Patient education in Germany

"For 20 years, we have been making sure that our treatment and care of chronically ill patients includes therapeutic patient education, so that patients understand their condition, feel supported and involved, which helps them to avoid complications and find answers to their questions," says Professor Karin Lange from the Hannover Medical School in Germany.

Therapeutic patient education is being built into the structure of health care in Germany - legally, financially and through policy.

Background

Patient education has been an essential part of medical training in Germany since the 1980s, when a group of young physicians rejected the traditional relationship between doctors and patients, and felt that the only way to ensure that people with diabetes stay healthy is to allow them to self-manage. Professionals in other fields such as asthma and cardiovascular disease joined in, and Hannover and Berlin universities pioneered the philosophy that the patient should be the focus of the curriculum.

Disease Management Programmes

In 2003, Germany introduced Disease Management Programmes (DMPs). These national programmes currently cover 12 diseases. The purpose is to improve the quality of care available to chronically ill patients throughout Germany and to ensure that they receive coordinated treatment according to the best available evidence and following clinical guidelines. DMPs also emphasize the importance of strengthening patients' self-care competencies in order to control the course of the disease. They also aim to ensure more efficient, coordinated patient care across different service providers, in line with individual patients' requirements. Any patient or physician can participate.

Treatment in DMPs starts with giving the patient a thorough explanation of the programme. Based on an assessment of the patient's individual risk, the physician and the patient jointly establish therapy goals and draw up an individual therapy plan for the patient's condition, such as diabetes or chronic obstructive pulmonary disease (COPD). In addition, the physician has to offer the patient the opportunity to take part in patient education courses. By June 2020, more than 7 million people were enrolled in 9253 DMPs covering diabetes type 1 and type 2, asthma, COPD, coronary heart disease, heart failure, breast cancer, depression, chronic back pain and osteoporosis. The DMPs are frequently updated and the latest addition is rheumatoid arthritis.

Financing

Patient education as part of DMPs is financed and reimbursed by all statutory health insurance funds. A prerequisite for financing the training is a structured and evaluated programme that includes patient materials, a curriculum, and a trainer manual and materials; publication of the evaluation results; and train-the-trainer seminars. The programmes are accredited by the Federal Office for Social Security (Bundesamt für Soziale Sicherung) for use in the Programme of the Federal Joint Committee (Gemeinsamer Bundesausschuss).

Medical curricula

Alongside these structural changes, medical curricula in Germany also include patient education. Germany's national catalogue of competence-based learning objectives in medicine, the core curriculum that drives medical training, places a lot of emphasis on communication, shared decision-making; motivational interviewing; and patient empowerment. Its introduction states that, "The universal basis of our concept of man is the concept of human dignity … As soon as doctors take a look at individual patients as persons, they always encounter - directly or indirectly - the social dimensions of illness and health as well as their own actions. And where the health of the population - for example, in the context of health promotion and prevention, or counselling and information - control and coordination of health protection is of primary importance. The interest and self-determination of individuals must always be taken into account."

Professor Karin Lange, former Head of the Medical Psychology Unit at the Hannover Medical School, Germany, specializes in the treatment of diabetes from first diagnosis, and has pioneered patient education through model courses for health-care professionals and medical students as part of the Hannover Medical School's curriculum. Great importance is attached to patient contact from the beginning. It includes compulsory training on doctor-patient communication, patients recounting their own history, communication of diagnosis, shared decision-making, and motivational interviewing. A comprehensive curriculum was also created for specialized diabetes nurses, with an emphasis on communication with patients, and a path to becoming diabetes educators. Professor Lange dismisses the idea that patient education takes up too much time. "Time is always tight for clinicians and nurses. But when you educate patients well, you don't need more time because they have fewer complications, lower morbidity and even a reduction in mortality."

The WHO Regional Office for Europe has published a new introductory guide to therapeutic patient education for policy-makers, health professionals, and education and training bodies.