Patient education in Belgium: evolution, policy and perspectives.

Patient education started in Belgium in the late 70s. Tuberculosis and diabetes management and care were the first topics addressed. In the two main regions of the country (Flemish and French), the development of patient education has been very different. The Belgian French Ministry of Health and regional hospital associations appointed a non-profit resource center, the "Center d'Education du Patient", in order to help hospital departments and health care teams start and improve patient education work and programs. University training programmes were created in the 80s, and an inter-hospital network organized to facilitate collaborations. Later, patient education hospital committees and coordinators were appointed, and professional organizations (patient education nurses and coordinators organization) were set up. In 1999, 98% of French speaking hospitals state that they have patient education programmes (three per hospital, on average), a remarkable growth from 7% in 1983. Belgium has joined the WHO health promoting hospitals project in 1996. In private practice, due to the "payment on service" system that does not allow means for patient education work, patient education is still rare. In the Flemish region, patient education programmes exist in some hospitals, on private initiatives, without support from the Ministry of Health, nor from the health promotion agency. On the conceptual side, programmes have shifted from a "patient instruction" perspective focusing on the biomedical aspects of health and disease, and professional expertize and needs assessment, to "patient participation" dealing with biopsychosocial health and disease. Lay and subjective needs and "life projects" are more and more taken as a basis for patient counseling and therapeutic education. With the renewed involvement of the government in patients rights, and the possibility to start funding patient education as any other care work, new developments of patient education are expected in the next years.