From patient compliance to empowerment and consumer's choice : Evolution or regression? An overview of patient education in French speaking European countries.

OBJECTIVE: This paper presents a historical overview of patient education in French speaking (parts of) countries of Europe, as well as the emergence of new concepts in Health care and education. Further it describes the results of research and studies on current practice and political decisions and positions about patient education, based upon laws and regulations. The present trends will be discussed, and propose an overview of the next possible developmental steps. METHODS: Articles, reports and policy documents about publications on patient education in French speaking (parts of) countries of Europe. RESULTS: In the last years, in France, Belgium, Switzerland, Luxemburg, patient education has undergone a lot of changes whether in theories, models, policies or practice. These changes came with the emergence of concepts such as effectiveness of care, chronic disease follow-up, compliance, adherence, health promotion, empowerment, salutogenesis, resilience, patients' rights, health care costs control, coaching, disease management, consumer choice, and participation. Each of these concepts seems to have been defined and implemented in various ways, according to settings or countries. Political and social choices seem to have oriented choices from humanistic approaches to pragmatic decisions, with ethical problems rising. Consensus on definitions are often hard to reach, especially among policy makers, health care teams, health managers, and patient organizations, even though these concepts do coexist in daily practice, sometimes in very conflictual ways. CONCLUSIONS: Hard or subtle, changes are happening in patient education and cannot be ignored. PRACTICE IMPLICATION: Many questions rise on the future of patient education, wondering how to anticipate next models of health care practice, and their ethical and social stakes. Clear positions need to be taken.