Optimizing medicines management: From compliance to concordance

Figures & data

Figure 1 The patient-centered clinical interview (adapted from Levenstein et al 1989).

Figure 2 Key tasks in consultations about behavior change. Reprinted from Health Behavior Change: A Guide for Practitioners. Rollnick S, Mason P and Butler C, p 12, London, Churchill Livingstone. Copyright (2000), with permission from Elsevier.

Table 1 Areas for improvement in medicines discussions and suggested actions

Areas for improvement	Suggested action
Doctors don’t always refer to the medicine by name	Tell the patient: The name of the drug and what it does
Doctors rarely ask patients’ experiences and views – these are central to concordance	Ask patients opinion and explore them. “How are you feeling about your illness … and its management” “How are you finding the medication?” “What concerns you the most?” “How do you feel about taking it?”
Non-adherence rarely explored – if patient mentioned it doctors likely to change medication or provide education	Anticipate and explore non-adherence. “Often patients have difficulty with or concerns about taking medication. How are you getting on?”
Doctors talk more about benefits than side effects, risks or precautions	“It’s important for me to tell patients not only about the benefits but also other effects of medicines which can sometimes occur. This is to help you decide if you want to take it. The common ones with this medication are …”
Patients thought GPs reluctant to discuss side effects	Be open to listening and taking concerns seriously. “It sounds like that’s been causing you some problems …” “What do you think about that?”
Practitioners did not express their own views about medicines. Patients want to hear these	Give your opinion. “My recommendation would be …” “My concern would be …” “I think this would be best because …”

Table 2 Outline of steps to take for achieving concordance in the consultation

How to have open discussions about treatment options

Embark upon treatment decisions with the aim of involving the patient as much as they want to be and declare this

Explore what the patient already knows and thinks

Explain the condition; identify treatment options, benefits, precautions and common side effects

Explore patient’s ideas, concerns and expectations

Ask

Listen

Repeat back and Acknowledge

Check any assumptions you are making

Offer your opinion

Invite response and welcome any expression of any disagreement that would normally remain hidden

Try to achieve a shared decision

Check patient’s decision and defer for reflection if necessary

Arrange follow-up and support as appropriate

Anticipate non-adherence rather than adherence and ask about it at follow-up in non-judgmental way

Ask patients for their thoughts on what might help them in managing medicines taking

LevensteinJHBrownJBWestonWWStewartMRoterDPatient-centered clinical interviewing, ch 8 p109Communicating with medical patients1989LondonSage Publications

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