Measuring Concordance in Clinical Practice

Abstract

This article describes the construction of a tool to measure concordance in clinical practice. The second of two parts, it details the strategic background underpinning concordance and expands the rationale as this relates to the construction of individual items within the evaluation tool used and described. Cribb (2011) considers that while policy drivers extol the rhetoric of shared decision-making and person-centred care, the application of this is complex. Cribb's thesis is summarised to show that the evaluation tool is grounded in the right type of evidence to support the facilitation of concordance in clinical practice.

Concordance: a concept analysis

“…Surrogates mainly entailed expressions of partnership and shared communication such as ‘participant partner’ (Barron & Snowden ). Equal understanding about medicine taking (Cashin et al .…”

“…In line with the referents, the antecedents depended on the political, legal, professional and practical context of the discussion in the papers. For example Barron and Snowden () cited Scottish practice guidelines and legislation such as the Millan principles (Scottish Government ) as precursors to the principle of concordance, whilst in Australia the national strategy for the Quality Use of Medicines(Commonwealth of Australia ) was described as an antecedent (Cashin et al . ).…”

“…According to Barron and Snowden () the consequences of concordance included improved prognosis and an enhanced nurse/patient relationship which resulted in better patient understanding of the therapeutic component of medication. This is a consequence also emphasized by Cashin et al .…”

“…Surrogates mainly entailed expressions of partnership and shared communication such as 'participant partner' (Barron & Snowden 2012). Equal understanding about medicine taking (Cashin et al 2009), 'two-way communication' (Gray et al 2002) and agreement were common surrogates for concordance, with (Courtenay et al 2011) using adherence and concordance interchangeably.…”

“…In line with the referents, the antecedents depended on the political, legal, professional and practical context of the discussion in the papers. For example Barron and Snowden (2012) cited Scottish practice guidelines and legislation such as the Millan principles (Scottish Government 2005) as precursors to the principle of concordance, whilst in Australia the national strategy for the Quality Use of Medicines(Commonwealth of Australia 2002) was described as an antecedent (Cashin et al 2009). More practical and professional antecedents focused on evidence that patients often failed to take medication consistently, hence the need for a new approach (Latter et al 2007, Lehane & McCarthy 2009, Courtenay et al 2011) grounded in the perceived need for more collaborative working (Gray et al 2002).…”