The Pharmaceutical Journal
Vol 270 No 7248 p649
10 May 2003

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Contributions invited for a special issue on concordance in medicines taking

The Pharmaceutical Journal, in common with the BMJ, will be publishing a special edition on 11 October 2003 to coincide with "Ask about medicines" week, a campaign intended to raise awareness of concordance issues among health professionals and patients. Freelance writer Debbie Andalo finds out why concordance is so important to successful medicines management

Pharmacists across the health service and from industry and academia are expected to take a leading role in a campaign which organisers hope will be the catalyst for a sea change in the relationship between health professionals, their patients and their medication. "Ask about medicines" week from 12 to 18 October will include a series of events to promote the principles of concordance throughout the United Kingdom. Pharmacists will receive details in June about the role they can play.

The campaign is being run by a consortium made up of the Medicines Partnership (a government-backed initiative to promote concordance), the Doctor Patient Partnership (a British Medical Association organisation set up to improve the relationship between doctors and their patients) and PECMI (Promoting Excellence in Consumer Medicines Information, a group devoted to improving patient medicines information).

The idea for the campaign came from PECMI chairman and health communications consultant Mark Duman although it is based on similar initiatives in the United States, Australia and Finland. He said: "These countries have been doing similar campaigns for years although in America it was much more bureaucratic and focused on medication education. The view there is 'let's tell you as a professional what you want to hear', whereas the UK campaign is very much consumer-driven." Mr Duman, a pharmacist, hopes that the initiative will set the foundations for a change in the relationship between health professionals and their patients and medication. He said health professionals who take the "holier than thou" approach have a poor relationship with their patients. "What we want to do is create the culture that says patients are not the enemy but that patients can be partners."

This philosophy of patients and health professionals working together is at the heart of Medicines Partnership. The partnership has signed up to the campaign and its director Joanne Shaw will help guest edit a special theme issue of the BMJ on 11 October 2003, which will be devoted to "people taking medicines". A similar themed issue of The Pharmaceutical Journal is also being planned for publication on the same day.

Ms Shaw, a former director of the Audit Commission, relishes her new editorial role. "As a guest editor I have the opportunity to commission articles for the edition as well as proposing the colour picture for the front page of the BMJ. We have had lots of interest from people who want to write things and are starting to get proposals submitted.

"More importantly, however, is that a themed edition offers the opportunity to raise people's awareness about the issue of concordance and to get it debated and discussed."

She is keen that the campaign will be seen as a catalyst for long-term changes. "I hope that this week will lay the foundations for a long-term cultural change to a world where prescribers see prescribing decisions as something which they do jointly with patients — where patients ask questions as a matter of course. We want the campaign to kick-start that and to act as the catalyst for long-term change."

Ms Shaw recognises, however, that attitudes will not change over night. "I think it is something which will happen over a period of years which will reflect the changes in society generally where people expect to be involved in a whole variety of decisions which affect their lives."

Chairman of the Doctor Patient Partnership Dr Simon Fradd, a general practitioner, hopes the campaign will improve the relationship between GPs and pharmacists. "A key message of the campaign will be to promote the expertise of the pharmacist in medicines management to the public and this message will be supported by GPs." He is also confident that the campaign will help him understand his own patient's views about their medicines. That kind of information will make GPs better prescribers, he predicts.

Theo Raynor, professor of pharmacy practice, medicines and their users at Leeds University, hopes the initiative will mean in future patients will ask questions about their medication without relying on a health professional to raise the issue first.

He said: "I think this campaign is about trying to ensure that both sides are asking questions about medication." He predicts that the new skill mix within pharmacy which gives a greater role to pharmacy technicians will also increase the opportunity for more discussion with patients about their medication. But, he said, although pharmacists are already well aware of medicines management, the profession is less informed about the issue of concordance and he hopes the campaign will help illustrate the key differences.

He said: "If you ask a pharmacist to define concordance, I'm not sure they would give the correct answer, which is that it is a two-way process between the patient and the health professional with the patient having the ultimate say. Every week I see something published where the author mentions patient concordance when they really mean patient compliance, which is something completely different."

Professor Raynor, who is a member of PECMI, welcomes the decision to have themed editions of the PJ and the BMJ. "I think this encourages people like myself to think and put forward ideas for these issues which may have remained in the head rather than being written down.

He hopes that pharmacists across the NHS, industry and academia will endorse the campaign because the profession has a duty to involve patients in their medication. "This campaign is aimed at everybody who is involved in medicines because we all have a stake in getting people involved in their medicines. I don't think this campaign is about saving money; it may indeed increase health spending in terms of persuading people to reconsider who may not have been taking their medicines. The campaign is all about medicines and making better use of the money rather than saving money — you are never going to spend less on medicines."

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