Do you want to take your medicine?
This week's issue is devoted to concordance — or what is easier to understand, but rather cumbersome — developing partnerships with patients. It coincides with a themed issue of the BMJ, both designed
to draw attention to Ask
About Medicines Week (12–18 October).
During the week patients are to be encouraged to ask pharmacists in particular,
but also doctors and other health professionals with whom they have contact,
about any aspect of their illness and medicines.
The trouble with concordance is that many health professionals do not
quite grasp what it means. When the call went out for articles and papers
for this themed issue, a number submitted to The Journal fell into the
compliance category. But concordance is not compliance with bells on — it
is an entirely different way of looking at medicine-taking.
Concordance depends on the patient (or customer) being fully engaged
during a consultation — whether it be in the formal surroundings
of a doctor’s surgery or over the counter at a pharmacy — so
that he (or she) understands what the condition is, and why particular
medicines are being recommended and prescribed. Armed with that knowledge,
so the argument goes, people are more likely to take the medicines prescribed
for them and stick to the regimen. However, a concordant consultation
can also result in the patient saying “Thanks, but no thanks” — which
may not please the health professional but, importantly, leaves the patient
in control. But admonishing patients when they fail to comply is going
in the opposite direction to concordance, but probably happens all too
frequently.
Many hard-pressed health care professionals think they do not have time
to devote to concordant consultations but, with evidence showing that
many medicines are taken by fewer than half the patients to whom they
are prescribed, the waste alone should make them think again. In addition,
if a patient has symptoms that are not controlled and keeps on returning
for further consultations and advice, then that is just as wasteful.
This issue offers no quick-fix solutions, and only a few tips on how
to develop concordance in practice. Rather it is designed to make pharmacists
think what more they could contribute. One of the recurring themes within
this issue (and The Journal would like to thank Dr Marjorie Weiss of
the University of Bath for her support in putting it together) is how
ethnic and cultural differences impact on health and health care.
Pharmacists could start the week by asking themselves one question: with
how many patients or customers do I have concordant discussions? If the
answer is few (or even none), now is the time to get the ball rolling.
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