Structured Patient Education Research Articles

Effectiveness of structured patient education on the knowledge level of adolescents and adults with congenital heart disease

Patients with congenital heart disease (CHD) have poor understanding of their heart condition, treatment and prevention of complications. To improve their level of health-related knowledge, a structured education program was implemented in the adult congenital heart disease program. This study aimed (a) to evaluate the level of knowledge of patients who received structured CHD education as compared to patients who did not receive this education; (b) to explore if the provision of structured education is an independent determinant of knowledge; and (c) to evaluate whether patients who received structured education reached the educational target (>80% correct answers). A total of 317 patients were included: 226 in the education group, and 91 in the comparison group. Knowledge was assessed using the 'Leuven Knowledge Questionnaire for Congenital Heart Disease'. The mean total knowledge score in the education group (57%) was significantly higher as compared to the comparison group (43%) (p<0.001). However, only 24 patients (11%) in the education group reached the educational target of the program. After adjusting for patient's age, educational level and disease complexity, hierarchical multivariable linear regression analysis showed that the provision of structured CHD education was an independent determinant of higher levels of knowledge. A structured education program was associated with a higher level of knowledge. However, the educational target for sufficient knowledge was reached in a very limited number of patients. Hence, continuous efforts in educating patients and developing alternative education methods are needed.

Pratiques d’éducation thérapeutique en psychiatrie. Enquête auprès des psychiatres hospitaliers d’Aquitaine

The aims of this study were to assess the characteristics of therapeutic education practice in French public psychiatric hospitals and to describe the ongoing patient education programs. We conducted an online survey. Adult and child psychiatrists (n=264) of Aquitaine's public hospitals (n=9) were asked to describe their daily educational practice using an internet questionnaire. Coordinators of patient education programs were invited to complete a specific questionnaire describing these programs. Of the 264 psychiatrists contacted, 95 participated in the only survey (participation rate 36%), 85.7% were adult psychiatrists and 14.3% child psychiatrists. Most psychiatrists (85% or more) "always or often" educated their patients on the disease (name, etiology, symptoms), its treatment and the prevention of relapses and complications. Other mental health professionals, such as nurses, were rarely involved in this educational process. Less than a quarter of the psychiatrists "always or often" invited their patients to participate in a structured patient education program. Twelve education programs were described by their coordinators (13.6% of the participants). Compared to non-coordinators, coordinators had graduated significantly more frequently less than 10years before (92% vs. 49%) but did not differ regarding other characteristics. Bipolar disorder (n=4) and schizophrenia (n=7) were the most frequent indications of these programs. Half of the programs were distributed by pharmaceutical companies. Almost half (45%) of the programs were opened to patient's carers and relatives. Increase in knowledge and competence were evaluated in 73% of the programs, and satisfaction in 64% of the programs. These findings have to be interpretated in the light of a possible selection bias favouring the participation of practitioners supporting or actively implicated in patient education, contributing to inflated estimates of the real frequency of educational practice in public psychiatric hospitals. On the one hand, our study shows a strong involvement of psychiatrists in patient therapeutic education in daily practice. On the other hand, very few structured programs were ongoing, mostly concerning bipolar disorder and schizophrenia, i.e. disorders for which evidence of efficiency of patient education has been demonstrated. These findings suggest that implementation of further patient education programs should be encouraged and that formation of further professionals is a priority.

Pie diabético

Diabetic foot includes a group of syndromes in which the interaction among loss of protective sensation due to sensory peripheral neuropathy, a change in pressure spots due to motor neuropathy, autonomic dysfunction, and decreased blood supply due to peripheral vascular disease can lead to the occurrence of wounds or ulcers usually related to minimal injuries that are usually unnoticed. Diabetic foot is associated with higher morbidity and a high risk of amputation of the foot or limb. These situations can be avoided with an appropriate prevention program, based on the early detection of diabetic neuropathy and assessment of the associated risk factors in addition to structured patient education. Also important are optimal treatment of the acute injury, with specific antibiotics and foot care measures that encourage early and effective healing.

National differences in ulcerative colitis experience and management among patients from five European countries and Canada: An online survey

Background and aimsPatients' and physicians' perceptions of ulcerative colitis and its management are important for developing and guiding appropriate therapies. This study explored national differences in patients' and physicians' experiences, expectations, and beliefs about ulcerative colitis. MethodsStructured, cross-sectional, online surveys evaluating various indices were completed by 775 adult patients with ulcerative colitis and 475 physicians actively managing ulcerative colitis patients from France, Germany, Ireland, Spain, the United Kingdom, and Canada. ResultsPatients' classification of their symptom severity differed across countries (mild, 16%–45%; moderate, 46%–58%; severe, 4%–36%). Expectations of disease control also varied, with 26% (Ireland) to 65% (Spain) describing that remission realistically involves “living without symptoms.” Within each country, more patients (45%–69%) than physicians (28%–45%) considered ulcerative colitis symptoms to affect patients' quality of life. Mean number of patient-reported flares during the past year ranged from 2.5 in Ireland to 8.0 in France. Self-reported adherence with oral 5-aminosalicylic acid (during remission) was highest in Spain (91% vs 50%–73% across other countries). Spanish patients were more likely to self-adjust their medications (54% vs 2%–5%), but reported the most dissatisfaction with therapy (42% vs 9%–27%). Irish patients were least likely to arrange physician/specialist nurse visits (14% vs 36%–49%) and least open to discussion of their condition. ConclusionsImportant national differences in ulcerative colitis patients' attitudes and perceptions were observed, which may help physicians improve patient care based on country-specific needs and influence self-assessments in clinical trials. The results suggest a need for structured patient education to improve adherence and outcomes.

A comparison of a short nurse-based and a long multidisciplinary version of structured patient education in irritable bowel syndrome

Structured multidisciplinary patient group education has positive effects on symptoms, health-related quality of life, and disease-related knowledge in patients with irritable bowel syndrome (IBS), but few studies comparing different forms of educational interventions are available. Our aim was to compare the effects of long multidisciplinary group education with a short nurse-based group education with regard to symptoms, knowledge, quality of life, and satisfaction with the intervention in IBS patients. Patients with IBS according to the Rome II criteria were randomized to either short nurse-based or a long multidisciplinary-based education. The effects were evaluated by self-administered questionnaires at 3, 6, and 12 months after baseline, and compared between the groups. No differences in effects were detected in the between-group comparisons at any of the follow-up assessments. However, positive effects on symptoms, knowledge, quality of life, and satisfaction with the intervention were found in both the short and the long version. A short, nurse-based educational intervention seems to be as efficacious as a longer multidisciplinary version. In both groups, positive effects on patients' well-being were found to a similar extent. This is an important finding that, from a cost-effective perspective, could contribute toward an optimized management of patients with IBS.

Managing post-operative intestinal failure through the virtual ward: An assessment of effectiveness and patient attitudes to a new model of care

Summary Background and aims Type 2 intestinal failure (IF) commonly results from post-operative short bowel leading to metabolic instability. Specialist multi-disciplinary management is often required for nutritional, fluid and/or electrolyte support, either intermediate term or until revision surgery. This can lead to prolonged or repeated acute hospital admission. Methods A virtual ward model was developed to address the need for on-going specialist support and facilitate home discharge. This provides an outreach specialist service with structured patient education, remote biochemical monitoring, telemedicine consultations and open access outpatient clinics. Patients' status is reviewed at multi-disciplinary virtual ward rounds. Results A prospective audit assessed effectiveness of the programme. Of 20 patients referred with post-operative type 2 IF and metabolic instability, 18 were discharged home for a total of 2731 days, with a mean readmission days of 2.0%. 12 patients were managed with modified enteral nutrition. Management was unsuccessful in only 1 patient due to non-compliance. A patient satisfaction study suggested high levels of patient satisfaction. Conclusions The IF virtual ward is associated with low levels of hospital readmission amongst complex and metabolically unstable IF patients. It provided integrated multi-disciplinary management and is associated with high levels of patient satisfaction.

Reducing Chronic Obstructive Pulmonary Disease Readmissions

Exacerbation and frequent rehospitalization in chronic obstructive pulmonary disease exacts a heavy toll on the US health care system. To address these issues, new initiatives have been proposed that are largely based on financial penalties to promote patient education and postdischarge care. However, as laudable as these goals are, improving outcomes in the chronic obstructive pulmonary disease population is more confounding than it may first appear. Chronic hypoxia, cognitive dysfunction, poor nutrition, and economic disadvantage are just a few of the challenges that require creative solutions and ongoing support. Case managers need to utilize all the potential products and services that can assist in improving outcomes for these patients. Durable medical equipment providers are often viewed as purveyors of medical equipment that offer little in the form of clinical support. However, in many cases these providers represent an overlooked resource that provides individualized, highly structured patient education and ongoing support programs. The challenge is in identifying those durable medical equipment providers that offer patients contemporary technology, and have both the resources and the commitment to provide patient support that is amenable to the goals of the hospital. This article reviews many of the confounding issues that contribute to the frequent rehospitalization of chronic obstructive pulmonary disease patients. Recommendations to improve patient education and oxygen therapy outcomes are provided along with suggestions to aid in the vetting of durable medical equipment providers. Acute care hospitals, long-term acute care hospitals, extended care facilities, integrated delivery systems. 1. An understanding of the complex variables that play in the management of chronic obstructive pulmonary disease will help the case manager to plan an effective course of care. 2. Case managers need to ensure that patients receive long-term oxygen technology that supports their lifestyle, promotes compliance, and ultimately achieves the desired outcomes. 3. Case managers must advocate for coordinated, ongoing patient education and stress the need for continuing reinforcement. 4. Case managers must ensure that patients under their care be matched with durable medical equipment providers that provide the technology and support that favors positive clinical outcomes.

Management of diabetes mellitus: is the pump mightier than the pen?

Continuous subcutaneous insulin infusion (CSII, or insulin pump therapy) reduces HbA1c levels and hypoglycaemia in patients with type 1 diabetes mellitus (T1DM) compared with multiple daily insulin injections (MDI). The greatest reduction in HbA(1c) levels with CSII occurs in patients with the worst glycaemic control; therefore, the most appropriate and cost-effective use of CSII in adults with T1DM is in those who have continued, elevated HbA(1c) levels or disabling hypoglycaemic episodes with MDI (including the use of long-acting insulin analogues and structured patient education). The disadvantages of CSII include higher costs than MDI and the risk of ketosis in the event of pump failure. In children with T1DM, CSII may be used when MDI is considered impractical or inappropriate. Pumps are not generally recommended for patients with type 2 diabetes mellitus but may improve control in some subgroups. A new generation of smaller insulin infusion pumps with an integrated cannula, called patch pumps, could improve uptake of CSII in general. The important clinical question is not whether CSII is more efficacious than MDI in general adult T1DM, but whether CSII further improves glycaemic control when this control continues to be poor with MDI, and evidence exists that in most cases it does.

Self-Management in Daily Life with Psoriasis: An Integrative Review of Patient Needs for Structured Education

The aim of this integrative review is to identify and discuss patient needs for education to support self-management in daily life with psoriasis. As psoriasis increasingly gains recognition as a serious chronic autoimmune skin disease with long-term impairment on the life course, and not mainly a cosmetic problem, nurses are highly challenged to develop efficient education to support patient self-management. The paper includes five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and synthesis, and (5) presentation, based on theoretic scaffolding around the concept “need.” Nineteen of 164 original papers within nursing, medicine and psychology, and reflecting patient perspective were included. To capture the patients' cultural understanding of the implications of the disease and care, we developed an interlevel model indicating that self-experienced burden of disease and its visibility, personal conditions such as illness perception, and the patient's age at onset time are high-impact factors that should be addressed in future structured patient education programmes. The research on patient needs has hitherto focused on adults, but the problems and vulnerability associated with having a chronic and visible disease during adolescence must be acknowledged, and patient education initiatives designed for this young group are recommended.

Conception d’un programme d’éducation thérapeutique pour les patients porteurs de lymphœdème : « Vivre avec un lymphœdème »

Lymphedema is a chronic condition considered to be rare in its primary form and potentially frequent in women after breast surgery for cancer: 27,000 new cases annually. Therapeutic management is a serious challenge. In France, the health authorities (Haute Autorité de santé [HAS]) have recently proposed that appropriate management practices for lymphedema include "patient education". The HAS and the National institute for health care prevention and education also published a methodology guide devoted to structuring a therapeutic education program for patients with chronic disease. Current hospital regulations state that this education program is part of the care to be delivered to patients with chronic disease and that it must comply with the national directives. The purpose of our present work was to present the concept and the contents of a patient education program entitled "Live with lymphedema" designed for patients with lymphedema and developed within the inpatient-outpatient network GRANTED in Sud-Isère. A standard detailed educative approach was applied. It was designed after the educational program for patients with lower limb arterial occlusive disease authorized by the Rhône-Alpes regional health agency. It was adapted to the specific problematic of patients with lymphedema, including medical management, rehabilitation, dermatology and nutritional aspects. It was developed in cooperation with patients and favors local associative actions. The specifically structured program included three therapeutic education consultations and five workshops. Less than one year after its institution, more than 30 patients have participated in the program. We report a structured patient education program designed for patients with lymphedema. This program was authorized by the Rhône-Alpes regional health agency in March 2011 and is in compliance with the national directives and HAS guidelines.

The Neglect of Chronic Disease Self-Management in Medical Education: Involving Patients as Educators

An estimated 133 million Americans and 16 million Canadians (roughly half the population of both countries) live with at least one chronic illness; about one in four suffers limitations to daily activities as a consequence. As the population ages and people live longer, we can expect to see an increase in the prevalence and complexity of chronic illness. Chronic disease management will become a major part of the work of health professionals, both as individuals and as members of interprofessional teams. The need to align medical education with changes in health care delivery will require more emphasis on chronic disease management as well as on the related topics of behavioral and social sciences and interprofessional teamwork. 1 Yet medical education is still focused on, and in, acute care. A PubMed search of all issues of two top medical education journals for the term “chronic disease management” yielded four papers in Academic Medicine and nine in Medical Education. In chronic disease, the patient/family is the chief provider of care. Patient chronic disease self-management (CDSM) and selfmanagement support by clinicians have been identified as essential components of chronic care programs. The need for health professionals to be trained in the core competencies required in CDSM support has been identified. Yet there appears to be a wide gap between health professionals’ understanding of CDSM and the wider concerns and realities of patients. Whereas health professionals identify selfmanagement primarily as structured patient education, patients identify selfmanagement as a process initiated to bring about order in their lives that involves recognizing and monitoring the boundaries, mobilizing resources, managing the shift in self-identity, and balancing, pacing, planning, and prioritizing. A seminal study identified three lines of work that people managing chronic illnesses at home must undertake: illness work, referred to as trajectory management (symptom management, diagnostic-related work, crisis prevention and management); everyday life work (house work, looking after family, paid work, eating, etc.); and biographical work (reconstruction of the patient’s biography). 2These tasks may compete or conflict with medical

Rapid Improvement of Glycemic Control in Type 2 Diabetes Using Weekly Intensive Multifactorial Interventions: Structured Glucose Monitoring, Patient Education, and Adjustment of Therapy—A Randomized Controlled Trial

We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff. Sixty-three patients were randomized to an intensive treatment group that obtained self-monitoring of blood glucose (SMBG) profiles (six or seven values per day, 3 days/week) and were seen in the clinic at Weeks 1-6 and 12. SMBG results were downloaded, analyzed using Accu-Chek(®) 360° software (Roche Diagnostics, Indianapolis, IN), and used to adjust therapy. Control group subjects obtained glucose profiles and had clinic visits only at Weeks 0, 6, and 12. There were highly statistically significant improvements in the intensive treatment group compared with the control group between Weeks 0 and 6 with greater reductions in weekly mean glycemia (WMG) (-76.7±8.9 mg/dL vs. -20.5±8.1 mg/dL), glycemic variability (SD) (-16.3±3.1 mg/dL vs. -5.0±3.1 mg/dL), and glycated hemoglobin (-1.82±0.16% vs. -0.66±0.22%) without significant changes in frequency of hypoglycemia or weight. Improvements were sustained in the intensive treatment group through Week 12. A minimal but statistically significant degree of improvement was seen in the control group at Week 12. This short-term pilot study of an intensive monitoring, educational, and pharmacological interventions program resulted in dramatic improvement of glycemic control within 6 weeks, and these effects are sustained through Week 12. SMBG glucose profiles, calculation of WMG and SD, and graphical displays of glucose data can improve the effectiveness of adjustment of therapy at weekly clinic visits when combined with intensive support from a multidisciplinary team.

Diabesity: aims of treatment and the multidisciplinary practice team

Practice NursingVol. 22, No. 6 Diabetes Evidence-Based Management 32Diabesity: aims of treatment and the multidisciplinary practice teamChinnadorai Rajeswaran, Jo Bissell, Ravi Bachuwar, Balasubramanian Thiagarajan SrinivasanChinnadorai RajeswaranSearch for more papers by this author, Jo BissellSearch for more papers by this author, Ravi BachuwarSearch for more papers by this author, Balasubramanian Thiagarajan SrinivasanSearch for more papers by this authorChinnadorai Rajeswaran; Jo Bissell; Ravi Bachuwar; Balasubramanian Thiagarajan SrinivasanPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2011.22.6.315AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesAndersson B, Marin P, Lissner Let al. (1994) Testosterone concentrations in women and men with NIDDM. 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Managing temporomandibular disorders (TMD) by integrating exercise therapy into therapeutic patient educational programs: why, when, how?

Current evidence based data found in the scientific literature recommend that the therapeutic management of patients suffering from temporomandibular disorders (TMD) should be based initially on simple, conservative and reversible procedures including exercise therapy. The integration of this message into oral health instructions for patients makes it easy for them to keep informed about TMD and aware of the steps they can take to deal with their symptoms. The integration of exercise therapy into structured patient education programs provides patients with information about TMD and suggests methods to deal with it. This medical approach is similar to those used to treat other joints in the musculoskeletal system.

A literature review of continued dietary education provided to adolescents with type 1 diabetes

Background: Dietary education aims to facilitate diabetes self-management skills to achieve optimal glycaemic control. Poor glycaemic control is associated with micro-vascular (retinopathy, nephropathy and neuropathy) and macro-vascular (cardiovascular) diseases, which risk poor quality of life and reduced life expectancy (The Diabetes Control and Complications Study Group, 1994). The aim of this project was to conduct a literature review of factors that influence adolescent diabetes educational needs. Methods: A literature review was conducted using the method of Aveyard (2007) by searching Medline, Cinahl, EMBASE, Cochrane and ISIS Web of Knowledge databases. Electronic searches were conducted on single terms and as Boolean searches using the patient group (adolescen*, child*, teenager, pediatric, paediatric), disease focus (type 1 diabetes, multiple daily injections, basal bolus) and intervention (education needs, diabetes education, diabetes care, self management). Hand searching of key journals was also conducted. The inclusion criteria were studied that reported directly on children or adolescents (<20 years) type 1 diabetes and in the English only. The selected publications were critically appraised using Critical Appraisal Skills Programme tools to assess methodological quality and determine significance of the reported findings (Public Health Resource Unit, England, 2007). Results: Limited quality literature is available to conclude what adolescent views are in relation to dietary educational needs. In total 36 articles were identified and abstracts screened. A total of eight were identified as relevant. Literature to determine nutritional factors to assist adolescent diabetes self management and carbohydrate counting is also weak and mainly consensus based, however carbohydrate counting is acknowledged as a useful tool. In total 67 articles were identified and abstracts screened. A total of six were identified as relevant. Discussion: The review by Couch et al. (2008) highlighted that there is insufficient evidence to identify a particular diabetes intervention that is more effective than standard care. Factors indicated by adolescents that may assist receptiveness to diabetes education and management discussed: continued support from parents; research participation; application and practice of decision making; insulin adjustment to achieve positive outcome; and the importance of education to dispel inappropriate dietary restrictions. Nutritional factors worth considering with regard to dietary management highlighted: healthy eating reinforcement; carbohydrate counting and dietary education tools to promote self management skills; accuracy of dietary education; and methods of engagement which support structured patient education for adolescents. Conclusion: Limited published evidence is available on factors that influence the educational needs of adolescents with type 1 diabetes. A trial of group education to target problem solving strategies is a proposed recommendation for service development.

Long-term impact of a structured group-based inpatient-education program for intensive insulin therapy in patients with diabetes mellitus

Structured patient education aiming to improve self-management strategies might be beneficial for insulin-treated diabetic patients. However, in previous studies the extent of the benefit has been inconsistent in different subgroups of patients. The aim of the present study was to assess the potential benefit of a structured inpatient-education program for intensive insulin therapy according to the basal-bolus concept with particular emphasis on self-management strategies. We included 81 diabetic patients (59 with type 1, 14 with type 2, eight with other forms) in this retrospective longitudinal study; all had completed the training program on eight consecutive days at a university clinic between 2003 and 2005. Data assessment included HbA1c, LDL-cholesterol, HDL-cholesterol and BMI at baseline (0-15 months before the training) and after 0-5, 5-10 and 10-20 months. A transient decrease of HbA1c (0.2%, 95% CI: 0.04-0.37, P = 0.017) and LDL-cholesterol levels (9.95 mg/dl, 95% CI: 2.24-17.76, P = 0.013) between baseline and the first follow-up examination was observed in the group overall. Thereafter, HbA1c and LDL-cholesterol were similar to baseline, whereas a persistent increase in HDL-cholesterol (P = 0.025) was evident in the multivariable analysis. No changes in BMI were observed. A significant type-by-time interaction (P = 0.008) in HbA1c suggests a long-term benefit in glycemic control in patients with type 2 diabetes. A diabetes training program for intensive insulin therapy with particular emphasis on self-management skills was followed by a moderate and transient improvement of glycemic control and LDL-cholesterol and by a persistent increase in HDL-cholesterol. Long-term improvement in glycemic control was observed only in patients with type 2 diabetes.

Glycaemic goals in patients with type 2 diabetes: current status, challenges and recent advances

Recommendations for the management of type 2 diabetes include rigorous control of blood glucose levels and other risk factors, such as hypertension and dyslipidaemia. In clinical practice, many patients do not reach goals for glycaemic control. Causes of failure to control blood glucose include progression of underlying pancreatic beta-cell dysfunction, incomplete adherence to treatment (often because of adverse effects of weight gain and hypoglycaemia) and reluctance of clinicians to intensify therapy. There is increasing focus on strategies that offer potential to improve glycaemic control. Structured patient education has been shown to improve glycaemic control and other cardiovascular risk factors in people with type 2 diabetes. Payment of general practitioners by results has been shown to improve glycaemic control. New classes of glucose-lowering agents have expanded the treatment options available to clinicians and patients and include the dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These new classes of therapy and other strategies outlined above could help clinicians to individualize treatment and help a greater proportion of patients to achieve long-term control of blood glucose.

Structured patient education is superior to written information in the management of patients with irritable bowel syndrome: a randomized controlled study

Education and reassurance are proposed to be of great importance in the management of patients with irritable bowel syndrome (IBS), but few trials supporting this are available. Our aim was to compare the effects of a structured patient group education (IBS school) versus receiving written information in the form of an IBS guidebook, on knowledge, symptoms, and quality of life in IBS patients. Patients with IBS according to the Rome II criteria were randomized to participate in the group education or to receive the guidebook. The effects were evaluated by self-administered questionnaires at 3 and 6 months after baseline. One hundred and forty-three patients - 71 in the guidebook group and 72 in the IBS school group - completed the study. Compared with the guidebook group, the patients in the education group showed greater reduction in IBS symptom severity and gastrointestinal (GI)-specific anxiety, as well as greater improvement in perceived knowledge of IBS. Several aspects of health-related quality of life were significantly improved after the group education, but not in the group who received the written information. A structured patient group education is superior to written information to enhance knowledge of IBS, and improve GI symptoms and GI-specific anxiety in IBS patients.

Structured discharge education improves early outcome in orthopedic patients

Summary Background Optimally efficacious patient education at discharge is a challenge for medical staff, patients and the patients' families. The unique fears and concerns associated with discharge to the community and the self-care of orthopaedic patients must be dealt with as well. The instructions given at the time of discharge could influence the perception of and overall satisfaction levels of patients when related to their hospital experience. Objective To assess the impact of structured, compared to standard patient education, at the time of hospital discharge. Methods Orthopaedic patients given structured ( n =47, Group 1) or standard ( n =48, Group 2) instructions at discharge were compared. The nurses used specially designed booklets containing relevant questions and answers to guide them in providing instructions to Group 1. Six weeks after discharge, all patients were interviewed via the telephone regarding their satisfaction levels in relation to their hospitalisation, pain management, functional status and compliance with follow-up visits. Results Group 1 patients had fewer pain complaints (23, 48%) compared to Group 2 (34, 70.8%). Their follow-up compliance was also higher (44, 93.6% versus 37, 77.1%) and they reported greater satisfaction from the nurse–patient communication and discharge instructions (19.4 and 11.5) than Group 2 (17.8 and 9.7). The number of unplanned medical visits (to emergency services or general practitioners) after discharge was similar for both groups. Group 1 had better functional status as measured by activity of daily living and instrumental activity of daily living indices. Discussion Structured patient education at discharge offers an easily implemented alternative to standard instructions and improves patient satisfaction, pain management, compliance with follow-up and better functional status.

Structured patient education: the X-PERT Programme

The X-PERT Programme seeks to develop the knowledge, skills and confidence in diabetes treatment for health-care professionals and diabetes self-management. The programme trains health-care professionals to deliver the six-week structured patient education programme to people with diabetes. Over 850 health-care professionals have attended the X-PERT 'Train the Trainer' course and audit results document improved job satisfaction and competence in diabetes treatment and management. National audit statistics for X-PERT implementation to people with diabetes illustrate excellent attendance rates, improved diabetes control, reduced weight, blood pressure, cholesterol and waist circumference and more confidence in self-managing diabetes that has impacted positively on quality of life.