Concordance - is it a synonym for compliance or a paradigm shift
Non-compliance with the taking of prescribed, and often dispensed, medicines leads to waste of a valuable resource and ineffective treatment. Undisclosed non-compliance can also confound future management of a patient’s condition. In 1995, a working party was convened to explore the reasons behind non-compliance with medicine taking. I was privileged to be a member of that working party, charismatically and efficiently chaired by Professor Marshall Marinker. Together we all made the journey from a medically dominated, paternalistic view of non-compliance to one which realised the patency of the patient’s perspective — and thus concordance was born.
What has been achieved since the publication of the working party’s report “From compliance to concordance: achieving shared goals in medicine taking”?1 There has certainly been an increased awareness of the patient’s perspective by health care professionals and lip service, at least, is now paid to this in the consultation. The exact extent of health care professionals’ real understanding and application of the principles of concordance to their interactions with patients remains unquantified, as do the effects on patient outcomes. Isolated research reports do indicate, however, that this sort of approach should bear fruit.2,3 However for the most part, I cynically observe that my colleagues happily substitute the word “concordance” for “compliance”, believing this to be politically correct while not appreciating the difference.
There has also been an increased interest in the psychological and sociological theories that can be applied to medicines taking (eg, the health behavioural model, illness representation, attribution theory and the theory of planned behaviour). Much of this theoretical work dates from 20 years ago or more. It is sad that it has taken so long to link with colleagues in other related and relevant disciplines to enhance our own professional-patient behaviour and understanding.
The biggest achievement is Government funding for the Medicines Partnership initiative, which has the remit to put medicines concordance — or do we mean partnership? — into practice. This initiative has been instrumental in successfully raising the profile of the importance of informed decision-making through a range of approaches.
Concordance has evolved at the same time as other similar initiatives that increasingly recognise the roles and rights of the patient or client in a professional interaction. Medicine is no different in this from other professions, such as education, and we are seeing a sociological and cultural paradigm shift across our whole community. Within the health care environment, other related mantras include patient autonomy, holistic care, patient centredness, shared decision-making, patient partnerships and patient empowerment. These are taken forward in such policies as NHS modernisation, and the expert patient and patient information initiatives.
A topical example of the latter is “Ask About Medicines Week”. This campaign is designed to increase patients’ access to information about their medicines, in the belief that information will improve compliance — or do we mean concordance?
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Citation: The Pharmaceutical Journal URI: 10987122
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