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----IUVd823J;cygirt iii Contents Page Working Group on Therapeutic Patient Education............................... v Acknowledgements..............................................................................vi 1. Therapeutic patient education: educational considerations........... 1 Introduction ........................................................................... 1 The need to train health care providers in therapeutic education of patients with chronic diseases .......................... 3 The need for educational programmes in therapeutic pati ent education................................................. 6 General cons iderations .......................................................... 8 Basic considerations concerning educational programmes for health care providers in therapeutic pati ent education............................................... 12 Elements of an educational programme .............................. 13 Network of basic edu cational prin ciples ............................. 14 Programme framework........................................................ 15 2. Competency profiles of therapeutically educated patients ................................................................. 17 Competencies of type 1 diabetic patients ............................ 17 Competencies of type 2 diabetic patients ............................ 20 Competencies of as thma patients ........................................ 22 Evolution of patien ts' attitu des ........................................... 24 3. Competency profiles of health care providers ............................25 Competencies in patient-based therapeutic patient education ................................................................. 26 4. Educational programmes for health care providers in therapeutic patien t educat ion .....................................................29 Considerations on the number of participants and the course duration ....................................................... 29 Introduction to therapeutic patient education Programme (A).................................................................... 30 iv Introduction to therapeutic patient education Programme (B).................................................................... 35 Implementation of therapeutic patient education Programme (C).................................................................... 38 Coordination of therapeutic patient education programmes Programme (D).................................................................... 52 Bibliography: an e ducational tool ...................................... 54 5. Obstacles ..................................................................................... 57 Common obstacles to educational programmes in therapeutic patient education for health care providers....... 57 6. Recommendations Recommendations to health care providers ........................ 61 Recommendations to educational institutions for health care providers...................................................... 62 Recommendations to heal th care inst itutions...................... 63 Recommendations to WHO collaborating centres ............... 63 Recommendations to the health indu stries.......................... 63 Recommendations to health insurance companies .............. 64 Recommendations to the media (print, audio, video) ......... 64 Recommendations to Member States of WHO .................... 64 Recommendations to the WHO Regional Office for Europe............................................................................ 65 Annex Index/Glossary .................................................................... 67 v Working Group on Therapeutic Patient Education 11–14 June 1997 Members A NTSIFEROV , M IKHAIL B., Head Endocrinologist, National Centre for Endocrinology, Moscow, Russia C OSTEA , M ARIANA , Psychologist, Institute of Nutrition and Metabo- lism, Bucharest, Romania F ELTON , A NNE -M ARIE , Registered Nurse, Chairperson, Federation of European Nurses in Diabetes, London, UK ( Vice-Chair ) G AGNAYRE , R ÉMI , Département de Pédagogie des Sciences de la San- té, Université Paris-Nord, Bobigny, France M ALDONATO , A LDO , Istituto Clinica Medica 2, Policlinico Umberto I, Rome, Italy ( Chair ) P ACCAUD , U RSULA , Registered Nurse, Directrice Adjointe, Départe- ment des Soins Infirmiers, Hôpitaux Universitaires de Genève, Swit- zerland P ETRENKO , V LADIMIRAS , Head, Department of Diabetology, Aca- demic Clinics, Kaunas, Lithuania R OSENQVIST , U RBAN , Department of Social Medicine, Akademiska sjukhuset, Uppsala, Sweden V ISSER , A DRIAAN , European Editor, Patient Education and Counsel- ling, Helen Dowling Institute for Biopsychosocial Medicine, Rotter- dam, Netherlands ( Rapporteur ) Secretariat A METOV , A LEXANDER S., Head, Chair of Endocrinology, Russian Academy for Advanced Medical Studies, Moscow, Russia ( temporary adviser ) A SSAL , J EAN -P HILIPPE , Chief, Division of Therapeutic Patient Educa- tion for Chronic Diseases, Hôpitaux Universitaires de Genève, Swit- zerland (c onvenor ) F AWCETT -H ENESY , A INNA , Regional Adviser for Nursing, WHO Re- gional Office for Europe, Copenhagen, Denmark G UILBERT , J EAN -J ACQUES , Consultant, Division of Therapeutic Pa- tient Education for Chronic Diseases, Hôpitaux Universitaires de Genève, Switzerland ( Secretary ) J ACQUEMET , S TEPHANE , specialist in adult education, Division of Therapeutic Patient Education for Chronic Diseases, Hôpitaux Uni- versitaires de Genève, Switzerland ( temporary adviser ) K ALO , I SUF , Regional Adviser, WHO Regional Office for Europe, Copenhagen, Denmark vi Acknowledgements The WHO Working Group on Therapeutic Patient Education ac- knowledges the valuable contributions to its work made by the follow- ing colleagues in the preparation of working papers. B ERGER , M ICHAEL , Director, Medizinische Klinik & Poliklinik, Heinrich Heine Universität, Düsseldorf, Germany C HASTONAY , P HILIPPE , Institute of Social and Preventive Medicine, University of Geneva, Switzerland D ECCACHE , A LAIN , Director, Health Education Unit, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium D OMINICE , P IERRE , Professor, Director of Continuing Education, Fac- ulty of Psychology and Education Science, Geneva, Switzerland E ULLER -Z IEGLER , Liana, Professor, Department of Rheumatology, University Hospital Centre, Nice, France G OLAY , A LAIN , Privat Docent, Research Associate, Division of Therapeutic Patient Education for Chronic Diseases, Hôpitaux Uni- versitaires de Genève, Switzerland G RABAUSKAS , V ILIUS , Rector, Medical Academy, Kaunas, Lithuania I VERNOIS (d'), J EAN -F RANÇOIS , Director, Department of Health Sci- ences Education, Faculty of Medicine, University Paris-Nord, Bo- bigny, France J UNOD , A LAIN , Professor, Medical Director, Hôpitaux Universitaires de Genève, Switzerland L ACROIX , A NNE , Psychologist, Division of Therapeutic Patient Edu- cation for Chronic Diseases, Hôpitaux Universitaires de Genève, Switzerland O ERTEL , W OLFGANG , Philips University, Marburg, Germany P ARTRIDGE , M ARTYN R., Consultant Physician, Chest Clinic, Whipps Cross Hospital, London, United Kingdom P OSTEL -V INAY , A., Paris, France S HATCHKUTE , A USHRA , Regional Adviser for Chronic Disease Pre- vention, WHO Regional Office for Europe, Copenhagen, Denmark W ALDVOGEL , F RANCIS , Professor, Director, Department of Internal Medicine, Hôpitaux Universitaires de Genève, Switzerland 72 active student participation 54 Level of performance (ac- ceptable) : criterion of a spe- cific learning objective (see specific learning objective ) 12 Lifestyle : a person's particular way of life ; habits used to cope with life and ease social contact; shaped by patterns of interpersonal interaction and social learning that interrelate with and are determined by the social environment 1, 27 Locus of control : (psycho- logical theory – Rotter, J.B., 1954). Refers to the amount of personal control over the envi- ronment which individuals believe they possess. "I can anticipate difficulties and take action to avoid them " ( internal locus of control). "I think peo- ple are the victims of circum- stances beyond their control" ( external locus of control) 8, 40, 49 Long-term diseases : see chronic diseases M Management : the actions nec- essary for the preparation of plans , their implementation , the evaluation of results and the re-planning stage 2, 5, 7, 11–12, 17, 20, 22, 27, 29–30, 41, 52, 57, 59, 61, 64 Medical chart : see Patient chart Motivation : what causes a person to act in a particular way 10, 35, 49, 57, 58 Multiprofessional education : learning activities , with inter- action as an important goal, shared by learners of different health professions during cer- tain periods of their education 12, 14, 39, 62 N Networking : action of work- ing together, in order to be more efficient, concerning members of different profes- sions. See also teamwork 9 O Objective : in management terms, a statement of purpose or a condition/situation desired in some stated future 8, 10, 13, 17, 20, 22, 27, 30–33, 35, 38– 42, 44–47, 49–53, 62 Objectives (learning) : see learning objectives Objectivity : the extent to which independent and compe- 73 tent examiners agree on what constitutes an acceptable level of performance 50 Obstacles : impediments that must be overcome to achieve objectives. In contrast to con- straints, obstacles can be re- moved, by-passed or over- come. See also constraints 26, 31, 49, 57, 59 P Patient-based education : an educational process in which the patient is one of the essen- tial learning resources 12, 26, 29, 31, 62 Patient-centred approach : a process that puts the patient at the centre of the picture. It is concerned with patients' opin- ions, concepts, ideas and feel- ings as well as their biological state. This approach should not be used only for chronic- disease patients: all patients deserve it 13, 17, 25, 26, 30, 34, 39 Patient-centred education : see therapeutic patient education Patient chart : usually called "medical chart". It is a collec- tion of information (usually on paper) reported by health care providers concerning the pa- tient, including main complaint, history of the illness (anamne- sis), and physical and other find- ings, laboratory results etc. In a multiprofessional patient- centred approach each patient should have a single chart in which the periodic contributions of all health care providers con- cerned are recorded 62 Patient's competencies : see educated patient profile Patient education : see thera- peutic patient education Performance : accomplish- ment of an act ( task ). An indi- vidual result obtained from carrying out a task, depending largely on level of competence and on motivation 11–12, 27, 41 Prerequisites : conditions, in- cluding experience and compe- tencies , which must be present before a task can be performed 38 Prerequisite level : level of competence required from a learner in order to begin an educational activity 40–43, 45–48, 50 Problem (health) : difference between current and desired health conditions, or between actual and expected results, 74 which causes concern to the patient or the population as a whole 13 Problem-based learning : a process whereby a learner uses, from the beginning of the learning activity, a problem as a stimulus to discover what information is needed to un- derstand and help in the resolution of the problem 2, 13, 26, 35–38, 40–42, 46 Problem-solving approach : see problem-based learning Professional profile : a list of functions and activities corre- sponding to a given profession. Also called job description 12, 15–17, 24–26, 29, 35, 42, 62 Profile : see professional pro- file or educated patient profile. Programme (educational) : a series of planned and coordi- nated educational activities that a learner is to experience with the assistance of teachers 1–2, 5–15, 25–30, 32–35, 38, 46–47, 51–52, 54, 57–59, 62– 63, 65–66 R Reformulation (ing) : express- ing in other words what a per- son said 41, 43 Relevance : quality of being appropriate to and consistent with the object pursued. In this report it is the quality of con- formity with the health needs of the patient 16, 48 Resources : the sum of total manpower, finance, facilities, technology, legislation and materials (supplies and equip- ment) available for rendering a service 1–2, 10, 14, 26, 29–31, 34, 57, 59 S Self-evaluation : process by which learners directly obtain information on their progress or gain in competence (see also formative evaluation) 14 Self-management : what pa- tients decide to do in order to manage their treatment and prevent complications 5, 27 Skill (professional ): a learned ability to perform an act com- petently. It may be an intellec- tual skill (cognitive), an inter- personal-communication skill (affective) or a practical skill (sensori-motor) 5, 7–8, 41 Specific educational objec- tive : an objective derived di- rectly from a professional task and with the following quali- 75 ties: unequivocal, feasible, ob- servable and measurable. Well formulated, it should include: the act corresponding to the expected competency, ex- pressed by an active verb; the content specifying the subject in relation to which the act is to be performed; the conditions , describing the resources avail- able to perform the act; and a criterion for the acceptable level of performance . Strategy(ies) : approach(es) to solving a problem by achieving stated objectives while taking account of resources , obstacles and constraints 2 System approach : an ap- proach that considers the ele- ments of a problem as an in- terdependent whole 35, 38, 52 T Task, professional : a measur- able action derived from the segmentation of a professional activity 11, 14 Teacher-centred approach : in conventional education, a proc- ess describing what teachers do (number, length and content of lectures), as distinct from a learner-centred approach 38, 39 Teaching : interactions between teacher and learner, under the teacher's responsibility, de- signed to bring about expected changes in the learner's behav- iour 2, 31, 33–34, 36–39, 45– 46, 58–59, 62 Teamwork : a process includ- ing coordinated action aimed at solving problems, carried out by two or more persons jointly, concurrently or se-quentially, formally or informally. It im- plies commonly agreed goals; respect for, and a clear aware- ness of, others' roles on the part of each member of the team; adequate human and material resources; effective leadership and provision for evaluation (see also Networking ) 2, 12 Teamwork competence : the ability to work as colleagues rather than in a superior-sub- ordinate relationship 12 Therapeutic patient educa- tion : educational activities essential to the management of pathological conditions , man- aged by health care providers duly trained in the field of education, designed to help a patient (or a group of patients and their families) to manage their treatment and prevent avoidable complications, while keeping or improving their qual- ity of life. What is specific 76 about it is that it produces a therapeutic effect additional to that produced by all other inter- ventions (pharmacological, phy- sical therapy, etc.) 1–15, 25–31, 35–36, 38–50, 52–53, 57–59, 61–66 V Validity : the extent to which an instrument measures what it is intended to measure 16, 35, 38–39, 48, 50, 67 77 https://www.euro.who.int/__data/assets/pdf_file/0007/145294/E63674

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