The Pharmaceutical Journal
Vol 269 No 7215 p358-361
14 September 2002

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Letters to the Editor

Concordance

Forgotten or misunderstood?

From Mrs J. L. Westbury, MRPharmS

After reading (PDF 150K) "How pharmacists can be recognised for helping patients stay on course" (PJ, 10 August, p187) I question if the whole movement from "compliance to concordance" has been forgotten or misunderstood.

Many studies have shown that most "non-compliant" patients do not forget doctors' instructions or misunderstand directions. Instead, patients consciously choose to ignore advice or alter doses because of concerns and beliefs they hold about their medicines, such as a fear of experiencing side effects or becoming dependent on the medication. Many studies have shown that over 70 per cent of non-compliance is intentional.^1,2 Monitoring patients, typing friendly reminders on labels or even timely mobile phone messages, as encouraged by the Medicines Partnership, will do little to recognise patients' concerns or beliefs which account for most of non-compliance.

The idea of concordance is not to strive to help patients "stay on course". That is compliance. Concordance in medicine taking aims to involve the patient to a much greater extent when treatment decisions are made. In concordant consultations, patients are informed about therapy options and encouraged to voice their beliefs and preferences about medicines so that the most appropriate therapy can be prescribed for them. Open relationships between health professionals and patients are vital for this exchange of information. It is thought that patients would be more likely to follow the treatment option they had chosen than an option chosen for them.

Concordance requires long-term cultural change. We need to encourage pharmacists to promote and assist patients in making informed decisions not simply help patients stay on course.

J. Westbury
Nantwich, Cheshire

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