Jean-François d’Ivernois

Characteristics and development of therapeutic patient education in rheumatoid arthritis: Analysis of the 2003–2008 literature

OBJECTIVE The aim of this study is to point out the recent characteristics and developments of therapeutic patient education (TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. METHOD Studies were selected from major databases, using the following keywords: rheumatoid arthritis, patient education, self-management, programs. Three authors independently reviewed each study and selected the data using the patient education research categories (PERC). Articles consistently related to patient education in rheumatoid arthritis (37 among 109) were included. RESULTS The selected articles have been published in 23 scientific journals. The majority of them concern TPE for adult patients with rheumatoid arthritis. TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team. There are two types of programs: educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers to TPE are linked to cultural and socio-economic factors. CONCLUSION A large number of studies still assess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barriers to this practice have become a major issue for research.

The use of degrees of certainty to evaluate knowledge.

In patients with chronic diseases education should improve knowledge about the disease and increase certainty in knowledge. We present here a technique to measure changes in certainty after an educational intervention. For this purpose, before and after a course, patients answer a questionnaire in which answers are accompanied by an estimate of the degree of certainty. Answers are then assigned to areas of knowledge defined a priori: mastered (certainty > or = 90%, correctness > or = 90%), hazardous (certainty > or = 90%, correctness < or = 50%), uncertain (certainty < or = 50%, correctness > or = 90%) and residual. Finally differences in the distribution of answers among different areas are analysed statistically. Using this technique in a group of patients with type I diabetes who followed a course on insulin use, we found significant changes in the distribution of answers among different areas of knowledge. Thus changes in certainty can be analysed quantitatively and used to evaluate better the effect of therapeutic education.

Towards promotion, structuring and acknowledgement of patient education activities in France

As patient education becomes more and more widespread in use among French health professionals, it is also becoming increasingly structured, but remains very heterogeneous depending on practitioners and institutions. For several years, this activity has been integrated into various professions. Training is becoming more frequent, and care providers show a certain willingness for common though on improvement and evaluation of their practices. At the same time, health institutions show an increasing interest in these activities, which they wish to promote. Significant improvements recently observed by them may finally lead to the professional and financial recognition expected by care providers.

L'exercice infirmier dans un contexte d'isolement géographique: Implications pour la formation

L’etude des caracteristiques du contexte d’exercice d’infirmieres et d’infirmiers isoles et semi-isoles en Polynesie francaise et dans le Nord quebecois montre l’importance d’une formation preparatoire specifique de ces professionnels.Vingt professionnels ont ete interroges : six infirmiers/eres exercant dans les postes isoles de Polynesie francaise (archipel des Tuamotu, des Marquises et des Australes), six infirmiers/eres exercant dans les postes semi-eloignes du Nord quebecois (Algonquins, Cris et Attikameks), quatre responsables a la Direction de la Sante de Polynesie francaise et quatre « concepteurs » de programmes quebecois rencontres lors de notre exploration a Montreal, Mistissini et Trois-Rivieres.Dans les deux contextes d’exercice, dix caracteristiques ont ete identifiees que nous avons regroupees en deux grandes categories : celles inherentes a la pratique professionnelle isolee (comprenant les caracteristiques de l’exercice professionnel infirmier, des conditions d’exercice, des problemes de sante de la population et du mode de relation socioprofessionnelle ainsi que du mode de vie et la perception de l’isolement), et celles inherentes a l’environnement social et naturel, au contexte economique et aux specificites culturelles de la communaute. L’ensemble des resultats montre bien les specificites des competences mises en œuvre par les infirmier(e)s bien differente de celles pour lesquelles on les prepare en formation initiale. Si une formation preparatoire au contexte isole apparait primordiale, les predispositions individuelles de ces infirmiers a exercer dans un contexte aussi complexe, et la reconnaissance de leurs competences professionnelles sont egalement a considerer dans une perspective de gestion des ressources humaines.