patient education: from motivation to efficacy€¦ · patient education: from motivation to...
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Patient education:from motivation
to efficacy
Professor Alain GolayUniversity Hospital Geneva,
Switzerland
2
Contents
Therapeutic Patient Education
How to motivate our patient
Efficacy and efficiency of TPE
Therapeutic
Patient Education
4
Avoid or decrease
Complications
Relapses
Improve or maintain
Quality of life
Adherence to treatment
Autonomy
Aims of Therapeutic Patient Education
To help the patient deal as effectively as possiblewith his chronic disease
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Objectives of Therapeutic Patient Education
Obtain knowledge
Achieve competencies 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
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Patient education is a Tango
Follow andguide
the patient
Listen tothe inner music
of the patient
Respect the rhythm of
the patient
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How to motivate our patients
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Intellectual
Emotional
Spiritual
Communication
Acceptance
Trust
Compassion
Relationship
Empathy
Respect
Warmth
Attitude
From communication to attitude
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Attitudes for a good relationship
Congruence (Feeling-Expression)
Open-mindedness
Acceptance (unconditioned)
Empathy
Readiness to allow to grow
Carl Rogers 1958
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The 4 attitudes of motivational interviewing
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
Motivational Interviewing – Miller-Rollnick, 2002
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Efficacy of motivational interviewing on behaviour changes
Hettema JM et al. Annual Review of Clinical Psychology 2005;1:91–111
Odds ratio
At 3 months Long term follow-up
Alcohol 0.41 0.26
Smoking 0.42 0.72
Diet 0.14 0.78
Exercise 0.20 0.82
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Efficacy of Patient Education
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Diabetes
Asthma
BPCO
Hypertension
Cardiology
Obesity
Rheumatology
Oncology
Total
Lagger, Pataky, Golay, Patient Education and Counseling 2010
Efficacy of patient education
4 meta-analyses3 reviews
3 meta-analyses1 review
3 meta-analyses2 reviews
3 meta-analyses
3 meta-analyses,1 review
1 meta-analysis,6 reviews
1 meta-analysis
4 meta-analyses
22 meta-analyses 13 reviews
60 studies
30 studies
80 studies
100 studies
63 studies
71 studies
17 studies
177 studies
598 studies
12,000 patients
4,000 patients
5,000 patients
8,000 patients
8,000 patients
8,000 patients
4,000 patients
12,000 patients
± 61,000 patients
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Efficacy of patient educationP
erc
en
tage
of
stu
die
s
2%
39%
59%
0
10
20
30
40
50
60
70
Less good No effect Improvement
Lagger, Pataky, Golay, Patient Education and Counseling 2010
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Efficiency of Therapeutic Patient Education
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Diabetes: decrease in hospitalisations
Garcia Ortega C et al. Rev Esp Salud Publica 1996;3:45–50
Pe
rce
nta
ge (
%)
0
5
10
15
20
25
Days of hospitalisation Days of hopitalisation/ patient
N=86
Before 4 years
After 4 years
-80%
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Asthma: decrease in hospitalisations
Fireman et al. Pediatrics 1981;68:341
Pe
rce
nta
ge (
%)
0
5
10
15
Crises/patient Visit to emergencyrooms
Hospitalisationdays (n=pt)
Education Control
p<0.001
p<0.001
p<0.001
-80%
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Schizophrenia: decrease in hospitalisations
Rund BR et al. Acta Psychiatr Scand 1994;89:211–18
Nu
mb
er
of
pat
ien
ts
0
2
4
6
No relapse Shorthospitalisation
Longhospitalisation
Continuinghospitalisation
With TPE Without TPE
-60%
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Heart attack: decrease in readmissions
Meta-analyses of 8 randomised controlled studies
Readmission diminished by 21% in 7/8 studiesNNT = 9
No effect on mortality
Gwadry FH. Arch Intern Med 2004;164:2315–2320
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Asthma: effects of TPE on days out of work
Muhlhauser et al. J Int Med 1991;230:157
67 employees – follow-up during a year
0
20
40
60
80
100
120
140
160
180
Days out of work Days (/10)
Before After -50%
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Back pain: return to work
Mayer et al. Spine 1985;10:482
50 patients in each group Education – cognitivo-behavioural – physical activity(54 hours for 3 weeks)
Pe
rce
nta
ge (
%)
0
20
40
60
80
100
Education Control
+50%Return to work
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Efficiency of obese patient education
During 9 months before
During 9 months after
Difference
Medical costs induced by physicians
€64,101 €56,253 - €7,848
Medical direct costs €18,341 €16,686 -€1,655
Paramedical direct costs
€10,005 €9,142 -€863
Indirect costs: days out of work
12,649 5,377 -7,272
TOTAL savings €115,101 €87,458 €17,638
Sanguignol, Golay Patient Education and Counseling 2010
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€1 spent for Therapeutic
Patient Education saves €4
Cost-benefit analysis of patient education E. Bartlett
Conclusion
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Summary
Patient education is a Humanistic medicine
Patient centered approach to help him to deal daily with his chronic disease
Approach which enables a better quality of life
Efficient for therapeutic adherence and complications
Efficient for medical costs
