In France, health education is an ethical obligation for the pharmacist. In fact, the article R. 4235-2 of the French Public Health Code states that the pharmacist “must contribute to inform and educate the public on health and social matters”.

The article L. 5125-1-1 A of the French Public Health Code defines the missions of the community pharmacists. In particular, it states that community pharmacists “contribute to primary care" (which includes health education, prevention and screening) and “may participate in therapeutic patient education”.

According to the Haute autorité de santé (2007), Therapeutic Patient Education (TPE) concerns all health care professionals involved in the management of patients with a chronic disease, including pharmacists. To be effective, TPE should be provided by a multiprofessional and interdisciplinary team working in a formal or informal network.

Pharmacists have a number of assets for contributing to health education and TPE:
- their geographic proximity (23,000 community pharmacies in France);
- their accessibility and their availability during long opening hours;
- their frequent contacts with the public (4 million people a day enter french community pharmacies);
- their global acquaintance with the patient (eg social and family environment, professional activity, drug history,...);
- a trust relationship established with the patient;
- their credibility with the French public as health care professionals (Ipsos Santé survey "Les français et leur pharmacien", January 2008; Vision Critical survey "Image et attachement des français à la profession de pharmacien", November 2009);
- their training, which is both scientific and professional.

Pharmacists have many roles to play in health education and TPE, especially:

• Informing the public, raising public awareness, promoting prevention and screening

The pharmacist has an important role to play in disease information, prevention and screening. He or she may get involved by:
- taking part in public awareness and information campaigns about public health issues;
- transmitting scientifically validated information about prevention, diseases, ...The health messages must be adapted to and accessible to the public. Personally handing out information leaflets may be very helpful to reinforce health messages;
- relaying disease screening campaigns;
- identifying people at risk and referring them to their doctor.

• Helping patients to understand their disease and their treatment

To adhere to their treatment, patients need to understand the mechanisms of their illness, the action of their medication, the expected benefits and the potential side effects. Information given to patients must be adapted to them. Beforehand, it is essential to assess what patients know about their illness and their treatment in order to reinforce or correct their knowledge. Different tools (eg drawings, explanatory leaflets, ...) may be useful to facilitate the patients' comprehension. It is important to check patients' understanding by asking them to reformulate what they have understood.

• Promoting proper use of medications

When a pharmacist dispenses a medication, he or she should:
- explain the correct use of drug (dosage, frequency of administration, ...) and make sure the patient understands how the drug has to be taken;
- teach the patient any special drug administration techniques, such as inhalation or injection;
- emphasize, for chronic diseases that may long remain asymptomatic (eg hypertension, type 2 diabetes, ...), the importance of taking the medication regularly, even if the patient does not feel any symptoms;
- raise awareness of the risks of taking medicines without a medical or pharmaceutical advice;
- teach the patient to manage side effects : educate him to recognize side effects, inform him of how to decrease the risk of their occurring, explain what to do if they occur, and make sure he has understood;
- establish with the patient a personalized, clear and operational therapeutic plan which suits the patient’s habits and constraints, help the patient to adapt his treatment in any particular circumstances such as change of time zone or forgetting to take a dose.

• Teaching and reinforcing drug administration techniques

It is essential to teach patients to properly take drugs requiring special method of administration (eg eye drops, asthma inhalers,...). The best way for patients to learn is not to get a long speech, but to have a demonstration and then try the technique themselves. Then, the pharmacist should regularly offer patients to check their drug administration technique in order to maintain and reinforce the patients' technical skills.

• Helping patients to learn self-monitoring

The pharmacist may play an important role in teaching patients self-monitoring of their illness and their treatment, including:
- educating patients on self-measurement : Every time a self-monitoring device is dispensed (eg device for self-monitoring of blood glucose or blood pressure, peak flow, ...), full pedagogical information should be given on use of the device and frequency and conditions of measurement. Asking patients to perform self-monitoring under the guidance of the pharmacist ensures effective learning of the technique.
- educating patients on warning signs : For their safety, patients need to recognize warning signs (eg signs of an uncontrolled disease, appearance of a major side effect, ...) requiring a rapid medical consultation.

• Supporting and guiding patients

Because the pharmacist is accessible, has frequent contacts with the patients and may know them well, he or she is well-placed to guide them, from the announcement of the diagnosis, to start of treatment and throughout care management. The pharmacist supports the patient (and his relatives), especially in case of difficulties with the treatment, appearance of a complication or a major event in the patient's life, a drop in motivation, a loss of confidence in himself and/or in his treatment. It is important to:
- encourage the patient to express any worries, doubts or difficulties with his disease and his treatment, without minimizing any of these concerns;
- be available and listen without judgment;
- show empathy;
- show interest in the patient without interfering;
- praise all the patient’s efforts (even the slightest);
- refer the patient, if needed, to a patients’ association or an organization providing TPE.

Where to get a TPE training ?

To provide therapeutic patient education, it is important to receive training to acquire relational, pedagogical and methodological skills. There are different types of TPE training depending on the level of competence the pharmacist wishes to acquire and transfer into his practice, including :

- postgraduate degrees:
A selection of TPE degree courses is listed by the Institut national de prévention et d’éducation pour la santé.

- continuing education organizations specialized in TPE, in particular:
. IPCEM
. EDUSANTE

The Cespharm and the UTIP Innovations offer a one-day training course on therapeutic education of asthmatic patients. The training program has received scientific and technical approval from the professional committee in charge of evaluating the quality of continuing education programs intended for French community pharmacists (HCFPC).