (non-exposed group). Our study consisted of analyzing the data contained in the patients’ medical files and conducting a telephone questionnaire. We included 55 patients in the exposed group and 50 in the non-exposed. The primary endpoint is the number of psychiatric hospitalizations occurring at 2 years and at 5 years following the index date. The index date (T0) is the end date of participation in the 4 SARA® sub-programs of Bipolis® for the exposed patients. ResultsOur study established a significant link between Bipolis® and the number of hospitalizations at either 2 or 5 years following the end of the program. In effect, at 2 years after the program (involuntary admission in psychiatric care at the request of a third party) we observed an 80 % decrease in ASPDT hospitalizations. In the 5 years following the end of the program, we noted that the implementation of the Bipolis® program is associated with an overall decrease in hospitalizations (all categories combined) and more precisely a drop of 41.17% in voluntary hospitalizations. As for the results regarding the impact of Bipolis® on destabilizations treated on an outpatient basis, we find, however, that within 2 years, they are fewer in number but the differences are not significantly conclusive. Whereas at the 5-year mark following the end of the program, there is a 34.62% decrease in destabilizations for those patients in outpatient care. We can therefore hypothesize that, surprisingly, Bipolis® seems to provide better protection from outpatient relapse at 5 years, than at 2 years. Several hypotheses can be suggested : in the first place, 31% of the Bipolis® patients we included participated in at least one other SARA® program and therefore did more than 4 SARA® programs, or at least one SARA®, after their T0 when they personally felt the need for reinforcement. The results of the questionnaire show that Bipolis® improves the patients’ perception of their mental and physical health. 93.1% of patients found that Bipolis® helped them in understanding and accepting treatment, and 85.7% of the patients were able to identify complementary non-medicinal strategies and to distinguish between them and chemical treatments. Bipolis® allows patients to feel less limited in carrying out domestic tasks, establishing social links, participating in leisure activities or setting up projects. It also reduces the difficulties experienced by patients in the workplace. ConclusionBipolis® reduces the severity of hospitalizations: in fact, 2 years after the end of the program, there is an 80% reduction in ASPDT hospitalizations in the exposed group compared to the non-exposed Bipolis® group. In the long term, this same program reduces the number of hospitalizations at 5 years following the end of the program and particularly for voluntary hospitalizations. Outpatient destabilizations are also reduced over the same period. This program is also associated with an improvement in the patients’ quality of life.