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Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools
PJiENT EdUCATiCN
/wd coms$irvq Patient Education and Counseling 26 (1995) 343-347
Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools Silla M. Consoli*“, Mohamed Ben Said’, Jocelyne Jeanb, JoCl Menardb, Pierre-Franqois Plouinb, Gilles Chatellier” “Departments
of Medical
Psychology,
H.vpertensionb and Medical Informati&, 75014 Paris, France
Broussais
Hospital,
96 rue Didot,
Abstract ISIS (Initiation SanitaireInformatiseeet Scenarisee), a French computer-assisted hypertensionand cardiovascular risk education program, was developed to provide patients at cardiovascular risk with a modern interactive educationaltool combiningrigorously scientificinformation with the aestheticattractivenessof multimediacommunication. To test the impact of this tool on patient health information retention, 158 hypertensiveshospitalizedfor initial work-up (day hospital) or therapeutic adjustments(3 days) were randomizedinto control (n = 79) and ISIS (n = 79) groups.Both groupsreceivedcardiovasculareducationthrough standardmeans:physicians,nurses,dietitians and pamphlets.In addition, ISIS patientsunderwenta 30- to 60-min sessionon the computerwith the ISIS program. Cardiovascular knowledgewas tested by the sameinvestigator administeringa standardized28-item questionnaire before and 2 months after education. Retestingwas madeby telephone.At the time of first assessment, all patients were aware that they would be retested.A total of 138completedquestionnaires(69 from eachgroup) wasanalyzed. Overall meancardiovascularknowledgescorebefore educationimproved significantly after education. This improvement was greater in the ISIS than the control group. These results confirm the potential of computer-assisted education in hypertensivesfrom a specializedcenter. Keywords:
Computer-assisted educationprogram; Hypertensivepatients; Standard education tools
1. Introduction
Hypertension represents a major risk factor for coronary, cerebral and renal vascular diseases. Sustained hypertension needs long-lasting drug therapy but many non-pharmacological interven-
* Corresponding author.
tions and behavioral changes are often recommended, especially in mild hypertension or when other cardiovascular risk factors are associated with hypertension (hypocholesterolemic diet, reducing overweight, tobacco withdrawal, regular physical exercise, relaxation, stress management techniques). However, compliance with medical advice and antihypertensive treatment is frequently poor, making the long-term effectiveness
0738-3991/95/$09.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI
0738-3991(95)00747-N
344
SM.
Consoli
et al. I Patient
Education
of hypertension management questionable [ 1,2]. Health education is one way of improving patients’ involvement in health education and in lifelong treatment [3]. Among various educational procedures, computerized educational tools are both powerful and attractive. Nevertheless, evaluation studies of the effectiveness of computer-assisted education are still uncommon in the literature [4,5]. Between 1990 and 1992, we developed a computer-assisted program named ISIS in the Department of Hypertension of the Broussais Hospital (Paris, France). ISIS are the initials of the French title of the program ‘Initiation Sanitaire Informatiste et SdnarisCe’. Isis is also the Egyptian goddess of medicine and the name of the guide who accompanies the patient throughout his/her scientific learning, combined with an imaginary trip in the world of ancient Egypt. In designing ISIS, our aim was not to replace the health professional by the computer. By providing more autonomy, the computer-assisted education comforts the patient in the role of actively controlling the access to the knowledge, thus avoiding the passiveness or even the infantilization of a ‘one-way education’. Consequently, interaction with the computer could result in an enriched relationship between the patient and the health professional. This paper reports the specifications and content of the ISIS program and the results of evaluation of the effect of this computer-assisted education tool on patients’ health knowledge tested using a comparative randomized trial. 2. Material 2.1. Hardware
and methods and software
ISIS was developed on a color Macintosh, and uses the following software to create graphics (MacPaint, PixelPaint), to create animations (MacroMind Director) and to digitize sound (MacRecorder). It runs on Macintosh II and higher and requires 8 megabytes of RAM, a coprocessor and a color monitor of 13 inches. It takes 32 megabytes of disk space and is organized into 30 MacroMind Director files or ‘movies’. Macros and scripts use a high level language (‘Lingo’) to navigate between files and to keep
and Counseling
26 (1995)
343-347
track of the patient performance. Creating animations is trivial and sophisticated scenarios are not difficult in ‘Lingo’ programming language. 2.2. Program
content
The educational program alternates relaxing interludes with educational messages. Patients discover ISIS as they progress through an imaginary trip in the ancient Egyptian world. At any time, they may learn how far they have gone in the trip by consulting a map, or learn how far they went in the educational part by consulting a list of modules visited in a table of contents. Leaving the program can be done at any time, and a patient identifier number allows patients to continue where they left off. The educational part consists of several series of questions (three to five) presented to the patient and requiring a response. Animated messages of ‘Bravo’ or ‘Inexact’ follow each answer, and a performance score summary is presented after each series of questions. The patient may then seek explanations, usually made using graphical animations, review the questions, move to the following section, or just leave the program. The following six modules covering educational topics on hypertension and on cardiovascular risk factors constitute the educational part of ISIS: 1. Physiology of circulation and of normal blood pressure. 2. Usual values of systolic and diastolic blood pressure. Definition and prevalence of hypertension. Clinical signs. Etiology. Target organs of hypertension. Heart anatomy and physiology. Definitions, mechanisms and complications of atherosclerosis. Description of cardiovascular risk factors, including a section on cholesterol and nutritional characteristics of a variety of food. 6. Main classes of antihypertensive drugs and their mechanism of action. During the development phase, a committee psychologists, expert physicians, comprising nurses and dietitians working in the Hypertension Department and professionals working in the Medical Informatics department, provided valu-
S.M.
Consoli
et al. 1 Patient
Education
able feedback and helped reaching a consensus about the contents of ISIS, their representation and the communication methods. 2.3. ISIS specijicarions
The following specifications identified the scope and the context of using ISIS: 0 The computer-assisted education needs no educator’s full-time assistance; a nurse helps the patient in becoming acquainted with the computer and with handling the mouse; she can also answer supplementary questions for the patient, after a computer session. 0 The educational content is represented and communicated in an easy-to-access way, considering age, education level or cultural background diversity, as well as possible unfamiliarity in using computers. l Communication avoids scientific texts written in small characters or too long to read, and keeps a large part for animated scenes, iconic synthetic representations, sounds and music. 0 The results of the interaction with the user are saved on the hard disk and allow education through more than one session as well as some statistical analysis on the population of users. 2.4. Evaluation protocol
To analyze the effect of using ISIS as a complement to the already existing patient education methods, on patient knowledge about hypertension, a randomized study was undertaken between March lst, 1993 and September, 30th 1993. Onehundred fifty-eight hypertensive patients hospitalized for an initial check-up or therapeutic adjustment were included. They were randomly separated into two groups, a control group (CG: 79 patients) and an intervention group or ISIS group (IG: 79 patients). An initial evaluation of the patients’ knowledge of hypertension was made through a 28-item questionnaire administered by a nurse (J.J.) before any educational procedures. The CG patients were then provided with the standard education (dialogue with physicians, nurses, dietitians plus various pamphlets). The IG patients, along with the standard education, underwent a 30- to 60-min interactive educational
and Counseling
26 (1995)
345
343-347
session with ISIS. Two months after discharge, the same investigator (J.J.), asked the patients, by telephone, the same series of 28 questions. Twenty patients (10 IG and 10 CG) missed the follow-up questionnaire, mainly for personal reasons, and were dropped from the final analysis. Results on 138 patients (69 IG and 69 CG) are reported in the final analysis. The general characteristics of these patients are described in Table 1. 3. Results 3.1. Baseline health knowledge
Mean score of prior health knowledge tested with the first questionnaire was 14.3 + 4.2 (range, 4-25), which corresponds to approximately 50% of correct answers. This score was positively correlated with age (Pearson’s r = 0.31; P = 0.0002), and with the general education level (Spearman’s p = 0.36; P = 0.0001). It was higher among men than among women (15.1 f 4.6 vs. 13.5 + 4.7; P= 0.027 using an unpaired Student’s t-test), but the general education level was higher in the male sub-population. 3.2. Evolution of health knowledge score in the global population
Evolution of health knowledge was estimated by calculating the difference between the global scores obtained at the two questionnaires (a positive change from baseline means an improvement). The mean knowledge score significantly improved in the whole population (mean score for Table 1 General characteristics of the study population Number of patients Sex (M/F) Age (years) Duration of hypertension < 6 months 6 months to 2 years z 2 years Educational level High school Finished high school College/University Initial knowledge score
138 85173 50.4 + 12.4 51 26 61 51 35 51 14.3 f 4.2
346
SM. Consoli et al. / Patient Education and Counseling 26 (1995) 343-347
Table 2 Comparative evolution of health knowledge Study group
ISIS
Control
P-value
Total population (n = 138) Initial score <16(n=89) > 16 Age 165 years (n= 118) > 65 years Sex Men Women (n = 73) Duration of hypertension I 6 months > 6 months (n = 87)
3.8 k 3.6
2.4 + 3.2
0.02
4.8 k 3.6 2.0 ) 3.0
2.9 i 3.0 1.5 i. 3.5
0.008 0.62
4.2 * 3.4 0.6k4.1
2.6 k 3.3 1.7 k 2.7
0.01 0.50
3.1 + 3.5 4.6 + 3.7
2.4 f 3.8 2.4 + 2.9
0.45 0.006
3.7 k 3.8 3.8 k 3.5
3.9 & 3.3 1.8 If: 3.0
0.83 0.006
the second questionnaire 17.4 + 3.5; mean difference between the two questionnaires 3.1 f 3.5, P = 0.0001 using the Student’s t-test for paired groups). Such a change represented 22% of the initial score. Improvement was negatively correlated with the duration of hypertension (p = - 0.19; P = 0.04) and with the initial health knowledge score (p = - 0.32; P < 0.0001). 3.3. Comparison between the ISIS and the control group Table 2 illustrates the differences between the two groups. Improvement in hypertension knowledge is higher in the IG than in the CG group (Student’s t-test for unpaired groups, P = 0.02). Twenty patients of the IG group strongly improved (change in the global score, 2 6 points) versus only 10 patients in the CG group. On the other hand, eight patients of the IG group IG did not improve or even worsened (change, I 0 point) versus 19 in the CG group. As shown in Table 2, the differences between the intervention and the control group are stronger among patients whose initial score was I 16, patients _<65 years old, and patients whose hypertension had been found more than 6 months previously.
4. Discussion
Despite the peculiarity of its context (hypertensive patients, hospitalized for a short stay in a
specialized health center), results of the evaluation of ISIS support the use of a computerized educational program as an enrichment of the usual educational techniques. Patients with medium or low baseline scores had more opportunity to present a higher health knowledge score in the second test (note the regression to the mean). Women improved more than men between the two tests, but this can be due to their lower initial score. The increased receptivity observed among patients aged less than 65 years is not surprising: indeed, it is well known that learning is negatively related to age. It is important to stress the superiority of a computer-assisted education program like ISIS for patients whose hypertension was known for more than 6 months. In other words, recently diagnosed hypertensives are more curious, more concerned and more receptive, no matter what the educational method. Whereas the effectiveness of standard education techniques becomes blunted for hypertensives diagnosed or treated for a long time, hence their interest in an interactive, modern and pleasant education tool. Finally, the role of a highly motivated nurse in the organization of the evaluation protocol, and in encouraging the patients using the computer, was certainly an essential factor in the success of ISIS. The results of this work are an incentive to pursue the experiment in other specialized health centers, and in a more representative population of hypertensive patients. However, it remains to
S.M.
Consoli
et al. / Patient
Education
be demonstrated that the health knowledge improvement, and the pleasure the patients experienced in using the ISIS program, will result in a better compliance with therapy, and therefore a better long-term control of hypertension and cardiovascular risk factors. Acknowledgements
ISIS was developed thanks to grants from Assistance Publique Hopitaux de Paris and APREPSOM (Association pour la Promotion des Recherches Psychosomatiques). The committee of experts was composed of: M. Ben Said MD, G. Chatellier MD, S.M. Consoli MD, P. Corona MD, P. Corvol MD, P. Degoulet MD, P. Giral MD, S. Laurent MD, J.L. Megnien MD, J. Menard MD, I. Merli MD, P.F. Plouin MD, A. Simon MD, B. Varet MD, J. Jean RN, E. Paris RN, A. Massari, C. Point and P. Truffe.
and Counseling
26 (1995)
343-347
341
References [I] Consoli SM, Safar ME. Predictive value of the patient’s psychological profile and type of patient-practitioner relationship in compliance with antihypertensive treatment. Arch Ma1 Coeur 1988; 81 Suppl HTA: 145-150. [2] Rota-Cusachs A, Sort D, Altimira J, Bonet R, Guilera E, Monmany J, Noila J. The impact of a patient education programme in the control of hypertension. J Hum Hypertens 1991; 5: 437-441. [3] Bury JA. Education pour la Sante: concepts, enjeux, planifications. Bruxelles: De Boeck Universite, 1988. [4] Degoulet P. Fleschi M. Perspectives for computers and medical education. In: Bakker S, Cleland MC, editors. Information transfer: new-age - new-ways. Proceedings of the Third European Conference of Medical Libraries, Montpellier, France, September 23-26, 1992. Dordecht: Kluwer Academic Publishers, 1993. [5] Hanna P, Conley-Price D, Fenty E, McKiel, Soltes D, Hogan T, Wiens D. Computer applications for staff development patient education. Methods Inf Med, 1989: 28: 261-266.
/wd coms$irvq Patient Education and Counseling 26 (1995) 343-347
Benefits of a computer-assisted education program for hypertensive patients compared with standard education tools Silla M. Consoli*“, Mohamed Ben Said’, Jocelyne Jeanb, JoCl Menardb, Pierre-Franqois Plouinb, Gilles Chatellier” “Departments
of Medical
Psychology,
H.vpertensionb and Medical Informati&, 75014 Paris, France
Broussais
Hospital,
96 rue Didot,
Abstract ISIS (Initiation SanitaireInformatiseeet Scenarisee), a French computer-assisted hypertensionand cardiovascular risk education program, was developed to provide patients at cardiovascular risk with a modern interactive educationaltool combiningrigorously scientificinformation with the aestheticattractivenessof multimediacommunication. To test the impact of this tool on patient health information retention, 158 hypertensiveshospitalizedfor initial work-up (day hospital) or therapeutic adjustments(3 days) were randomizedinto control (n = 79) and ISIS (n = 79) groups.Both groupsreceivedcardiovasculareducationthrough standardmeans:physicians,nurses,dietitians and pamphlets.In addition, ISIS patientsunderwenta 30- to 60-min sessionon the computerwith the ISIS program. Cardiovascular knowledgewas tested by the sameinvestigator administeringa standardized28-item questionnaire before and 2 months after education. Retestingwas madeby telephone.At the time of first assessment, all patients were aware that they would be retested.A total of 138completedquestionnaires(69 from eachgroup) wasanalyzed. Overall meancardiovascularknowledgescorebefore educationimproved significantly after education. This improvement was greater in the ISIS than the control group. These results confirm the potential of computer-assisted education in hypertensivesfrom a specializedcenter. Keywords:
Computer-assisted educationprogram; Hypertensivepatients; Standard education tools
1. Introduction
Hypertension represents a major risk factor for coronary, cerebral and renal vascular diseases. Sustained hypertension needs long-lasting drug therapy but many non-pharmacological interven-
* Corresponding author.
tions and behavioral changes are often recommended, especially in mild hypertension or when other cardiovascular risk factors are associated with hypertension (hypocholesterolemic diet, reducing overweight, tobacco withdrawal, regular physical exercise, relaxation, stress management techniques). However, compliance with medical advice and antihypertensive treatment is frequently poor, making the long-term effectiveness
0738-3991/95/$09.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI
0738-3991(95)00747-N
344
SM.
Consoli
et al. I Patient
Education
of hypertension management questionable [ 1,2]. Health education is one way of improving patients’ involvement in health education and in lifelong treatment [3]. Among various educational procedures, computerized educational tools are both powerful and attractive. Nevertheless, evaluation studies of the effectiveness of computer-assisted education are still uncommon in the literature [4,5]. Between 1990 and 1992, we developed a computer-assisted program named ISIS in the Department of Hypertension of the Broussais Hospital (Paris, France). ISIS are the initials of the French title of the program ‘Initiation Sanitaire Informatiste et SdnarisCe’. Isis is also the Egyptian goddess of medicine and the name of the guide who accompanies the patient throughout his/her scientific learning, combined with an imaginary trip in the world of ancient Egypt. In designing ISIS, our aim was not to replace the health professional by the computer. By providing more autonomy, the computer-assisted education comforts the patient in the role of actively controlling the access to the knowledge, thus avoiding the passiveness or even the infantilization of a ‘one-way education’. Consequently, interaction with the computer could result in an enriched relationship between the patient and the health professional. This paper reports the specifications and content of the ISIS program and the results of evaluation of the effect of this computer-assisted education tool on patients’ health knowledge tested using a comparative randomized trial. 2. Material 2.1. Hardware
and methods and software
ISIS was developed on a color Macintosh, and uses the following software to create graphics (MacPaint, PixelPaint), to create animations (MacroMind Director) and to digitize sound (MacRecorder). It runs on Macintosh II and higher and requires 8 megabytes of RAM, a coprocessor and a color monitor of 13 inches. It takes 32 megabytes of disk space and is organized into 30 MacroMind Director files or ‘movies’. Macros and scripts use a high level language (‘Lingo’) to navigate between files and to keep
and Counseling
26 (1995)
343-347
track of the patient performance. Creating animations is trivial and sophisticated scenarios are not difficult in ‘Lingo’ programming language. 2.2. Program
content
The educational program alternates relaxing interludes with educational messages. Patients discover ISIS as they progress through an imaginary trip in the ancient Egyptian world. At any time, they may learn how far they have gone in the trip by consulting a map, or learn how far they went in the educational part by consulting a list of modules visited in a table of contents. Leaving the program can be done at any time, and a patient identifier number allows patients to continue where they left off. The educational part consists of several series of questions (three to five) presented to the patient and requiring a response. Animated messages of ‘Bravo’ or ‘Inexact’ follow each answer, and a performance score summary is presented after each series of questions. The patient may then seek explanations, usually made using graphical animations, review the questions, move to the following section, or just leave the program. The following six modules covering educational topics on hypertension and on cardiovascular risk factors constitute the educational part of ISIS: 1. Physiology of circulation and of normal blood pressure. 2. Usual values of systolic and diastolic blood pressure. Definition and prevalence of hypertension. Clinical signs. Etiology. Target organs of hypertension. Heart anatomy and physiology. Definitions, mechanisms and complications of atherosclerosis. Description of cardiovascular risk factors, including a section on cholesterol and nutritional characteristics of a variety of food. 6. Main classes of antihypertensive drugs and their mechanism of action. During the development phase, a committee psychologists, expert physicians, comprising nurses and dietitians working in the Hypertension Department and professionals working in the Medical Informatics department, provided valu-
S.M.
Consoli
et al. 1 Patient
Education
able feedback and helped reaching a consensus about the contents of ISIS, their representation and the communication methods. 2.3. ISIS specijicarions
The following specifications identified the scope and the context of using ISIS: 0 The computer-assisted education needs no educator’s full-time assistance; a nurse helps the patient in becoming acquainted with the computer and with handling the mouse; she can also answer supplementary questions for the patient, after a computer session. 0 The educational content is represented and communicated in an easy-to-access way, considering age, education level or cultural background diversity, as well as possible unfamiliarity in using computers. l Communication avoids scientific texts written in small characters or too long to read, and keeps a large part for animated scenes, iconic synthetic representations, sounds and music. 0 The results of the interaction with the user are saved on the hard disk and allow education through more than one session as well as some statistical analysis on the population of users. 2.4. Evaluation protocol
To analyze the effect of using ISIS as a complement to the already existing patient education methods, on patient knowledge about hypertension, a randomized study was undertaken between March lst, 1993 and September, 30th 1993. Onehundred fifty-eight hypertensive patients hospitalized for an initial check-up or therapeutic adjustment were included. They were randomly separated into two groups, a control group (CG: 79 patients) and an intervention group or ISIS group (IG: 79 patients). An initial evaluation of the patients’ knowledge of hypertension was made through a 28-item questionnaire administered by a nurse (J.J.) before any educational procedures. The CG patients were then provided with the standard education (dialogue with physicians, nurses, dietitians plus various pamphlets). The IG patients, along with the standard education, underwent a 30- to 60-min interactive educational
and Counseling
26 (1995)
345
343-347
session with ISIS. Two months after discharge, the same investigator (J.J.), asked the patients, by telephone, the same series of 28 questions. Twenty patients (10 IG and 10 CG) missed the follow-up questionnaire, mainly for personal reasons, and were dropped from the final analysis. Results on 138 patients (69 IG and 69 CG) are reported in the final analysis. The general characteristics of these patients are described in Table 1. 3. Results 3.1. Baseline health knowledge
Mean score of prior health knowledge tested with the first questionnaire was 14.3 + 4.2 (range, 4-25), which corresponds to approximately 50% of correct answers. This score was positively correlated with age (Pearson’s r = 0.31; P = 0.0002), and with the general education level (Spearman’s p = 0.36; P = 0.0001). It was higher among men than among women (15.1 f 4.6 vs. 13.5 + 4.7; P= 0.027 using an unpaired Student’s t-test), but the general education level was higher in the male sub-population. 3.2. Evolution of health knowledge score in the global population
Evolution of health knowledge was estimated by calculating the difference between the global scores obtained at the two questionnaires (a positive change from baseline means an improvement). The mean knowledge score significantly improved in the whole population (mean score for Table 1 General characteristics of the study population Number of patients Sex (M/F) Age (years) Duration of hypertension < 6 months 6 months to 2 years z 2 years Educational level High school Finished high school College/University Initial knowledge score
138 85173 50.4 + 12.4 51 26 61 51 35 51 14.3 f 4.2
346
SM. Consoli et al. / Patient Education and Counseling 26 (1995) 343-347
Table 2 Comparative evolution of health knowledge Study group
ISIS
Control
P-value
Total population (n = 138) Initial score <16(n=89) > 16 Age 165 years (n= 118) > 65 years Sex Men Women (n = 73) Duration of hypertension I 6 months > 6 months (n = 87)
3.8 k 3.6
2.4 + 3.2
0.02
4.8 k 3.6 2.0 ) 3.0
2.9 i 3.0 1.5 i. 3.5
0.008 0.62
4.2 * 3.4 0.6k4.1
2.6 k 3.3 1.7 k 2.7
0.01 0.50
3.1 + 3.5 4.6 + 3.7
2.4 f 3.8 2.4 + 2.9
0.45 0.006
3.7 k 3.8 3.8 k 3.5
3.9 & 3.3 1.8 If: 3.0
0.83 0.006
the second questionnaire 17.4 + 3.5; mean difference between the two questionnaires 3.1 f 3.5, P = 0.0001 using the Student’s t-test for paired groups). Such a change represented 22% of the initial score. Improvement was negatively correlated with the duration of hypertension (p = - 0.19; P = 0.04) and with the initial health knowledge score (p = - 0.32; P < 0.0001). 3.3. Comparison between the ISIS and the control group Table 2 illustrates the differences between the two groups. Improvement in hypertension knowledge is higher in the IG than in the CG group (Student’s t-test for unpaired groups, P = 0.02). Twenty patients of the IG group strongly improved (change in the global score, 2 6 points) versus only 10 patients in the CG group. On the other hand, eight patients of the IG group IG did not improve or even worsened (change, I 0 point) versus 19 in the CG group. As shown in Table 2, the differences between the intervention and the control group are stronger among patients whose initial score was I 16, patients _<65 years old, and patients whose hypertension had been found more than 6 months previously.
4. Discussion
Despite the peculiarity of its context (hypertensive patients, hospitalized for a short stay in a
specialized health center), results of the evaluation of ISIS support the use of a computerized educational program as an enrichment of the usual educational techniques. Patients with medium or low baseline scores had more opportunity to present a higher health knowledge score in the second test (note the regression to the mean). Women improved more than men between the two tests, but this can be due to their lower initial score. The increased receptivity observed among patients aged less than 65 years is not surprising: indeed, it is well known that learning is negatively related to age. It is important to stress the superiority of a computer-assisted education program like ISIS for patients whose hypertension was known for more than 6 months. In other words, recently diagnosed hypertensives are more curious, more concerned and more receptive, no matter what the educational method. Whereas the effectiveness of standard education techniques becomes blunted for hypertensives diagnosed or treated for a long time, hence their interest in an interactive, modern and pleasant education tool. Finally, the role of a highly motivated nurse in the organization of the evaluation protocol, and in encouraging the patients using the computer, was certainly an essential factor in the success of ISIS. The results of this work are an incentive to pursue the experiment in other specialized health centers, and in a more representative population of hypertensive patients. However, it remains to
S.M.
Consoli
et al. / Patient
Education
be demonstrated that the health knowledge improvement, and the pleasure the patients experienced in using the ISIS program, will result in a better compliance with therapy, and therefore a better long-term control of hypertension and cardiovascular risk factors. Acknowledgements
ISIS was developed thanks to grants from Assistance Publique Hopitaux de Paris and APREPSOM (Association pour la Promotion des Recherches Psychosomatiques). The committee of experts was composed of: M. Ben Said MD, G. Chatellier MD, S.M. Consoli MD, P. Corona MD, P. Corvol MD, P. Degoulet MD, P. Giral MD, S. Laurent MD, J.L. Megnien MD, J. Menard MD, I. Merli MD, P.F. Plouin MD, A. Simon MD, B. Varet MD, J. Jean RN, E. Paris RN, A. Massari, C. Point and P. Truffe.
and Counseling
26 (1995)
343-347
341
References [I] Consoli SM, Safar ME. Predictive value of the patient’s psychological profile and type of patient-practitioner relationship in compliance with antihypertensive treatment. Arch Ma1 Coeur 1988; 81 Suppl HTA: 145-150. [2] Rota-Cusachs A, Sort D, Altimira J, Bonet R, Guilera E, Monmany J, Noila J. The impact of a patient education programme in the control of hypertension. J Hum Hypertens 1991; 5: 437-441. [3] Bury JA. Education pour la Sante: concepts, enjeux, planifications. Bruxelles: De Boeck Universite, 1988. [4] Degoulet P. Fleschi M. Perspectives for computers and medical education. In: Bakker S, Cleland MC, editors. Information transfer: new-age - new-ways. Proceedings of the Third European Conference of Medical Libraries, Montpellier, France, September 23-26, 1992. Dordecht: Kluwer Academic Publishers, 1993. [5] Hanna P, Conley-Price D, Fenty E, McKiel, Soltes D, Hogan T, Wiens D. Computer applications for staff development patient education. Methods Inf Med, 1989: 28: 261-266.