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Therapeutic patient education (TPE) is an essential component of pulmonary readaptation in chronic respiratory diseases. Numerous and varied patient education projects offer heterogeneous contents and methods, which render them difficult to analyze and to compare. The objective of this review was to provide perspective on the main principles of patient education, using a non-exhaustive approach.This review is focused on patient education using a patient-centered approach, physician-patient partnership and self-management, which are presented at once pragmatically and conceptually. One of the main objectives of TPE is the acquisition of self-management skills by patients with a chronic disease, which will be considered from a clinical standpoint. Lastly, TPE will be assessed in the overall framework of patient-centered pulmonary readaptation.TPE needs to be structured in view of assessing its effects. It is consequently essential for caregivers to receive continuous training so as to more clearly understand the methods employed, the objective being to build evaluable contents contributing to performance of multicentric trials.Current literature on TPE emphasizes the extent to which the patient remains the central actor in his or her care pathway. If patients are called upon to modify their behaviors, it is equally necessary that caregivers proceed likewise, adopting postures favoring the acquisition and appropriation by the patient of skills that shall be required as he or she learns to live with chronic disease.

Resume Les patients peuvent nous interpeller sur la guerison du diabete de type 2. L’important est de bien comprendre ce que le patient entend par « guerison », et quelle peut etre sa demande profonde. Meme si la reversibilite est physiologiquement envisageable, les obstacles se situent principalement dans la motivation du patient a apprendre et a changer sur le long terme. Un profond engagement des differents soignants, dans une demarche d’education therapeutique et en reseau, est necessaire, tant les notions et les competences a maitriser peuvent paraitre vastes, et parfois contre-intuitives. Que cela mene a la remission complete de la maladie ou pas n’est alors pas forcement le plus important.

Resume Introduction Les exacerbations sont les complications evolutives les plus frequentes dans la BPCO. En matiere d’education therapeutique, la realisation de plans d’action personnalises ecrits a montre un impact sur la gestion et le retentissement des exacerbations. Etat de l’art Le plan d’action personnalise est un document, elabore conjointement entre les soignants et chaque patient, qui comporte trois parties : description des signes actuels de la maladie, description des signes des exacerbations et conduite a tenir par le patient en cas d’apparition d’une exacerbation. Le plan d’action est consigne dans un document conserve par le patient. Il fait partie d’un programme d’education therapeutique qui permet de rendre le patient competent pour gerer sa vie avec sa maladie et prendre les mesures adequates quand necessaire. L’education ne concerne pas seulement le patient mais aussi le soignant, chacun devant etre sensibilise a l’interet du plan d’action et arriver a se sentir competent dans sa realisation et sa mise en œuvre. Conclusion Une formation reguliere est necessaire pour sensibiliser les soignants et augmenter le nombre de plans d’action personnalises ecrits. Une telle formation permet de redefinir le role du patient et du professionnel dans cette demarche.

Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.

Les patients souffrant d’un syndrome d’apnees-hypopnees obstructives du sommeil sont aujourd’hui plus souvent identifies et certainement mieux pris en charge qu’hier. Les progres techniques du traitement par pression positive continue permettent a plus de personnes de supporter d’etre appareillees et de beneficier du traitement plus confortablement. L’engagement dans la prise en charge de differents professionnels de sante represente une aide importante pour le quotidien des patients. Cependant, l’adhesion au traitement reste sub-optimale. En reponse a ce probleme, nous discutons ici le role crucial de l’education therapeutique du patient apneique dans une perspective de long terme.

Resume Comme la plupart des malades chroniques, les patients apneiques s’autoadministrent leur traitement, ce qui necessite l’acquisition de reelles competences et la mise en place d’une education therapeutique des patients. L’education doit etre construite sur des besoins educatifs averes. La litterature montre l’ecart entre les besoins determines par les patients et ceux apprecies par les soignants. Nous avons realise une enquete de besoins aupres de 52 patients apneiques et 15 conjoints et aupres de 29 de leurs professionnels de sante. Les resultats les plus remarquables sont la difficulte de certains patients a apprehender la realite de leur maladie, la lourdeur du traitement amenant les patients a devoir reellement bâtir leur motivation au traitement et l’etroitesse des relations entre tolerance au traitement et implication du conjoint. Nous presentons les besoins educatifs que l’on peut deduire des resultats de cette enquete et discutons des implications en terme de strategies educatives dans le cadre du syndrome d’apnees du sommeil.

Type 2 diabetes is a potentially reversible disease. Patient education encompasses a deep investment of the health care providers, who with the aid of pedagogic tools, help the pa tient commit to this path. This facilitates the learning of uncommon knowledge and skills required. Whether or not it leads to a complete remission of the disease may not be the main purpose. The main goal lies in the patient's motivation to learn and change on a long term basis.

Resume La definition de la vieillesse a beaucoup evolue grâce notamment aux progres de la medecine. Il n’est plus a demontrer les benefices de l’activite physique a tous les âges de la vie. Cependant, il est necessaire d’individualiser la rehabilitation respiratoire pour les personnes âgees. Ces dernieres doivent trouver un sens a la reprise d’une activite physique douce en restaurant un sentiment d’utilite. Elles doivent pouvoir en evaluer les benefices et se sentir confiantes et en securite dans cette pratique.

Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.

Objectif Recenser les difficultes rencontrees par les soignants lors de la creation d’un dispositif educatif et les solutions trouvees. Methodes Organisation d’une reunion pluridisciplinaire, analyse qualitative. Resultats Les resultats se trouvent sur la Fig. 1 . Discussion Mise en evidence de competences a acquerir : – savoir reperer les signes de dysfonctionnement d’une equipe ; – savoir amorcer un changement ; – gestion des conflits : connaitre le concept de bouc emissaire et les strategies a mettre en œuvre ; – mettre en valeur l’acte d’apprentissage. Conclusion La creation d’un programme d’ETP n’est pas un simple ajout dans la prise en charge des patients. Elle change la posture de l’equipe soignante qui doit passer de la position de soignant a soignant educateur. La resolution des difficultes ne passe pas exclusivement par une formation.

Therapeutic education is a patient centred approach focused on patients' needs, values and strategies. It allows not only to increase patients' knowledge and skills on the disease, but also on their treatments. It brings a better quality of life, an increased therapeutic compliance, and decreases complications. The most difficult part of therapeutic education occurs when patients must change their behaviour. Motivational interviewing techniques are of great support and allow to prepare and support patients in "step by step" progressive changes. It is essential to work on resistance to change. The ambivalence in the choice of a new lifestyle must be measured, discussed and negotiate. Patients become partners and health care providers become coaches. To negotiate objectives must allow patients to choose their own strategies which should cost them minimum psychological efforts and bring them maximum benefits. The efficacy of therapeutic education has not to be proved any more: 80% less of amputations at 10 years in diabetic patients, 50% of stable body weight after weight loss at 5 years, etc. In conclusion, therapeutic education is part of a humanist medicine centred on patients which allow them to take care of their own treatment, in order to improve their quality of life, therapeutic compliance and potential complications. The health care providers teach, train, negotiate, motivate and accompany their patients in the long-term follow-up of their diseases.