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How concordance and patient empowerment challenge pharmacy

By Carol Watson

The National Health Service is changing: patient involvement has become far more a part of everyday life. The message about what patients and their carers want is clear. They want to be respected and fully involved in discussing, agreeing and providing their treatment and care plan. They also want professionals, agencies and specialists to work together.

Involving patients and their carers has to happen at all levels — it is no good having patients on boards or involved in staff recruitment if, at an individual level, they do not feel consulted and fully involved in their own treatment. It is important to recognise and support family carers not only as a principle but also because families provide the bulk of health and social care. If we do not support and engage with them, we have not only lost an opportunity but also may find treatment and care plans inadvertently undermined. Most importantly, patients want the best treatment possible — but “best” on their terms, taking into account personal preferences on issues like pain and the way they live their lives. The challenge is for professionals to fit the patient, to make the service patient-shaped, remembering that patients are not all the same shape.

Challenges

From the patient’s perspective there are some challenges for pharmacy. Patient organisations still report that too few patients receive information about their medicines that they can understand and use, in particular about possible side effects.

A hospital discharge project that I have been involved in identifies a mixed picture. On the one hand, there is a more patient-centred approach, where pharmacists work on the ward and provide a longer-term prescription so there is no delay to discharge. On the other there are examples of people waiting several hours for prescriptions before they can go home. We must not underestimate the impact on patients of those waits. Discharge is not just leaving the ward — it is going home. For many patients and their carers it is going home to a changed situation, involving anxiety and confusion for both parties. Minimising the additional anxiety caused by delay maximises the health outcomes. A patient-shaped service recognises that what to the professional is a number of points on a treatment pathway with a clear distinction between community and hospital, to patients is just one blurred aspect of a much bigger picture — their lives.

In the patient and carer movement we talk about empowerment: our jargon for patients and carers feeling in control of the situation by asking questions and using information. It is not about a stereotype of the unjustifiably angry and difficult patient — generally such people are those who have been disempowered. It is about patients feeling their perspective is listened to and understood — these patients are better able to take a full role in their own recovery.

Researching for a recent presentation led me to discover that “empowerment” has its counterpart in pharmacy practice — concordance. This concept fits into the modernisation agenda well. It places the patient, not the professional, at the centre. It emphasises a holistic approach because medicine-taking is as important, if not more so, than medicine-prescribing. This approach is only possible within a patient-shaped service that listens to, engages with, and tries to understand patients and the factors affecting their desire and ability to understand and follow a regimen. This flow of information from patient and carer to professional is more likely to lead to a flow of adequate and appropriate information and advice from professional to carer.

Download the attached PDF to read the full article.

Citation: The Pharmaceutical Journal URI: 10987127

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