[How health care professionals perceive chronic disease: Changes in therapeutic patient education (TPE) assessment from 2011 to 2017 in a French university hospital]

BACKGROUND

Since 2010, in France, Therapeutic Patient Education (TPE) programs have applied to the Regional Health Agency (RHA) for authorization. Every four years, these programs are mandatorily re-evaluated, and the assessment allows for change in the program management criteria. In our hospital, we studied the evolution of the Therapeutic Patient Education (TPE) appraisal benchmarks, otherwise known as "indicators", in the 17 programs having been authorized and renewed at least once by the RHA.

METHOD

The TPE program appraisal benchmarks are classified in terms of structure, process and outcomes; program activity itself as well as pedagogic, psychosocial and bioclinical indicators are taken into consideration. We wished to determine the extent to which these indicators were addressed, applied and renewed or created during renewal of the TPE programs. Statistical tests were carried out in order to compare changes in the number of benchmarks in each category before and after the renewal process.

RESULTS

During the first authorization, there existed 533 appraisal benchmarks, while they numbered 550 for the second. As for "before-and-after" changes, they consisted in a reduced number of outcome indicators (43.7% to 35.1%), whereas process indicators increased (36.8% to 43.1%) (P=0.0141). In comparison to the category pertaining to pedagogic, psychosocial and bioclinical indicators, the most widely registered indicator category (55.5%) and the most frequently collected indicator category involved the program activity itself (54.7%) (P<0.0001), which increased pronouncedly during renewal periods (67.6%) (P=0.0002). Conversely, the pedagogic and psychosocial indicators were little if at all collected. As regards the latter, there was nevertheless a considerable increase in indicators related to skills and changes favoring health-promoting behaviours. Strictly bioclinical indicators have been largely supplanted by those having to do with the disease evolution, its impact and risk management.

CONCLUSION

The major role assigned to process and structure indicators reflects the fact that they are predominantly structured by RHA requests. Even if this initial study necessitates further research, it highlights a change in the design of educational and psychosocial assessments among caregivers, a change likely to reflect their interest in how patients go about managing their illnesses, (more or less healthy) lifestyles and daily lives.