Transcript Concordance Monica Arora Bath VTS 2006 ppt

Concordance
Monica Arora
© Swindon/Bath GPR Day Release Course 2006
What is concordance?
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The process of prescribing and medicine taking
based on partnership.
It is an agreement reached after negotiation
between a patient and a healthcare professional
that respects the beliefs and wishes of the patient
in determining whether, when and how medicines
are to be taken.
Differs from compliance, as compliance suggests
the patient should simply follow the doctor’s
orders.
Patient concordance is a major challenge in
general practice.
Does concordance matter?
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Concordance sufficient to attain
therapeutic objectives occurs
approx 50% of the time.
1 in 6 patients take medication
exactly as directed.
20% of prescriptions are never
cashed.
Consequences of non-concordance
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May affect patient’s own immediate health or
have implications for the wider society.
Failure to prevent complications from chronic
diseases, formation of resistant infections or
untreated psychiatric illness.
There are also important implications when
assessing reports from research into treatment
efficacy rates, given that concordance rates
during closely monitored studies are usually far
higher than real world situations (eg 97%
concordance in some studies on statins but only
about 50% of patients continue at 6 months).
Consequences of non-concordance
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Financial- approximately £230
million worth of medicines are
returned to pharmacies each year
for disposal- the actually quantity
wasted is likely to be much more.
Causes of non-concordance
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Patients beliefs strongest
factor-how natural the medicine is
seen to be, the dangers of addiction
and dependence, the belief that
constant use may lead to decreased
efficacy have all been shown to
influence patient concordance.
Causes of non-concordance
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Lifestyle choices –
Unpleasant side-effects ( especially
if not pre-warned).
Inconvenience (e.g. multiple daily
dosing regimes- though little
difference between od and bd
dosage).
No perceived benefit.
Causes of non-concordance
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Information – instructions not
understood or poor understanding
of the condition/treatment.
Causes of non-concordance
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Practical –
Forgetfulness
Inability to open the containers
Causes of non-compliance
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Professional –
Doctor- patient relationship ( link
between patient satisfaction with
consultation and subsequent
concordance ).
Inappropriate prescribing- mistakes
in administration/ dispensing.
Improving Concordance
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Approx 70% of patients want to be more involved
in decisions about treatment.
Doctors underestimate the degree to which they
instruct and overestimate the degree to which
they consult and elicit their patients’ views.
The doctors task is, by negotiation, to help
patients choose the best way to manage their
problem.
Patients are more likely to be motivated to take
medicines as prescribed when they – understand
and accept the diagnosis; agree with the
treatment proposed; have their concerns about
the medicines specifically and seriously
addressed.
How do we improve concordance?
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Use simple language and avoid medical
terms.
Discuss reasons for treatment and
consequences of not treating the
condition- ensuring information is
tailored, clear, accurate, accessible and
sufficiently detailed.
Seek the patient’s view on their condition.
Agree on a course of action before
prescribing.
How do we improve concordance?
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Explain what the drug is, its function, and
( if known and not too complex ) its
mechanism of action.
Keep the drug regime as simple as
possible- od or bd dosing preferable,
especially long-term.
Seek the patient’s views on how they will
manage the regime within their daily
schedule and try to tie in with daily
routine ( e.g. take one in the morning
when you get up ).
How do we improve concordance?
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Discuss possible side-effects- especially
common or unpleasant ones
How do we improve concordance?
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Give clear verbal instructions and
reinforce with written instructions if it is
complex regime, the patient is elderly or
understanding of the patient is in doubt.
Deal with any questions the patient has.
Repeat information yourself and also ask
the patient to repeat the information back
to you to reinforce.
How do we improve concordance?
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If necessary, arrange review within a
short time of starting medicine to discuss
progress or queries, or arrange follow-up
by another member of the primary
healthcare team ( e.g. asthma nurse to
check inhaler technique 2-3 weeks after
starting an inhaler ).
Address further patient questions and
practical difficulties at follow-up.
Monitor repeat prescritions.
References
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NICE-Medicines concordance
Crome P,Pollock K, Age discrimination in prescribing:
accounting for concordance. Reviews in Clinical
Gerontology 2005:14:1-4
J Avorn et al. Persistance of use of lipid-lowering drugs. A
cross-sectional study. JAMA 1998 279:14558-1462
J Westbury, K Pollock and A Blenkinsopp, A study of
concordance issues for older people. The International
Journal of Pharmacy Practice 2003: 11:R41
Achieving Concordance Primary Care Pharmacy
September 2000 Vol 1 No 4 93-95
C Simon, H Everitt, T Kendrick Oxford Handbook of
General Practice