Need For "Concordance" In Medicine-Taking

Up to half of all patients with serious chronic illnesses do not taketheir medication as prescribed and thus fail to derive the expected benefits, says a new report, From Compliance to Concordance: achieving shared goals in medicine-taking.

The study is the result of a joint initiative by the Royal Pharmaceutical Society of Great Britain and Merck Sharp & Dohme Ltd, launched in early 1995. It says the assumption behind the terms "compliance" and "adherence" in medicine-taking suggest patient "fault," and should be abandoned in favor of "concordance." This expresses a therapeutic "alliance" between the prescriber and the patient, describing a negotiated agreement which may indeed be an agreement to differ.

Concordance imposes new responsibilities on both parties. The patient must take a more active part in the consultation process, while the prescriber must communicate the evidence to enable the patient to make an informed decision about diagnosis and treatment, and benefit and risk. The prescriber should know and accept the patient's choice whilst continuing to negotiate the treatment as part of a continuing consultation process.