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The administration of medicines to children
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Concordance is a term that seems to be misunderstood by many. For some, it is merely the latest in a series of terms used to describe compliance or adherence. For others, it is a radical shift in the way patients taking medicines are approached [1]. Concordance in its true sense, is fundamentally different from either compliance or adherence. It focuses on the consultation processes between health care professional and patient rather than on the specific behaviour of whether or not the patient takes his medicine as prescribed. It has an underlying principle of a shared approach to decision-making [1]. Concordance may be described as an agreement, following negotiation between patient and healthcare professional, respecting the beliefs and wishes of the patient to determine whether, when and how medicines will be taken [2]. It depends on the patient (or customer) being fully engaged during a consultation, whether it is in a doctor’s surgery or over the counter at a pharmacy, so that they understand what the condition is, and why particular medicines are being recommended and prescribed [2]. By being fully informed, patients may be more likely to take the medicines prescribed for them and stick to the regimen. Alternatively, they may wish to be told very little and prefer a totally didactic approach. However, a concordant consultation may result in the patient refusing treatment, which may not please the healthcare professional, but leaves the patient in control.
Epilogue
Published in John K. Crellin, A Social History of Medicines in the Twentieth Century, 2020
The quotes that head this epilogue (the first two from physicians)—more or less two hundred years apart—reflect two threads running throughout this book: uncertainty, sometimes cynicism, about medicines, and feeling that there is more to treatment than just handing out a medication. In Chapter 6, the suggestion was made that the concept of concordance could make a useful contribution to helping those people—at least those who are looking for a partnership in decision making—who have difficulty with validating prescription medicines. Since part of the intention of this book is to help bring into focus questions about people's relationships with medicines, I close by going one step further than concordance to suggest that the concept of a new therapeutics is wanted by many people.
How doctors talk to patients and why
Published in Peter Tate, Francesca Frame, The Doctor's Communication Handbook, 2019
The term compliance with therapy, which implies a subservient relationship, is still commonly used, particularly in the context of us pronouncing patients ‘non-compliant’. Some advocate the use of the term concordance instead, defined as a negotiated, shared agreement between clinician and patient concerning treatment regimen(s), outcomes and behaviours; a more cooperative relationship than those based on issues of compliance, non-compliance and adherence, and we share this view. What is clear is that the slavish following of medical advice by patients is not only an unusual behaviour but appears to be so uncommon in many cases as to be regarded as deviant.
Construct Validity and Concordance of Clinician- and Patient-Rated DUNDRUM Programme Completion and Recovery Scales
Published in International Journal of Forensic Mental Health, 2023
Austin A. Lam, Stephanie R. Penney, Alexander I. F. Simpson
Importantly, efforts to improve staff-patient concordance may in itself be an appropriate outcome measure for various forms of treatment programs and risk management efforts. Differing views between patients and staff represent the starting point for collaborative discussions on care planning that strive to incorporate both perspectives. As noted by Troquete et al. (2013), giving voice to the patient perspective regarding risk and protective factors can strengthen treatment motivation and treatment effectiveness. We have similarly proposed that an approach to risk and needs assessments that promotes patient voice would increase the likelihood that resulting case formulations and management plans are relevant and palatable to the patient, and encourage a deeper understanding and mastery over risk issues (Simpson et al., 2020). This, in turn, would presumably be associated with fewer adverse outcomes as patients’ progress in their recovery.
The reported effects of the COVID-19 pandemic on people with intellectual disability and their carers: a scoping review
Published in Annals of Medicine, 2021
This review highlights that the peer-reviewed press is dominated by professional opinion pieces, editorials and letters to the editors presenting various personal as well as professional polemics, some of which are supported with reference to the literature, as well as anecdotal evidence. However, there is limited research about pandemics/epidemics and people with intellectual disability. Rarely is space provided for population studies or the rich perspectives of the experiences of the person with an intellectual disability. In saying that, the research that does exist clearly highlights that core to the management of pandemics and epidemics are 1. A rights-based, person-centred approach to care is essential as professional and organisational approaches, as well as ubiquitous strategies often fail or fall short; 2. Professionals need to extend their understanding and practice of collaborative working to include people with an intellectual disability and their family/cares, not just begin to include other professional colleagues; 3. High levels of concordance with public health guidance and 4. Rigorous implementation of quality infection control measures are essential prerequisites.
Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review
Published in Physiotherapy Theory and Practice, 2020
Maria Sandborgh, Elizabeth Dean, Eva Denison, Maria Elvén, Johanna Fritz, Petra von Heideken Wågert, Johan Moberg, Thomas Overmeer, Åsa Snöljung, Ann-Christin Johansson, Anne Söderlund
The seventh line of reasoning, which curriculum planners and developers considered to be essential for maximizing movement and functional outcomes, was related to the need for physiotherapists to be effective communicators capable of accepting, empathizing, validating, supporting, and motivating their patients/clients (Rea, Hopp Marshak, Neish, and Davis, 2004). To achieve these attributes, students in our program are exposed to various communication models in the theoretical and practical components of their professional education program. Communication competencies are also essential in teaching patients/clients about self-management strategies to augment the benefits of physiotherapy. Techniques, for example, from Motivational Interviewing (Rollnick, Miller, and Butler, 2008) and Acceptance and Commitment Therapy (Hayes, Strosahl, and Wilson, 2012) are taught and practiced. The goal is to empower patients/clients and ensure concordance with management. Concordance implies agreement and shared decision-making between the physiotherapist and the patient/client (Horne, Barber, Elliott, and Morgan, 2005). Finally, patients/clients today are typically complex, often presenting with multi-morbidities, NCD risk factors, and/or living with one or more disabilities requiring one or more medications. In light of the global trend toward autonomous practice, physiotherapists need exceptional skills in communicating with other health professionals to best coordinate and streamline a given patient’s/client’s overall management.