The Pharmaceutical Journal
Vol 272 No 7302 p697
5 June 2004

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Related websites
Pharmaceutical Journal concordance articles (more)

Concordance review reveals good news and bad

A systematic research review has identified how patients and health care professionals can move towards concordance but has also highlighted several barriers that need to be overcome.

The authors say that for concordance to occur patients and health professionals have to have two-way discussions in which they exchange information and views.

A review of non-intervention studies reveals that patients consider talking to doctors about medicines to be important and most believe they have sufficient time to do this. However, patients were often passive during discussions. About half of patients on long-term medication asked questions of their doctors, commonly about quantity or supply and what the medicines were for.

The research revealed that only a minority of patients asked pharmacists about their medicines; common questions were about side effects, cheaper alternatives and interactions. Reasons for not asking questions included fear or embarrassment, lack of awareness of what questions to ask, the pharmacist being too busy and not wanting to bother the pharmacist.

In most cases, research found that pharmacists did not offer counselling about either prescription or over-the-counter medicines. Some patients refused counselling on the basis that their doctor had already given sufficient information. Pharmacists were more likely to use a participatory approach with older patients and with those collecting a repeat prescription.

Pharmacists and doctors rarely referred to the name of a medicine when talking to patients and there was some evidence that they did not ususally check patients’ understanding of their medicines.

Intervention studies showed that an advertising campaign encouraging patients to ask pharmacists about their medicines led to improvement in pharmacists’ communication but did not affect patients’ questioning. Asking patients to write down their questions to pharmacists led to increased questioning although this did not affect adherence. Four other interventions involving new or modified pharmacy services resulted in improved patient health outcomes.

Authors Kate Cox, Fiona Stevenson, Nicky Britten and Yenal Dundar say that much of the research reflected the paternalistic pattern of professional-patient interactions. On a positive note, they say that there was evidence that progress towards concordance is possible if, for example, patients become more confident in their knowledge of medicines or if doctors encourage participation and listen to views and concerns.

Commentating on the findings, Christine Bond, professor of primary care (pharmacy), University of Aberdeen, warns that some of the studies cannot be generalised to everyday practice. Although there is a move from a paternalistic to a partnership approach, she says that there is a need to revisit pharmacists’ communication styles and skills including their ability to check understanding. “The review includes a wealth of useful information which should inform future pharmacy training and practice in the interests of better patient care,” she adds.