Therapeutic Patient Education A new approach for chronic disease

Transcription

1 Therapeutic Patient Education A new approach for chronic disease Professor Alain Golay University Hospital Geneva, Switzerland Alain.Golay@hcuge.ch

2 Aims of Therapeutic Patient Education To help the patient deal dealy as well as possible with his chronic disease Improve or maintain Quality of life Autonomy Adherence to treatment Avoid or decrease Relapses Complications

3 Patient Therapeutic Education Empowerment Search success Use mistakes Reinforcement Roll resistance Work ambivalence Motivational Interviewing Support Motivate The objectives The evaluation Renegociate Formative Evaluate Patient centered Negociate Share the decision Transmit Take into account Type of treatment Behavioural changes Psycho-social Educational models Knowledge Skill Health believes Resources Needs Cognitivebehavioural therapy

4 Objectives of Therapeutic Patient Education Get Knowledge Gain competences on disease and treatment Understand the disease Accept the disease Manage the disease Find autonomy Change behaviour Help the patient to change Grow in life

5 The 3 tasks of the Health Care Provider UNDERSTAND Disease Patient Person

6 Patient s double need Cognitive dimension To know To understand Emotional dimension To be listened to To be known To be understood To be helped Bensing 2006

7 TO LISTEN IS TO GIVE A HAND Listening is everybody s matter

8 The Geneva school for Therapeutic Patient Education 30 years of Therapeutic Patient Education WHO collaborating centre since 1983 Educating the Patient patients, 5 day/hospitalization patients, 1 day/hospitalization More than hours were given Educating the Educator 48 seminars of one week post-graduate training attended by over HCP coming from more than 60 countries Continuing education Diploma on Therapeutic Patient Education A. Golay, JP Assal. Pat Ed Counsel 2001, 44:65

9 Efficacy of Patient Education

10 Efficacy of Patient Education Diabetes 4 meta-analyses 60 studies patients 3 reviews Asthma 3 meta-analyses 1 review 30 studies patients BPCO 3 meta-analyses 2 reviews 80 studies patients Hypertension 3 meta-analyses 100 studies patients Cardiology 3 meta-analyses, 1 review 63 studies patients Obesity 1 meta-analyses, 6 reviews 71 studies patients Rhumatology Oncology 1 meta-analyse 4 meta-analyses 17 studies 177 studies patients patients Total 22 meta-analyses 13 reviews 598 studies ± patients

11 Percentage of studies Efficacy of Patient Education % 39 % 59 % Less good No effect Improvement

12 Diabetes Decrease in hospitalisations % Days of hospitalisations - 80 % Days of hospitalisation / patient Total 86 patients Before 4 years After 4 years Garcia Ortega C. et al. Rev Esp Salud Publica : 45-50

13 Asthma Decrease in hospitalisations Crises/patient Education P<0.001 P<0.001 Visit to emergency rooms Control P<0.001 Hospitalisation days (n=pt) - 80% Fireman & al. Pediatrics 1981; 68 : 341

14 Number of patients Schizophrenia Decrease in hospitalisations 6 4 With TPE Without TPE - 60 % 2 0 No relapse Short hospitalisation Long hospitalisation Continuing hospitalisation Rund BR. Et al. Acta Psychiatr Scand :

15 Heart attack Decrease in readmissions Meta-analyses 8 randomised controlled studies Readmission diminished by 21% in 7/8 études NNT = 9 No effect on mortality Gwadry FH Arch. Intern Med. 2004, 164:

16 Asthma Effets of TPE on days out of work Days out of work Days (/10) - 50 % Before After 67 employees follow-up during a year Muhlhauser & al. J Int Med :157

17 Back pain : return to work 50 patients in each group Education - cognitivo-behavioural physical activity (54 h. for 3 weeks) % % Education Control 0 Return to work Mayer et al. Spine 1985 ; 10 : 482

18 Conclusion 1 spent for Therapeutic Patient Education saves 4 Cost-benefit analysis of patient education E. Bartlett

19 Summary Therapeutic Patient Education is a Humanist medicine Patient centered approach to help him deal daily with his chronic disease Approach which enables a better quality of life Efficient for therapeutic adherence and complications Efficient for medical costs

20 Thanks to all my collaborators