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Optimizing medicines management: From compliance to concordance.

Cushing A, Metcalfe R - Ther Clin Risk Manag (2007)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Clinical and Communication Skills Unit, Barts and the London, Queen Mary’s School of Medicine and Dentistry, University of London, London, England, UK. a.m.cushing@qmul.ac.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.

No MeSH data available.


The patient-centered clinical interview (adapted from Levenstein et al 1989).
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Related In: Results  -  Collection


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fig1: The patient-centered clinical interview (adapted from Levenstein et al 1989).

Mentions: Conventionally doctors have focused on their agenda of identification and treatment of disease. Patients present with symptoms of illness and many do not have definable disease. Identification and incorporation of both agendas in a management plan provides satisfaction to both parties. Levenstein’s (1989) model shown in diagrammatic form in Figure 1 provides a useful view of the relationships between disease and illness, doctor and patient agendas and the skills needed to reach a management plan. The physician is, at best, a bridge between the corpus of scientific knowledge, including what remains unknown, and the patient’s life. In the past 30-years, analysis of the consultation process itself and its social context has given us the tools to strengthen the bridge between what medicine can offer and what patients want but incorporation into actual practice has been patchy.


Optimizing medicines management: From compliance to concordance.

Cushing A, Metcalfe R - Ther Clin Risk Manag (2007)

The patient-centered clinical interview (adapted from Levenstein et al 1989).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2387303&req=5

fig1: The patient-centered clinical interview (adapted from Levenstein et al 1989).
Mentions: Conventionally doctors have focused on their agenda of identification and treatment of disease. Patients present with symptoms of illness and many do not have definable disease. Identification and incorporation of both agendas in a management plan provides satisfaction to both parties. Levenstein’s (1989) model shown in diagrammatic form in Figure 1 provides a useful view of the relationships between disease and illness, doctor and patient agendas and the skills needed to reach a management plan. The physician is, at best, a bridge between the corpus of scientific knowledge, including what remains unknown, and the patient’s life. In the past 30-years, analysis of the consultation process itself and its social context has given us the tools to strengthen the bridge between what medicine can offer and what patients want but incorporation into actual practice has been patchy.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Clinical and Communication Skills Unit, Barts and the London, Queen Mary’s School of Medicine and Dentistry, University of London, London, England, UK. a.m.cushing@qmul.ac.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.

No MeSH data available.