Clinical Trial Summary
Therapeutic patient education (TPE) is one of the approaches used to manage chronic diseases.
It aims to make the patient an active participant in his or her own care and to establish an
effective partnership with the carer, thereby also responding to the need to control health
expenditures.
However, the contribution of TPE has revolutionised healthcare professions, in particular by
profoundly changing the carer-patient relationship and certain aspects of their professional
culture.
a recent action-research study conducted in partnership with Crf-Cnam in Paris showed that
although the training of professionals appears to be a major issue, the integration of TPE
forces the involved parties to question their practices. TPE imposes a change in the
understanding that carers have of their usefulness in accompanying patients and in their
perception of education and care. It also changes their relationship to the involvement of
patients in maintaining their health.
The implementation of educational approaches in Mental Health is also at the origin of many
questions.
In a study of patients suffering from schizophrenia, discrepancies appeared amongst the
carers, whose outlooks seemed to be correlated with their experience in TPE. The
carer-caregiver relationship was evoked with a feeling of lack of exchange, and a feeling of
infantilization for certain carers. This study highlights the misconception that some
psychiatric caregivers have of TPE in somatic care, and the idea that TPE is limited to drug
treatments.
Therapeutic education is of particular importance as it is a determinant of the schizophrenic
patient's adherence to therapeutic principles. However, it must be based on an appropriate
strategy that facilitates communication and the exchange of knowledge with patients suffering
from severe and persistent psychological disorders.
During the implementation of two ongoing TPE programs initiated with schizophrenic patients,
we were able to observe that despite the knowledge of the TPE caregivers, there were still
difficulties in its implementation: lack of recruitment, organizational difficulties, loss of
motivation...
In the same prism as the development of new care strategies by the Ministère des solidarités
et de la santé, we asked ourselves questions about strengthening the training of paramedical
staff, such as: how can health literacy be enriched in mental health training programs? But
the trainig of individuals in the field seems to be only one of the components. This care
project raises questions about values systems and the mechanisms for legitimizing power, and
requires consent and commitment from the various actors.
The hypothesis formulated is that one of the keys to better patient adherence and better
appropriation of a TPE programme in mental health would be to take into account the
representations of the carers dispensing these programmes. This investigation will be based
on TPE programs dispensed to schizophrenic patients at La Chartreuse Psychiatric Hospital in
Dijon, France.
