One of the key themes of the 2010 White Paper is empowering patients to take an active role in managing their own care.
Patient education and counselling, including achieving concordance
One of the key
themes of the 2010 White Paper is empowering patients to take an active role in
managing their own care. This is also one of the themes of many of the
NHS–National Institute for Health Research collaborations for leadership in
applied health research and care that focus on translating research into practice.
Helping patients to
understand their medicines and how to take them is a major feature of clinical
pharmacy. Patient compliance, defined as adher-ence to the regimen of treatment
recommended by the doctor, has been a concern of healthcare professionals for
some time. Adherence to treat-ment, particularly for long-term chronic
conditions, can be poor and tends to worsen as the number of medicines and
complexity of treatment regi-mens increase. NICE noted that between a third and
half of all medicines prescribed for long-term conditions are not taken as
recommended and estimated that the cost of admissions resulting from patients
not taking medicines as recommended was between £36 million and £196 million in
2006–2007.
In recent years, use
of the term ‘compliance’ in the context of medication has been criticised
because it implied that patients must simply follow the doctor’s orders, rather
than making properly informed decisions about their healthcare. The term
‘concordance’ has been proposed as a more appropriate description of the
situation.
Concordance is a new
approach to the prescribing and taking of medi-cines. It is an agreement
reached after negotiation between a patient and healthcare professional that
respects the beliefs and wishes of the patient in determining whether, when and
how medicines are taken.
This change in
approach aims to optimise the benefits of treatment by helping patients and
clinicians collaborate in a therapeutic partnership. However, if patients are
to make informed choices, then the need for com-prehensive patient education
becomes more pressing.
Concordance with
treatment is dependent on a complex interplay of beliefs, trust and
understanding, with non-adherence falling into two over-lapping categories:
·
intentional: the patient decides not to follow the treatment
recommendations
·
unintentional: the patient wants to follow the treatment
recommendations, but practical problems prevent the patient from doing so.
Many surveys have
found that patients often know little about the medicines they are taking.
Several studies examining patient counselling and education have shown that
clinical pharmacists can help to improve patients’ knowledge of their
treatment. The contribution made can also improve patient adher-ence to treatment.
Improved adherence should lead to improved outcomes and evidence has been
collected to demonstrate this.
In addition to
providing face-to-face education and counselling on medi-cines, clinical
pharmacists can also help patients by contributing to the prep-aration of
written material and audiovisual demonstrations, or by using computer programs.
How patients take
their medicines is a crucial component of whether the desired outcomes will be
achieved. Key to this is the health beliefs of indi-viduals and the
relationship with their healthcare providers that are necessary in order to
ensure this happens. Society is moving away from a paternalistic approach to
healthcare to a more empowered one. Thus, whereas a course of treatment used to
be accepted obediently by patients, treatment is now nego-tiated and options,
risks and benefits are discussed and, where necessary, consent is obtained.
Thus there is a greater need for information and educa-tion of patients and/or
carers in order for them to be able to make informed decisions about their
treatment. Indeed, the 2010 White Paper emphasised the importance of patient
involvement, and included the phrase ‘nothing about me, without me’.
Related Topics
TH 2019 - 2026 pharmacy180.com; Developed by Therithal info.