Patient education and counselling, including achieving concordance

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’.