Therapeutic Patient Education Sessions Research Articles

Impact of therapeutic education on the choice of renal replacement therapy. Moroccan monocentric experience

Therapeutic patient education (TPE) is gaining importance in the management of patients with chronic kidney disease (CKD). The objective of this study is to assess the interest of TPE in the acquisition of knowledge concerning CKD and renal replacement therapy, as well as the orientation of the patients towards a personalized choice of treatment. Patients with a minimum stage 4 CKD were prospectively included between November 2016 and February 2020. We proposed TPE sessions on CKD and its treatment to all patients. We explained the theoretical part through a slideshow about the definition of end-stage renal disease, its symptoms and the various methods of renal replacement therapy. A “basket” of essential material to illustrate a session of hemodialysis (HD) or peritoneal dialysis (PD) was used to achieve the practical part of the study. Data was collected using two questionnaires: the first one, at the start of the session, included the socio-demographic and clinical characteristics of the patients and evaluated their level of basic knowledge, and the second one, at the end of the session, assessed the evolution of knowledge after TPE, leading to a therapeutic choice. The mean age of the 211 included patients was 55.59 years old (SD=15.47). Male to female ratio was 0.73. The level of education was low in 69% of the cases of whom 23.7% were employees. The glomerular filtration rate (GFR) was between 15 and 30mL/min in 56.8% of the cases. Initial nephropathy was known in 60% of patients while the stage of CKD was unknown in 66.4%. Before TPE, patients with a good level of overall knowledge were around 29%, rising to 73% after TPE. A significant correlation was found between the level of education of the patients and their knowledge score before and after TPE. The choice of renal replacement therapy was taken for PD, TR and HD respectively in 36%, 19% and 11.8% of the cases, while 33.2% asked for time to think. Elderly and/or low educated patients most often remained undecided; moreover those who are young and/or educated prefer TR. During the follow-up period, 46% of patients started renal replacement therapy (36.5% started HD, 8.1% PD and 1.4% KT). The choice made by our patients was respected in 42% of the cases: in all the patients who chose HD; in 36% of those who chose PD, and 19% of those who chose kidney transplantation (KT). The final therapeutic modality was strongly linked to the following parameters: age, GFR and level of education. This study highlighted the insufficient level of patients’ information about CKD and its treatment and allowed the patients to express their choice of their replacement therapy, which is a complicated process that must ­integrate the opinion of the nephrologist and the patient’s preference to lead to an ­optimal organization of the therapeutic modality.

Effects of a Therapeutic Patient Education Network on the Glycated Hemoglobin and Body Mass Index in 59 Patients with Type 2 Diabetes Mellitus: A Retrospective Study from 2013 to 2018

Introduction: In 2019, there were 4.5 million people with diabetes in France. To assist them, general practitioners can offer therapeutic patient education sessions (TPE). An education network was created for this purpose by healthcare professionals in the south of the Aisne region of France. With hindsight, what has been the impact of a TPE network like this one? Objectives: The main objective of the study was to assess the effects of unstable type 2 diabetic (T2DM) patients’ participation in the activities of an education network on body mass index (BMI) and glycated hemoglobin (HbA1c). These patients were monitored from January 2013 to June 2018. The secondary objective was to determine the impact of adapted physical activity sessions (APA) and of TPE on the two selected clinic-biological parameters. Methods: A retrospective, quantitative, and monocentric, observational study was performed with analysis of the evolution of HbA1c and BMI of T2DM patients. They were monitored for more than six months in the network between 2013 and 2018, using the Logireso® database. Statistical analysis was performed using SPSS® software. BMI and HbA1c were analyzed by Student›s T test for paired samples. A linear regression test was performed to assess whether there is a correlation between two variables among those measured. Results: Fifty-nine patients met the inclusion criteria (20.92% of participants in the network). The decreases in BMI (–1.65 kg/m²) and HbA1c (–0.86%) of the patients studied were significant (p Conclusion: The study showed the overall effectiveness of the proposed program in reducing BMI and HbA1c without highlighting a single factor that could explain it.

Characteristics of children and adolescents with atopic dermatitis who attended therapeutic patient education

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Therapeutic patient education (TPE) has been demonstrated to be effective in AD in reducing disease severity and improving coping and quality of life. To describe the sociodemographic and clinical characteristics of children and adolescents with AD who had attended TPE sessions, as well as the characteristics of their parents, and compare them with those who did not attend TPE. Parents of children with AD aged 6-17years old were recruited from a representative sample of the French population contacted by e-mail. Sociodemographic data and clinical information were collected in patients and parents. Clinical severity was assessed by parents using a proxy version of the Patient-Oriented Eczema Measure (POEM). Attendance to TPE sessions was assessed by the following question 'did your child or one or both parents attended TPE for AD?'. Also, the number of sessions was recorded. Determinants of TPE attendance were evaluated by univariable and multivariable analyses. Data were collected on 1063 parents and children with AD. A total of 131 (12.3%) children and/or parents attended TPE sessions. Most of them attended 2-5 TPE sessions. In that group, there were 85 boys (64.9%), and severity evaluated by POEM was mild in 29.8%, moderate in 52.7% and severe in 17.6% of patients. In the multivariable model, attending TPE sessions was significantly associated with sex of the child (boy vs. girl), consultation with a dermatologist or a paediatrician, high clinical severity and presence of AD in parents. Despite recommendations, the use of TPE in children with AD is still low in France. There is a need for implementing such programmes in the management of the disease, in particular when the disease is severe.

How do patients and health professionals perceive the role of family members in the decision-making process regarding the choice of a dialysis method? A qualitative study

BackgroundTherapeutic decisions often seem to be the product of interaction between health professionals and patients alone. However, some realities make it essential to consider family members when examining care of patients, especially in the construction of therapeutic choices. Implementation of measures such as therapeutic patient education to make the patient an actor in his own healthcare, and the impact of disease on the patient's social and professional activities mean there is an important place for family members in a patient's care pathway. This study aims to examine the role of family members and the family environment in decision-making on treatment for patients with chronic kidney disease. It also analyzes how they contribute to the construction of patients’ choices on dialysis methods through their involvement in a therapeutic patient education program. MethodsThis study involved thirty-six semi-structured interviews: sixteen with patients and twenty with health professionals. Therapeutic patient education sessions, interactions and information exchanges between patients and health professionals, as well as participant behaviours, were also observed. Analysis was thematic. ResultsResults indicate that the factors influencing the patient's choice of dialysis methods include the family environment as the place where the disease is experienced, the need to maintain family ties, the advice provided by family members and their active participation in therapeutic patient education sessions and partnership between family members and health professionals in the decision-making process. ConclusionThis study highlights the reality of decision-making processes that can start from a non-hospital setting. Furthermore, it argues for greater consideration of the needs, values, and preferences of family members in mechanisms designed to promote patient participation in therapeutic decisions.

Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education.

ObjectivePoor patient adherence to anti-TNF treatment has proven to be a major roadblock to effective management. Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like chronic inflammatory rheumatism and in improving treatment adherence. This study aimed to assess whether different TPE programs might improve adherence to subcutaneous anti-tumor necrosis factor (anti-TNF) treatment in patients with rheumatoid arthritis (RA), ankylosing spondyloarthritis (AS), and psoriatic arthritis (PsA).MethodsThis was a retrospective, observational, monocentric study of current care practices. We included 193 patients (124 women; mean age 53.3 ± 14.8 years). All patients received subcutaneous anti-TNF treatment and one of three TPE models, delivered by a nurse, from 2009 to 2013. The cohort was grouped according to different educational models: M1: information (N=92); M2: individual TPE (N=80); and M3: individual and group TPE sessions (N=21). Adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4™). Scores were rated as follows: good adherence (MMAS-4 = 4), moderate adherence (MMAS-4 = 2–3), and poor adherence (MMAS-4 = 0–1).ResultsThe mean disease duration was 10 years [95% CI: 5 to 18]. The cohort comprised 113 patients with RA, 73 with AS, and seven with PsA. Overall, 146 (75.7%) patients displayed good adherence, 34 (17.6%) displayed moderate adherence, and 13 (6.7%) displayed poor adherence. The M3 group displayed less adherence than the M1 and M2 groups. Old age was the only factor correlated with good adherence (p=0.005). The level of knowledge had no significant impact on adherence.ConclusionThis study demonstrated good adherence to anti-TNF treatment in patients that received TPE, particularly when it was delivered in individual sessions.

Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program

ObjectivesThe growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. MethodThis study used qualitative data from the French “ONCORAL” program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. ResultsAnalysis highlighted that TPE specifically helps patients’ functional health, revealed the medical expectations and social norms that shape the patient’s role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. ConclusionTPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. Practice implicationDedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.

Escuela de dermatitis atópica: importancia de la formación de cuidadores

IntroductionThe aim of this study was to determine the perception of knowledge about atopic dermatitis (AD) in caregivers of children with this disease, and the impact of therapeutic patient education (TPE) on improving this knowledge. MethodologyA non-validated questionnaire was used on parents of children suffering from AD that attended to Atopic School (AS) of Pontevedra. It consisted of 9 questions about: repercussion of AD in different life spheres, time taken up with topical treatments, and knowledge about AD before and after TPE. ResultsA total of 61 questionnaires were collected from 5 sessions in the AS. The large majority (83.6%) of the respondents perceived that AD had a moderate or severe influence on their children's quality of life. Just 6.6% of respondents mentioned that they had a lot of information before attending the AS, and in all cases the respondents thought the information given in the AS increased their knowledge. ConclusionOur data support that TPE increases the knowledge about AD. Since AD has a negative impact on the quality of life of children, TPE sessions are of utmost importance.

Qu’est-ce qui influence le choix de la dialyse péritonéale chez les patients ? une étude qualitative.

L’objectif de cette étude était d’identifier les facteurs qui influencent le choix de la dialyse péritonéale (DP) chez les patients insuffisants rénaux, dans un centre de dialyse en France offrant un dispositif d’éducation thérapeutique du patient (ETP) aux patients en pré-dialyse. Pour ce faire, nous avons mené trente six entretiens semi-directifs avec des patients, des médecins de l’équipe d’ETP et un cadre de santé. Nous avons également observé dix séances d’ETP afin d’explorer la nature des interactions entre les patients, leurs accompagnants et l’équipe soignante. Nos résultats révèlent que les facteurs qui poussent les patients à choisir la DP sont l’influence des proches, les préférences personnelles, l’influence des médecins, l’ETP à travers l’information transmise par les éducatrices. En plus de l’influence de ces facteurs dans la construction du choix des patients à s’orienter vers une méthode de dialyse, il pourrait être encore plus productif d’intégrer des patients ressources dans les dispositifs d’ETP grâce au partage de leur expérience de patients traités en dialyse avec les patients en pré-dialyse.
 
 Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International.

A quality improvement program for adolescents with cystic fibrosis: focus on psychosocial skills

BackgroundThe two pediatric cystic fibrosis centers (CFCs) in Paris (Robert Debré) and Nantes, France, have been developing therapeutic patient education (TPE) programs since 2006 and have been engaged in the pilot phase of the quality improvement program (QIP) named the Hospital Program to Improve Outcomes and Expertise in Cystic Fibrosis (PHARE-M) since 2011. The objective was to improve the FEV1 of the cohort of adolescents to prepare them for their optimal transition to an adult CFC.MethodsThe two CFCs formed a multidisciplinary quality team and used the analysis of causes of insufficient respiratory function taking into account the adolescents’ psychosocial factors. At the Nantes CFC, the approach was centered on adolescents’ body image and their motivation to take care of themselves by assigning specific aspects of patient follow-up to each professional in the team. At R. Debré, an individual cause-and-effect diagram identified for each patient the medical and psychosocial factors that could account for insufficient respiratory function. Personalized actions were offered to each patient.ResultsIn 2014, the median FEV1 (Forced Expiratory Volume in 1 Second) of the adolescent cohort exceeds 90% at the 2 CFCs (Nantes and R. Debré). Between 2011 and 2014 both centers improved their ranking for FEV1% in adolescents in the Registry histograms. At R. Debré, the personalized process allowed to reinforce equality of care, offering to all the opportunity to benefit from TPE sessions and coaching with an adapted physical activity teacher. The psychologist developed a specific tool to support the patient-centered process.ConclusionThe link between TPE and QIP was strong at our two centers enhancing patient centered care and targeting an optimal transition to an adult program.

From “Face to Face” Sessions to Education on Smartphone: What are the Implications for Persons with Chronic Diseases?

The use of digital solutions is rapidly expanding, including for the prospect of reducing social inequalities and geographical disparities as respect to access to health care and therapeutic education. Here, we question the transformations caused by the switching from therapeutic patient education sessions conducted face to face to the use of virtual digital applications developed on smartphones. From the perspective of developing health literacy, we analyse three complementary corpus: 9 in situ observations of educative sessions involving 34 patients, 27 observations of users of tablets with interactive application and 12 semi-structured interviews conducted with adults at home. Switching from face to face education sessions to education proposed on available smartphone application questions the changes of the trainers’ and carers’ roles and postures, the activities of the learners, the continuity of the educational process, and the contexts in which chronic illness is updated. The results obtained here question the development of digital education, while pinpointing numerous precautions to be taken for this development and the practical use of digital technology. Our analysis invite to continue innovations but suggests to accompany the advent of digital technology in the field of health and patient education by well-documented and grounded scientific work.

Factors associated with knowledge and safety skills of arthritis patients receiving biologics: A survey of 677 patients

ObjectiveWe aimed to determine patient and rheumatologist factors associated with the safety skills of patients receiving bDMARDs for inflammatory arthritis. MethodsData were obtained from a descriptive observational cross-sectional nationwide survey performed in 2011 in France. Community- and hospital-based rheumatologists were selected at random. The BioSecure questionnaire was used to collect information on patient safety skills. ResultsOf the 677 patients included (mean age 53±13years old; 452 (67%) women, 411 (61%) had RA; 421 (64%) received subcutaneous bDMARDs). Patients had received information about their treatments from their physician 610 (90%), a nurse 207 (31%), by a written booklet 398 (59%), and/or during therapeutic patient education (TPE) sessions 99 (15%). The median BioSecure total score was 72/100 (IQR 60-82). In total, 99 (16.4%) patients had a low skill level; 321 (53.2%) a moderate skill level and 183 (30.3%) a high skill level. On multivariate regression analysis, as compared with high safety skills, low skills were associated with living alone (OR 2.8 [95% CI 1.3⿿6.0]), low educational level (OR 4.3 [2.1⿿8.9]), living in a large city (OR 3.1 [1.2⿿8.2]), being unemployed (OR 3.3 [1.6⿿6.7]) and not receiving written information, participating in TPE sessions or consulting a nurse (OR 3.8 [1.6⿿8.8]). One rheumatologist-related factor was a high number of patients receiving bDMARDs in the practice. ConclusionWe reveal factors associated with low safety skills of patients receiving bDMARDs for inflammatory arthritis, which should be addressed to improve safety skills in this population.

Post stroke therapeutic education program: The experience of three aftercare and rehabilitation structures specialized in neurology in Lower Normandy

Since 2011, our work group involves three structures of aftercare and rehabilitation (SSR) and a health network specialized in Therapeutic Education. On the basis of the guidelines by the SOFMER and the SFNV, a Therapeutic Patient Education (TPE) program was developed dealing with 7 frequent post stroke physical or cognitive consequences. The point is to present the results after the implementation of the first themes. The steering committee (COPIL), created in December 2011, and supported by 8 work groups, achieved the elaboration of 38 TPE workshops. Patients and/or caregivers can join TPE sessions during their hospitalization in SSR wards, or later on (consultation, or medical and social structures). After the educational diagnosis interview and according to the post stroke consequences and to the skills they wish to improve, they take part in the five workshops, hosted by trained professionals. Three to 6 months after the session, the educational improvements, and the patients’ and caregivers’ satisfaction are assessed during a consultation. We have experienced the setting up of workshops in order to evaluate the feasibility for one year now, especially for the workshops elaborated by another SSR wards. Until now, 4 topics for a total of 23 workshops have been tested in our three structures. Twenty-seven patients (16 suffering from an ischemic stroke, 11 from an hemorrhagic stroke) and 12 family caregivers have benefited from TPE sessions in the 3 SSR wards. All patients had an educational diagnosis. Participation rate scores 98% for patients, 89% for caregivers. According to items assessed, satisfaction rate scores between 83% and 94%. Self-assessment of workshops by professionals allowed to improve educational tools and to implement improvement axes.

Perception of therapeutic patient education in heart failure by healthcare providers

Care provider support for therapeutic patient education (TPE), its results and relationships with patients are factors in the setting up and sustainability of this practice. With a view to understanding the factors determining TPE care provider participation and favouring its development, the aim of this study was to describe the perception healthcare providers have of TPE in heart failure. A national survey by self-administered questionnaire was performed in 2013 in 61 Observatoire de l'INsuffisance cardiaque (ODIN; Heart Failure Observatory) centres participating in the I-CARE programme. The cardiologist in charge of each centre received five questionnaires: one for him/herself and four for other healthcare providers working with him/her. We received 116 responses out of the 305 questionnaires sent (38.0%). Almost all of the responders stated that the patients were more observant after TPE sessions (91.4%). According to the responders, patients were better informed thanks to TPE (53.9%); they stated that TPE had changed their relationships with patients (81.9%); they also felt that they were educating the patient's close family/friends at the same time as the patients (86.2%). The survey showed that TPE improves care relationships. Healthcare providers recognize that they have been working differently since the programme was set up, and want the patient's close family/friends to be involved in treatment.

Oral anticoagulant treatment – Evaluating the knowledge of patients admitted in physical medicine and rehabilitation units

Introduction While numerous therapeutic education programs exist in physical medicine and rehabilitation (PM&R), they rarely concern pharmacological treatments. Nevertheless, drugs prescribed during a hospital stay can have a significant risk of adverse events. Vitamin K antagonists (VKA) are among them. Objective of the study To assess patients’ knowledge on their oral anticoagulant treatment before their hospital discharge. Methods Fifty patients were enrolled in this prospective, monocenter study. Their level of knowledge was assessed by a semi-structured interview between the pharmacist and the patients and/or their caregivers. Results Seventy percent of patients were able to give the name of the drug they were taking, 82% could explain its effect and finally, 24% of patient knew their INR target values. Twenty-two percent of patients were able to describe the symptoms in case of overdose and what to do in that case. Forty percent of patients were aware of food interactions and 60% of self-medication risks. The patient's knowledge and behavior acquired during their hospital stay are not enough to guarantee a safe treatment management upon discharge. Based on this study, therapeutic patient education sessions were implemented. Conclusion These results suggest that specific drug therapy management sessions should be developed as part of PM&R's therapeutic education programs for patients.