From Professor A. Blenkinsopp, MRPharmS, and Ms M. Harris
SIR,-Pharmacists can also contribute to achieving the targets of the coronary heart disease national service framework through their role in enhancing concordance in the use of medicines. Collette McCreedy identified "compliance" as an issue for pharmacists to address using medication reviews and several contributors to the same article (PJ, March 18, p432) mentioned "medication advice" from pharmacists. However, pharmacists' contribution is not limited to those who work in the GP practice setting or who conduct formal therapeutic review, and it needs to be wider than the giving of information.
The concept of concordance goes beyond traditional ideas about compliance and is about the relationship between patient and health professional. Patients' decisions about medicines and whether to take them are influenced by many factors.1 Encouraging patients to discuss any queries or concerns they have is one way to increase their involvement in treatment.2
The CHD national service framework is likely to lead to the prescribing of new medicines for large numbers of patients (beta-blockers, aspirin and lipid-regulating drugs, for example). There is good evidence that these medicines can save lives. Pharmacists in hospital and community practice have an opportunity to talk with these patients and help to build concordance from an early stage of treatment. Many other patients are already taking antihypertensive or angina medicines and there is encouraging evidence that they, too, could benefit from a pharmacist's input.3,4
Some patients may still decide to opt out of treatment despite intervention and pharmacists need to recognise and accept this. In fact, patients already do this although not always explicitly. Providing informed and balanced answers to patients' questions about medicines is an important component of concordance and pharmacists are well-placed to do it. Collaboration between practice-based pharmacists and colleagues in community pharmacy who can offer continued and regular support for patients is a powerful and exciting future.
Alison Blenkinsopp
Professor of the Practice of Pharmacy, Department of Medicines Management, Keele University, Member, Concordance Co-ordinating Group
Miriam Harris
Secretary, Concordance Co-ordinating Group, Royal Pharmaceutical Society
| 1. Royal Pharmaceutical Society. From compliance to concordance. London: The Society, 1997. |
| 2. Coulter A. Partnership with patients: the pros and cons of shared decision making. J Health Services Res Policy 1997;2:112-21. |
| 3. Solomon DK, Portner TS, Bass GE et al. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study. J Am Pharm Assoc 1998;38:574-85. |
| 4. Blenkinsopp A, Phelan M, Bourne J. Extended adherence support by community pharmacists for patients with hypertension: a controlled trial. Final project report. Department of Medicines Management, Keele University, 1999. |