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What is Concordance?

Graphical definition of concordance

What is concordance?
Concordance is a new way to define the process of successful prescribing and medicine taking, based on partnership.  It has three essential elements (shown above).
Why is concordance needed?
There are a number of reasons why people do not take their medicines
  • Practical difficulties, such as getting to a pharmacy, opening containers and remembering to take medicines
  • Lack of information about their condition and the importance of treatment
  • Problems with side effects
  • Interference with their daily lives
  • Beliefs about the medicine, or medicines in general - for example that medicines are unnatural, harmful, addictive, or that they wear off over time
Many compliance programmes have focussed on practical difficulties in medicine taking. However, the differences between the patient's beliefs and understanding of the diagnosis and proposed treatment, and those of the health professional are crucially important. The health professional has a set of beliefs about the appropriateness of particular medicines, and about how they should be used based on a biomedical model. These beliefs are shaped by the content of professional training, and on the evidence from a large body of scientific research. The patient has a different, but equally cogent and coherent set of ideas about their own illnes, medicines in general and their medicines in particular. These are based on their own preferences, priorities, beliefs, attitudes and life experience.
It is important to recognise that the decision whether to take a medicine or not ultimately lies with the patient. A successful prescribing process will be an agreement that builds on the experiences, beliefs and wishes of the patients to decide when, how and why to take medicines. This agreement may not always be easy to reach, but without exploring and addressing these issues patients may not be able to get full benefit from the diagnosis and treatment of the illness.
You can download a PowerPoint presentation that summarises the evidence for concordance, explains what concordance is and introduces Medicines Partnership below. 
Some relevant articles about concordance:
  • Not to be taken as directed: BMJ editorial written by Joanne Shaw and Professor Marshall Marinker describing the principles behind concordance
  • A wolf in sheep's clothing: a critical look at the ethics of drug taking: BMJ article written by Iona Heath (GP)engaging in a critical discussion of what concordance really means

Related Documents
PowerPoint presentation giving an overview of concordance and the role of the Medicines Partnership
Article from the Pharmaceutical Journal 11/10/2003 by Marjorie Weiss and Nicky Britten