Compliance, adherence and concordance

Concordance

‘informed agreement between patients and health professionals about the treatment to be followed’ (Kaveh et al 2001).

Concordance is a new approach to the prescribing and taking of medicines. It recognises that patients are not passive recipients of prescribing decisions. Patients have their own beliefs about medicines, how they work, how they are best used and how taking medicines fits in with their daily lives. They are most likely to take medicines correctly when they understand and agree with their treatment and have been active partner in prescribing decisions.

The concept of concordance has replaced the idea of compliance and non compliance.

Previously, a patient who did not comply with treatment was considered ‘deviant’ (Parsons 1951). They were not responding to ‘advice given’. The patients failure to comply - victim blaming - ‘their fault’ for not getting better. Intresting as evidence suggests that non- compliance with treatment is around 30-60%, (Humphries 2002).

Reasons for lack of concordance (non- compliance)

Patients forget 37-54% of information after consultation (Ley et al 1976).

Not related to social class or IQ.

Age > 75 because of more to take and complicated regimes.

More of a problem if drugs to be taken over a long period – chronic diseases.

Cost related especially where have to pay for drugs in other countries.

Poor if more side effects e.g. weight gain (HRT , Oral contraception, chlorpromazine).

Better if life threatening diseases exception renal disease.

Health belief model – shared not authoritarian.

How to promote concordance?

Improve understanding of the disease and how medicine works.

Ascertain health beliefs of patient.

Explain choices – pros and cons.

Take account of patients lifestyle when considering dosage per day, also format of medication- liquid, tablet, injection.

Support for medicine taking

Good communication/ active listening skills, non- patronising.

Tailored.

Interactive.

Printed repeat form.

Variety of Pils.

Keep up to date. www.concordance.org.