Treatment Compliance, TherapeuticEducation And Phosphorus Mission

Frédérique Quinio

Disclosure

Frédérique Quinio has received funding from Sanofi to attend and speak at this educationalsymposium. This is the first time funding has been received from Sanofi.

Agenda

• Compliance and therapeutic education

• Phosphorus Mission

• Phosphorus Mission demonstration

• Feedback on independent EDTNA validation

Chronic Disease & Treatment Compliance

The WHO defines compliance with treatment as « the concordance between the behaviour of a person (use of

prescribed drugs, diet and changes of behaviour) and the recommandations of caregivers »

Source: OMS.2003.Adherence to Long Term Therapies:Evidences for Action.OM/MNC/03.01.

www.who.int/chronic_conditions/en/adherencereport.pdf

Determinants For Non Compliance

• Socio-demographic factors (age, gender, socio-economic & professional background, family situation, personality and psychological state of the patient)

• Belief system (religion, representation of the disease, the treatment, the role of caregivers)

• Pathology (intensity of symptoms, duration, severity, prognosis)

• Treatment regimen (number of pills, side effects, daily frequency, drug form, treatment understanding)

Source: OMS.2003.Adherence to Long Term Therapies:Evidences for Action.OM/MNC/03.01.www.who.int/chronic_conditions/en/adherencereport.pdf

Therapeutic Education: StrengtheningTreatment Compliance

• The WHO defines therapeutic education as « all the actions done to help patients to improve, maintain the skills / competences they need to manage their lives with a chronic disease »

• Goals- allow patients and their environment to better understand the pathology

and the treatments

- co-operate with caregivers

- introduce patient empowerment into their lives to better manage their disease

- help patients to maintain and improve their quality of life

Source: WHO-Europe report Therapeutic Patient Education- Continuing Education Programs for Health Care Providers in thefield of chronic disease.1996

Therapeutic Education: 4 Stages

• Personalised educational diagnosis

• Definition of a personalised education program - identifying

short and long term learning priorities

• Planning and implementing individual sessions and collective workshops

• Evaluation of learned skills and program flow

Source : Sandrin.B.(2009) : Education thérapeutique du patient : de quoi s’agit il ? . ADSP n° 66 mars 2009

Personalised Diagnosis

• Allows the educational team to be aware of the patient’s five dimensions (bioclinical, cognitive, socio-professional, psychoaffective and projective)

• Gives healthgivers elements to understand the reality of living with a chronic disease

– problems experienced – Prioritized and identified by the patient – adaptive strategies already developed– representation of the disease, the treatment and the relation between caregivers

and the patient)

• Strengthens the therapeutic alliance between the patient and the multi-disciplinary care giver team

Source : Sandrin.B.(2009) : Education thérapeutique du patient : de quoi s’agit il ? . ADSP n° 66 mars 2009

Personalised Program

• Joint definition and priorization of learning priorities

• Joint definition of educational goals so to ensure common aims between patient and health care team

• Establish an « education contract » between patient and educational team

Source : Sandrin.B.(2009) : Education thérapeutique du patient : de quoi s’agit il ? . ADSP n° 66 mars 2009

The Journey In Therapeutic Education

• Presentation of existing programs (themes, frequency, individual and group modalities, resources, learning tools and professionals involved in the process)

• Organisation of the patient’s own program (planning individual and group sessions)

• Assessing procedures for mid and final term evaluations

Source : Sandrin.B.(2009) : Education thérapeutique du patient : de quoi s’agit il ? . ADSP n° 66 mars 2009

Assessment And Re-adjustment

• Provided while designing the program

• Occurs during program at different defined stages

– allows a readjustment of already learned skills– an adaptation to the patient’s learning speed– consolidation and valorisation of the changes seen during the program

• Necessary for both patient and educational team

• Final evaluation is undertaken at end of patient involvementin program

Source : Sandrin.B.(2009) : Education thérapeutique du patient : de quoi s’agit il ? . ADSP n° 66 mars 2009

What About CKD ?

• Main concerns for both health carers and patients

- Disease understanding- Understanding dialysis - what is happening during procedure?

- Understanding importance of healthy diet ,

- Informing and communicating with the family (support of family crucial to help patient cope with CKD diet restrictions)

- Treatment understanding (potassium, phosphate binders, etc. rationale for use and compliance)

- Liquid restrictions

Source: http/www.ipcem.org/Ressources/PDFress/complet%20dialyse.pdf

Goals For The Future Of CKD Patients’ Support Teams

• Bring knowledge with attractive, interactive, useful and easy to use methods

• Promote life style changes according to patient’s reality and needs

• Encourage sharing of patient experience between key stakeholders (expert patient, support groups, alternative educational methods, etc.)

• Empower patient and their environment to help them cope with disease

Phosphorus Mission

• Phosphorus Mission is a mobile application designed and developed by Sanofi for people with advanced chronic kidney disease (CKD)

• Phosphorus Mission helps patients better understand their disease, treatment options and dietary choices related to their health

• Phosphorus Mission enables patients to better assimilate essential information on CKD and understand the impact of food choices and the role of prescribed treatments

CONNECTING NURSES | 15

The Information Shareapy Community gives access to

practice tips and best practice information gleaned

by nurses and KOL nursing organizations. By

uploading and sharing links on the platform, every

single nurse can make patient support tools and

materials available to their peers and patients.

Nurses can share their education, practice and

research projects on Care Challenge and discover

their colleagues innovations worldwide : they get

immediate visibility and recognition

• Connecting Nurses is a worldwide recognition program for nurses supported by

sanofi, built in partnership with nursing organizations as

International Council of Nurses and EDTNA

• Discover both web platforms through the www.connecting-nurses.com portal and post

your project in Renal Care NOW : your project might be championed in May 2015

16

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Phosphorus Mission Educational Tool Validation Survey

Phosphorus Mission

• April 2014 EDTNA/ERCA members validated Phosphorus Mission via on line survey

• Responses were anonymous and based on members reviewing PC version of Phosphorus Mission

• Survey five areas:

• Patient educational challenges in pre dialysis and dialysis patients • Overall impressions of Phosphorus Mission• Feedback on individual sections of Phosphorus Mission • The best location to use Phosphorus Mission • Ease of use

• https://fr.surveymonkey.com/s/ValidationCommitteePhosphorusMissioneducationaltool

Country Feedback

• Belgium• Greece• Israel• Netherlands• Poland • Slovenia• Spain• Sweden• UK• Two skipped country responses

Three Main Challenges: Life Style Changes, Treatment Compliance & Change To Low Phosphate Diet

Answered: 10 Skipped: 2

What do you see as the biggest patient education challenges for your pre-dialysis patients?

Three Main Challenges: Lifestyle Change, Change To Low Phosphate Diet & Treatment Compliance

Answered: 10 Skipped: 2

What do you see as the biggest patient education challenges for your dialysis patients?

Phosphorus Mission Valuable For NursesAnswered: 9 Skipped: 3

How would you rate the usefulness of Phosphorus Mission as an education tool ?

Good Acceptance By NursesAnswered: 9 Skipped: 3

Based on your experience how likely do you think other dialysis nurses will use the Phosphorus Mission educational tool?

Value For Other Clinical Team Members Answered: 9 Skipped: 3

What other disciplines would find the Phosphorus Mission educational tool useful?

What Did You Like Most About Phosphorus Mission?

“ Animation”

“It really makes you think about how hard it is to keep phosphate down with high phosphate foods”

“Interesting, raising awareness about phosphorus and possible complications”

“Patient friendly” “Simplicity”

“Fun, and looked easy to use. made the subject enjoyable not a chore”

“Useful as a guide for clinical practice”

“The possibility to find extra information and explication during and after the game”

“”

The clearness of illustrations contents