The Pharmaceutical Journal
Vol 268 No 7188 p340-341
9 March 2002

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European Foundation for the Advancement of Healthcare Practitioners summary

Consultation and concordance: technicians can help

David Webb, director of clinical pharmacy, London NHS region, said that 30 to 50 per cent of patients do not take their medicines as intended — some intentionally, some unintentionally. Those who are non-concordant unintentionally are the patients on whom efforts are focused.

Concordance is an agreement about if and how patients are going to take their medicines. It is a partnership with reciprocal responsibilities.

Patients should have the opportunity to influence the agenda of their consultations in order to encourage participation but it is wrong to assume that all patients want to be decision-makers. Professionals need to individualise and tailor their advice to what the patients expect. They need to recognise a patient's expertise in his or her own disease or condition, ie, take an "expert patient" approach to disease management. Health professional are no longer the experts and they should recognise that patients are the experts at managing their chronic diseases.

Consultation

Consultations do not only take place in private in the GP's consulting room; they happen every time a health professional speaks to a patient. At the pharmaceutical care appraisal, it is first necessary to establish rapport with the patient: "explain who you are, why you are doing it and the benefits to the patient". Then there should be systematic data collection, with a professional carrying out a compliance check, ie, looking for facts about medicines-taking behaviour facts, not prescribed doses. Non-threatening language should be used in order to acquire useful information,

Patient information tends to explain the contraindications and side effects of medicines rather than the benefits, and professionals should recognise that some patients have concerns about medicines. For example, there are the common views that medicines are addictive and that natural is better than synthetic. "Data gathering is not jumping to conclusions, using assumptions and giving answers," said Mr Webb.