Optimizing medicines management: From compliance to concordance

Annie Cushing¹, Richard Metcalfe²

¹Clinical and Communication Skills Unit, Barts and the London, Queen Mary’s School of Medicine and Dentistry, University of London, London, England, UK; ²Department of Neurology, Institute of Neurological Sciences, Southern General Hospital,
Glasgow, Scotland, UK

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: concordance, patient participation, decision making, adherence, physician-patient relations, communication