Lesson-1 (Patient Education in Chronic Diseases).pdf.pdf

Objectives: Understand the need to patient education in chronic diseases. Recognize the burden of asthma. Learn the term “therapeutic patient education” and its main characteristics. Describe evolution of a patient after diagnosis of a chronic disease. List the objectives of patient...

Objectives: Understand the need to patient education in chronic diseases. Recognize the burden of asthma. Learn the term “therapeutic patient education” and its main characteristics. Describe evolution of a patient after diagnosis of a chronic disease. List the objectives of patient education in asthma as an example. Patient Education in chronic diseases: Asthma as an example Serap Çifçili, MU Medical School, Family Medicine Department 2023  Need: In health care practice, most of the diseases treated are CHRONIC. Treatment is efficient, quality????? Patients are inadequately informed about their condition. Few patients have been helped to manage or take responsibility for their treatment. A gap between current treatment success rates / believed to be achievable. Asthma: Burden of Disease World Prevalance: %1-8, 4.5% (WHO, age: 18-45) 250.000 deaths/year Turkey Seaside, urban areas, low SE status, hygiene theory Increase in years Prev: %2.8-14 School and work-day loss Need to education in asthma ▪What does a patient need to remember in order to accommodate their long-term condition within the context of their daily life? ▪ To use regular medication ▪ …… ▪ ….. which one of the below is right about therapeutic approch to asthma? Systemic, patient-centered Helps patients to take responsibility for their own care to maintain QOL. Therapeutic Patient An integral part of treatment and care. Education (TPE) Should be graduated. A continuous process and has to be adapted. in TPE the approch to the pateint is both subjective and objective TPE Takes into account: The patient’s adaptation process, Subjective or objective needs of patients.  Reduces costs of long-term care to patients and to Therapeutic society Patient Education (TPE) Helps patients to; prevent maintain or manage their avoidable improve their treatment, complications quality of life. , Therapeutic PRINCIPAL PURPOSE; Patient Education is to produce therapeutic effect Evolution of Patient’s Attitude acknowledges Copes, manages Does it work for asthma? Several reviews; effectiveness for self-management education in terms of medication adherence, emergency visits, hospitalizations. Labre MP et. al. Public Health Interventions for Asthma An Umbrella Review, 1990–2010. Am J Prev Med 2012;42(4):403– 410 Gordon MD. Education of the Pediatric Patient With Asthma: A Literature Review. Journal of Pediatric Nursing 2012; 27,:174–176. Viswanathan M et. al. Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States A Systematic Review Ann Intern Med. 2012;157:785-795. Barriers against treatment (WHO) ▪social/ economic, ▪therapy-related, ▪patient-related, ▪condition-related ▪World Health Organization. Adherence to long-term therapies: evidence for action Geneva: World Health Organization: 2003 Therapy-related (an example) ▪An individualized education program was used for “poor adherers». ▪Three individual sessions (30 min). 1. Knowledge and skill assessment and demonstration 2. Info about medication and dosage control. 3. A self-asthma action plan Result ▪ This intervention specifically improved both inhaler skills and increased PEF values, suggesting that asthma control became better. These effects sustained eight weeks after the intervention, and this was the last follow-up. Choi JY, Cho Chung HI. Effect of an individualised education programme on asthma control, inhaler use skill, asthma knowledge and health-related quality of life among poorly compliant Korean adult patients with asthma. J Clin Nurs 2011;20:119-26. Illness perception A structured step-wise and patient-centered approach. Defined goals and strategies. Improved asthma control, asthma self-efficacy and asthma quality of life. Smith L, Bosnic-Anticevich SZ, Mitchell B, Saini B, Krass I, Armour C. Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting. Soc Sci Med 2007;64:1501-11. Self-management education ▪Program addressing physiological and behavioural health indicators by tailored education. ▪Significant increase in adherence in relation to asthma medication and improved asthma symptoms in regard to severity, frequency, nocturnal awakenings and activity limitations. ▪Use of PEF monitoring to assess asthma was increased ▪ Morisky DE, et.al. The effects of a disease management program on self-reported health behaviors and health outcomes: evidence from the “Florida: a healthy state (FAHS)” Medicaid program. Health Educ Behav 2009;36:505-17. Exercise 1 1) List the topics that you would want to address about asthma in patient education (2 topics.) You have 1 minute. Topics Triggers and Definition of Risk factors how to avoid Symptoms asthma them Basic Complementar PEF Inhalation treatment y treatment measurement Management Attack according to Action plan symptoms PEF values Exercise 2 Choose 1 topic and write down at least 2 specific objectives about this topic 2 minutes General Objectives Asthma patients should be able to; Select objectives for the management of their disease. Recognize their own symptoms. Treat an asthma attack with prescribed medicine. Take steps to prevent another attack OBJECTIVES Symptoms: Recognize the symptoms of the onset of an attack. Implement their action plan accordingly. Contact immediately the treatment resource indicated by the symptoms. Examples OBJECTİVES Basic Treatment: Choose medicine according to its properties. Take anti-inflammatory medicine mornings or evenings. Avoid interruption of anti-inflammatory treatment without medical advice. OBJECTIVES Complementary: Choose medicine according to its properties. Always carry anti-inflammatory and bronchodilator medicaments. Use a broncodilator at first signs of an attack. OBJECTIVES Inhalation: Shake spray before use. Take one or more puffs into mouth and inhale deeply. Swallow gently and then breathe out. OBJECTIVES Peak-flow: Use peak-flow measure. Do a peak flow control mornings and evenings and when at risk. Rank peak-flow values into one of the three categories-stable, unstable, attack. OBJECTIVES Adaptation: Adapt treatment according to the values shown on peak-flow control. Follow-up on the evolution of the attack every 2-3 hours according to the action plan. Take corticoids orally according to a specified peak-flow value or if within the “orange zone” of the action plan. OBJECTIVES Precipitating factors Take action according to the environment (animals, dust...). Avoid “at-risks” (food and additives, beta-blockers, aspirin, passive smoking). Adjust treatment immediately if an actual or possible precipitating factor occurs. OBJECTIVES Precipitating factors For preventive purposes, take an additional dose of broncho-dilator before beginning a physical activity immediately (green zone). Take an additional dose of bronchodilator as soon as signs/symptoms appear and interrupt activity immediately. OBJECTIVES To avoid relapse: Recognize allergies and precipitating factors. Intensify peak-flow control if destabilization is likely to occur. Continue normal social activities, exercise and sports, if necessary, by adjusting treatment.  In Summary…….. TPE is the most important part of chronic disease management Consider patient’s adaptation process Involve patients to the education and treatment plan Plan a personally tailored and graduated education. Implement the education plan by using appropriate education methods Any questions?