The Pharmaceutical Journal
Vol 271 No 7275 p678
15 November 2003

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  Modernisation
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Letters to the Editor

Concordance

Achieving the therapeutic goal

From Mr K. S. Donlon, MRPharmS

Compliance, concordance and adherence are facets of the patient-practitioner relationship. No single term satisfactorily encompasses the philosophy driving patient-centred care.

Compliance implies obedience to instruction, a necessity in evidence-based medical management. Concordance describes the harmony and agreement between patient and practitioner, clearly desirable in all health care scenarios. Adherence suggests support for an idea or plan, upon which patients’ participation in a management strategy depends heavily.

These facets interact dynamically through the influence of patients’ health beliefs. Each facet can be expressed fully, not at all, or at any level in between. What is missing from all of these concepts is the requirement for an observable outcome. Full compliance, concordance and adherence are not necessary, provided the sum of those parts is enough to achieve therapeutic goals.

I would like to suggest the term “consummation” as a summary concept to imply the achievement of health through the administration of compliance, concordance and adherence.

Kieron Donlon
Wigan, Lancashire

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