Summary
Background
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.
Aim
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.
Methods
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.
Results
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%).
Conclusion
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.
Résumé
Contexte
Les représentations de l’éducation thérapeutique qu’ont les soignants, de ces résultats et de la relation au patient sont des facteurs d’implantation et de pérennisation de cette pratique.
Objectif
Dans la perspective de comprendre les leviers de la participation des soignants à l’ETP et dans l’optique de favoriser son développement, cette étude avait pour objectif de décrire la perception que les professionnels de santé avaient de l’ETP dans l’insuffisance cardiaque.
Méthode
Une enquête nationale par questionnaire auto-administré a été réalisée de janvier à mai 2013 auprès de 61 centres ODIN faisant partie du programme I-CARE. Le cardiologue en charge du centre a reçu 5 questionnaires : 1 pour lui et 4 à transmettre aux autres professionnels travaillant avec lui.
Résultats
Sur les 305 questionnaires envoyés, nous avons obtenu 116 réponses (38,0 %). La quasi-totalité des répondants déclaraient que les patients étaient davantage observants en ayant suivi une ETP (91,4 %). Selon les répondants, le patient avait acquis davantage de connaissances grâce à l’ETP (53,9 %). Ils disaient que l’ETP avait changé leur relation avec les patients (81,9 %). Ils déclaraient avoir le sentiment d’éduquer les proches du malade en même temps que le patient (86,2 %).
Conclusion
L’enquête montre que l’ETP améliore la relation de soin. Les professionnels de santé reconnaissent travailler différemment depuis sa mise en œuvre et souhaitent que l’entourage du patient soit intégré à la prise en charge.
Background
The aim of therapeutic patient education (TPE) is to help patients acquire or maintain the skills they need to better manage their lives with a chronic illness . Nowadays, the value of TPE has been recognized in most industrialized countries for many chronic diseases . In light of this, TPE is part of the recommendations for the treatment of heart failure (HF) , which has become a major public health problem . There is growing evidence that patient education in “HF self-care” decreases HF morbidity and mortality, lowers hospital readmission rates and improves quality of life . However, the efficacy of TPE programmes on HF remains questionable, in part because most studies in the literature lack a precise programme description, making comparative analysis of the studies difficult . TPE requires active participation of the patient in the care and follow-up processes of the illness . This non-pharmacological care takes both patient’s and care provider’s priorities into account, which facilitates patient monitoring. The efficacy of TPE in the improvement of patient health and quality of life, and in the reduction of morbidity and mortality, has already been demonstrated in the cardiovascular domain . This innovative care system has changed the care provider/patient relationship by advocating a partnership that incites healthcare providers to consider each patient as an equal . Moreover, TPE has modified the relationships that may exist among healthcare providers, given the multidisciplinarity of treatment by TPE . Despite the fact that TPE in HF has proven its efficacy in randomized trials and is recommended , it remains a minority practice. Care provider support for 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 HF.
Methods
A national survey by self-administered questionnaire was performed from January to May 2013 in all Observatoire De l’INsuffisance cardiaque (ODIN; Heart Failure Observatory) centres ( n = 61) participating in the I-CARE programme. The I-CARE programme was created by the Société française de cardiologie (SFC: French Cardiology Society) and the French Federation of Cardiology. In 2011, over 220 centres in France and French-speaking Benelux were participating in the I-CARE programme . The aims of the I-CARE programme were to evaluate the effect of TPE on the morbidity and mortality of HF patients and to develop and implement standardized tools and training sessions. Evaluation of the impact of TPE on morbidity and mortality was performed by creating a vast ODIN registry from patients treated in participating I-CARE centres, whether these patients were educated (in terms of TPE) or not. In all, the ODIN registry included 3248 patients from 61 participating centres. The 61 participating ODIN centres were as follows: seven rehabilitation centres; five treatment networks; 32 general hospitals; 14 university hospitals; and three private clinics .
In each of the 61 centres surveyed, the cardiologist in charge received five questionnaires: one for him/herself and four for the healthcare providers that work with him/her (nurses, dieticians, physical therapists, psychologists, pharmacists, ergotherapists, MDs, etc.). Each questionnaire was accompanied by an information letter and a self-addressed stamped envelope. The responses were anonymous. Data treatment was authorized by the CNIL (French Data Protection Authority). The questionnaire was drawn up by a pluridisciplinary team of cardiologists, lawyers and specialists in ethics and public health.
The questionnaire was divided into five parts with 37 questions (19 close-ended questions and 18 open-ended questions enabling the justification of responses). The first part of the questionnaire dealt with general subjects related to the profession and perception of TPE. To best respect patient anonymity, we did not ask responders about their age, background/education, TPE experience or which ODIN centre they worked in. The second part concerned the implementation of TPE, particularly the target population, the reasons for excluding some patients and the healthcare providers putting it into practice. These questions were also meant to evaluate the information given to patients before participation in the programme. The third part sought to evaluate care provider feelings about the impact of TPE on patient lifestyles, appreciation of changes in their observance and justification of the modification in their lifestyles. The fourth part was concerned with the repercussions TPE has for care provider/patient relationships. Finally, the last part dealt with care provider feelings in terms of the presence of a third party in the care relationship.
Variables were reported as percentages of the total number of responders. A textual analysis was used to process open-ended questions. Preliminary processing of open-ended questions was performed by grouping the responses in the various categories according to the ideas transmitted and the terms used by the responders.
For qualitative analysis of the results, we used the Morin-Chartier method , by designing a code grid that listed the various themes encountered in subthemes from detailed analysis of a sample of responses. Analysis of the results was simple, descriptive without comparison. For each responder group and for all of the responders, for each variable, the frequency of response modes was expressed in numbers and in percentage of total responses. We included all of the ODIN centres. For a proportion of the answers at 25%, the sample size that was obtained enabled an estimated 95% confidence interval of between 6% and 11%, according to the values of the frequencies observed.
Results
The results are summarized in Table 1 .
| Total | Cardiologists | Other healthcare providers | |
|---|---|---|---|
| Number of responders | 116 (38.0) | 30 (49.2) | 86 (35.2) |
| How do you view TPE? a | |||
| TPE is a continuous process in patient care | 108 (93.1) | 27 (90.0) | 81 (94.2) |
| TPE makes it possible to exchange information on the illness with the patient | 71 (61.2) | 19 (63.3) | 52 (60.5) |
| TPE is an education | 47 (40.5) | 14 (46.7) | 33 (38.4) |
| Compared with traditional care, do you think TPE provides added value in patient care? | |||
| Yes | 115 (99.1) | 30 (100) | 85 (98.8) |
| No | 0 (0) | 0 (0) | 0 (0) |
| No answer | 1 (0.9) | 0 (0) | 1 (1.2) |
| If yes, how? a | |||
| More knowledge | 62 (53.9) | 17 (56.7) | 45 (52.9) |
| Improves the care relationship | 25 (21.7) | 10 (33.3) | 15 (17.6) |
| Patients feel more supported | 15 (12.9) | 5 (16.7) | 10 (11.8) |
| Patients more confident on a daily basis | 13 (11.3) | 6 (20.0) | 7 (8.2) |
| Has TPE changed your relationship with patients? | |||
| Yes | 95 (81.9) | 21 (70.0) | 74 (86.1) |
| No | 21 (18.1) | 9 (30.0) | 12 (13.9) |
| No answer | 0 (0) | 0 (0) | 0 (0) |
| If yes, how? a | |||
| Relationship more stable | 55 (57.9) | 9 (42.9) | 46 (62.2) |
| More exchange of information between care providers and the patient | 45 (47.4) | 7 (33.3) | 38 (51.3) |
| Enables a holistic approach | 42 (44.2) | 6 (28.6) | 36 (48.6) |
| Greater confidence | 15 (15.8) | 3 (14.3) | 12 (16.2) |
| Greater tolerance in terms of non-observance | 5 (5.3) | 2 (9.5) | 3 (3.5) |
| Better communication | 4 (4.2) | 0 (0) | 4 (5.4) |
| Overall, what do you think of the presence of third parties in the care relationship? a | |||
| Added value | 93 (80.2) | 22 (73.3) | 71 (82.6) |
| Reassuring for the patient | 82 (70.7) | 20 (66.7) | 62 (72.1) |
| Optional | 64 (55.2) | 20 (66.7) | 44 (51.2) |
| Necessary for the success of the programme | 59 (50.9) | 12 (40.0) | 47 (54.6) |
| Necessary for the patient | 53 (45.7) | 10 (33.3) | 43 (50.0) |
| Restricting for the patient | 15 (12.9) | 4 (13.3) | 11 (12.8) |
| Problematic | 10 (8.6) | 2 (6.7) | 8 (9.3) |
| Compulsory | 8 (6.9) | 3 (10.0) | 5 (5.8) |
| When an expert patient steps in, what should his/her role be in TPE sessions? a | |||
| Sharing | 102 (87.9) | 25 (83.3) | 77 (89.5) |
| Advising | 55 (47.4) | 16 (53.3) | 39 (45.3) |
| Listening | 47 (40.5) | 11 (36.7) | 36 (41.9) |
| Observing | 27 (23.3) | 10 (33.3) | 17 (19.8) |
| Training | 21 (18.1) | 6 (20.0) | 15 (17.4) |
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