Taking medicines: concordance is not compliance

Abstract

Editor-Partnership with patients in sharing medical decisions is an idea of paramount civil importance for modern health systems, as raised in correspondence in the eBMJ. 1 Partnership stems, on the one hand, from the reasons underlying the right to informed consent to medical practices and the humanisation of the approach to patients and, on the other, from the development of advocacy in health promotion and self determination of civil rights. Such a profound innovation increases the complexity of and turbulence in organisations and has cost implications. Firstly, the medical profession needs to be trained in this aspect. Education should not be restricted to questioning current medical practices to improve human contact with patients but should embrace specific epidemiological knowledge on risks and outcomes as well as evidence based medicine. These disciplines should, despite their limits, play a pivotal part since they hold the information everyone needs to formulate an opinion. Secondly, all services will clearly become more costly since doctors will require more time for each patient. In some cases time will increase only minimally; in others it will increase considerably. The time devoted to patients will in no case fall. Thirdly, the breakdown of barriers between patients and doctors will remove inhibition and increase the possibility of legal wrangling. Fourthly, increased interplay between the roles of doctor and patient will probably unveil the limits of medicine, revealing that it is not an exact science as believed by most of the general population. The crude impact of predictive medicine may drive more people towards alternative or supernatural practices. Fifthly, boundaries, including legal limits, need to be outlined for the role of patients' relatives. Special attention should be paid to patients who are unable to communicate competently, who are medical or surgical emergencies, and who are psychiatric cases. Lastly, as outlined above, cultural change, fostered by health and political institutions through complex educational strategies, is required. Balancing the interactions between doctors and patients is a noble and pressing idea. But partnership is not a magic formula. The ground is not quite ready. Massive long term financial and cultural investment is required to realise this opportunity fully-but on the understanding that all patients have the right to delegate decisions to their doctor when this is the most comfortable solution for them.

A New Taxonomy for Describing and Defining Adherence to Medications

“…New taxonomy for adherence to medications providers to cooperate in the definition of a mutually agreed treatment programme, acknowledging that patients and providers may have differing views [83][84][85][86][87][88][89][90][91].…”

Optimising nutrition in chronic renal insufficiency?growth

“…Due to the difficulties observed in perseverance with oral nutritional supplements despite intensive nutritional counselling, and the recommended need for an energy intake of 125% EAR [20] to achieve catch-up growth, it may have been appropriate in hindsight to have considered an enteral tube feeding route [21] in the 4 children whose growth remained below -2 SDS, prior to considering the need for rhGH. Such a proposal would require involvement of the family in a concordant manner [22], with attempts to ensure that the resulting burden of care would not outweigh the current difficulties associated with adherence to the prescribed nutritional supplements and dietary regimen.…”

Patient-Centered Care in Affective, Non-Affective, and Schizoaffective Groups: Patients’ Opinions and Attitudes

“…The umbrella construct of concordance requires a new level of communication and understanding of patients with severe mental health disorders (De Las and Sanz 2007). The notion of medication concordance incorporates a patient's belief about the effectiveness of their medication along with their attitude about compliance (Dickinson et al 1999).…”