The Pharmaceutical Journal Vol 264 No 7102 p938
June 24, 2000 News

NICE effort wasted if patients will not take the medicine

The National Institute for Clinical Excellence is wasting its time developing guidelines for good prescribing if patients then fail to take the medicine, the Parliamentary All-Party Pharmacy Group has heard. At a meeting of the group at the Houses of Parliament on June 14, which had been called to develop a position statement on concordance, Mr Michael King (head of professional development, Pharmaceutical Services Negotiating Committee) suggested that all the NICE's efforts were directed towards an end point of getting the correct medicine on a prescription form. All this work fell on stony ground if the patient then failed to take the medicine, he said. Professor Marshall Marinker (Department of General Practice, Guy's King's & St Thomas's medical school, London university), who was the principal speaker on the topic, said that he had suggested that the institute should take an interest in what happened after medicines were prescribed. He added that there seemed to be little interest in that at the moment.

Professor Marinker (right) with Dr Howard Stoate (chairman, APPG)

Earlier, Professor Marinker had told the group that there was enormous emphasis on good prescribing, but little on patients' ability or willingness to take what might have been correctly prescribed. Half of all patients with chronic disease did not take their medicines as prescribed. He explained that this was of far greater financial significance than the cost of the wasted medicines. The additional cost to the nation of extra treatment, lost production and earnings and other knock-on costs could exceed £1bn. A study in the United States had estimated that non-compliance with treatment for coronary heart disease resulted in $1.5bn of lost earnings alone.
There was clearly a need for economic modelling studies.
However, Professor Marinker explained that concordance was not about achieving better compliance. It was a new approach to the prescribing and taking of medicines in which an agreement was reached after negotiation between the doctor and patient that determined whether, when and how medicines were to be taken. Although reciprocal, this was an agreement in which health care professionals recognised the primacy of the patient's position.
Commenting on the Royal Pharmaceutical Society report "From compliance to concordance" (PJ, March 8, 1997, p333), Professor Marinker said that he had wanted research into concordance to be followed by a public awareness programme and then professional education and training. He had been prevailed upon to put public awareness last in case patients got the message but the professions did not and were unable to deliver what patients wanted.
"I still believe that you should put patients first and expect professionals to stamp along as best they can," he said. "Those of us who are pushing concordance are asking for a culture change in medical care. No holds are barred. We need to revisit the task of all the professions. Saying ‘This is what doctors, nurses or pharmacists do' is worthless. We have to ask patients what they value. All of us are going to have to change our tasks and roles. This challenge to change will be one of the hardest barriers to cross."

A website dedicated to concordance can be found at www.concordance.org.