Appendix 21. Therapeutic patient education

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    Update: March 2023

     

    Therapeutic education should be provided promptly after diagnosis, then at each clinical visit and whenever considered necessary by the patient or the health staff, until the end of treatment.

    Interviews are done either by the prescribing clinician alone, or with the help of a specially trained staff member or counsellor. Patients may bring someone with them if they wish.

    21.1 Initial therapeutic education

    Two individual interviews should be organised:  

    • The first interview, before the start of treatment, aims to provide essential information to help the patient understand and manage the disease and treatment.
    • The second interview, one week later, aims to verify that the information given previously has been assimilated, and if necessary, complete or clarify it. 

    21.1.1 First interview

    • Plan a 30 to 45 minute-session.
    • Adapt the information according to the:
      • Stage of disease (latent TB infection, active TB).
      • Site of TB (pulmonary, extrapulmonary).
      • Resistance pattern (drug-susceptible, drug-resistant).
      • Treatment regimen.
      • Comorbidities, especially HIV infection.
    • Explain:
      • The disease and how it is transmitted.
      • The treatment:
        • Total duration; duration of phases (intensive/continuation) if relevant.
        • Clinical and bacteriological monitoring.
        • Treatment administration (self-administered or directly observed).
      • The TB drugs:
        • Where, when, and from whom to get them.
        • How to take them: number of tablets (or doses) per day; with or without food, etc.
        • Storage: e.g. do not removed tablets from blister pack ahead of time.
        • Main adverse effects and what to do if they occur.
        • Special precautions according to the situation (e.g. concomitant treatment, pregnancy).
      • Measures the patient and their household members should take to prevent the spread of TB or, if the patient is hospitalised, the hospital infection prevention and control measures in place (Chapter 14).
      • The importance of HIV testing if not already performed.
    • Explain the importance of adherence (regular treatment without omission or interruption). Adress patient issues. Identify barriers to adherence and possible solutions. Explain what enablers the patient is eligible for and how to access them (Chapter 13).
    • Answer any questions.
    • Give the date of the second interview.

    21.1.2 Second interview

    • Plan a 30-minute session.
    • Review patient's knowledge (disease, treatment and other information provided at the first interview).
    • Answer any questions.
    • Assess adherence (Appendix 22) and address problems if any (Chapter 13).
    • Give/remind the date of the next clinical visit.

    21.2 Continuing therapeutic education

    An individual interview should be organised at each clinical visit. For the schedule, see Appendix 14 or Appendix 15.

    These interviews aim to consolidate the patient's skills and update them if necessary, especially when there is a modification in the treatment regimen (e.g. when moving from intensive to continuation phase; when replacing a treatment regimen with another; when transitioning to outpatient treatment after hospitalisation).

     

    • Explain the changes in treatment if any (composition, duration, adverse effects, precautions, monitoring schedule, etc.).
    • Answer any questions.
    • Assess adherence (Appendix 22) and address problems if any (Chapter 13).
    • Give/remind the date of the next clinical visit.

     

    Additional sessions should be scheduled as needed, e.g. if there are learning difficulties or significant changes in the patient's life.

     

    For further information, refer to the specific guidelines on therapeutic patient education.

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