Optimizing medicines management: From compliance to concordance

Annie Cushing, Richard Metcalfe, Annie Cushing, Richard Metcalfe

Abstract

Medication prescribed but not consumed represents a huge loss in drug and prescribing costs and an enormous waste of expensive medical time. In this article we discuss what is known about compliance and adherence, explore the concept of concordance and demonstrate its fundamental difference from both. Not all patients are ready or suitable for shared decision making in management of their condition, some still preferring a doctor-led decision but an increasing number want a partnership approach. By opening up and rebalancing the discussion about medication, we can expect a consultation which is more satisfying for both parties and flowing from this, more effective, focused prescribing of medication which is more likely to be adhered to by the patient. We examine the extent to which doctor and patient behaviors are currently compatible with this change of concept and practice, look at available consultation models which might be useful to the reflective practitioner and consider what actions on the part of the doctor and the healthcare system could promote medicine prescription and utilization in line with this new approach based on partnership.

Keywords: adherence; communication; concordance; decision making; patient participation; physician-patient relations.

Figures

Figure 1
Figure 1
The patient-centered clinical interview (adapted from Levenstein et al 1989).
Figure 2
Figure 2
Key tasks in consultations about behavior change. Reprinted from Health Behavior Change: A Guide for Practitioners. Rollnick S, Mason P and Butler C, p 12, London, Churchill Livingstone. Copyright (2000), with permission from Elsevier.

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