Promoting health within patient: health care professional interactions about medicines: an exploration of the theory and practice of concordance

Latter, S. (2004) Promoting health within patient: health care professional interactions about medicines: an exploration of the theory and practice of concordance. 18th IUHPE World Conference on Health Education and Health Promotion, Melbourne, Australia. 26 - 30 Apr 2004.

Abstract

In the UK, as elsewhere in the world, health care professionals' roles in medicine management are changing, in pursuit of the delivery of modern services that are accessible and responsive to patient need. In the UK, nurses are taking on an expanded role in medicine management, including extended and independent prescribing powers. Nurses in a variety of clinical settings are prescribing medicines to patients with a range of illnesses, including acute self-limiting illness and also for patients living with longer term illnesses, such as asthma and diabetes.
The effective management of illness requires health care professionals to facilitate patient self management of medication regimes (Davis and Wagner 2000). This highlights the importance of health professionals using medication interactions as opportunities for shifting the balance of power and enabling patients to take control of their medication regimes as part of promoting health.
Within medicine interactions between patients and health care professionals, the concept of concordance has been advocated as a unifying framework for promoting partnership with patients, sharing control and power within interactions and for negotiating an agreed plan for medicine taking (Royal Pharmaceutical Society 1997).
In this paper, the rationale for conceptualising medicine interactions within a concordance framework will be presented including the theoretical, ethical and practical reasons why health care professionals need to adopt this approach. A critical overview of the evidence base for the effectiveness of this approach will then be presented, drawing on recently completed systematic reviews in this area.
The paper will then present findings from the author's recently completed and on-going research to illustrate the extent to which health professionals communicate using a concordance approach in practice. These studies have focused on nurses' role in educating patients about medicines (Latter et al 2000), patient participation in medicine interactions (Rycroft Malone 2002) and a national evaluation of extended formulary independent nurse prescribing in England (Latter et al, ongoing). Findings are drawn from observation and audio-recording of nurses' medication and prescribing interactions with patients, and indicate that generally nurses are not using a concordant approach within medicine interactions. The balance of power, as reflected in language and decision-making about medicine management, continues to reside with nurses despite the evidence and exhortations to facilitate a more participatory approach within a concordance framework.
The paper will conclude by presenting and discussing the factors found to be necessary in order for health professionals' communication to move towards a concordant and empowering approach to medicine interactions.

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