Installment 4: How do we create concordance?

The determinants of patient non‐compliance have been examined for years in an effort to better understand how to improve patient adherence. Patient and provider concordance is a factor that affects compliance. While compliance relates to how a patient is expected to follow advice from a healthcare professional, concordance represents a partnership between the patient and the health care professional.

As an educator, I have learned not to expect low compliance, nor to indicate as much in a patient’s chart. To do so indicates a lack of skill in reaching agreement with my patient with respect to their treatment goals.

A successful treatment strategy is a shared responsibility between a patient and the healthcare professional. A mutual agreement is accomplished by taking into consideration the patient’s personal circumstances and holistic needs. Considering the patient’s perspective on treatment needs and involving the patient in the decision-making process allows for the autonomy needed to foster concordance.

In my own practice, concordance happens when I tailor my educational approach to maximize the therapeutic needs of the individual. I try to understand and address the patient’s own health beliefs with an open mind, and consequently, choose the most appropriate treatment that the patient is comfortable with. The open communication I have with my patients allows me to individualize, review and adjust plans as needed. We focus on goals and outcomes and encourage family involvement.

My process includes asking the right questions at the right time. I ask open-ended questions like, ‘If we could make one thing better for your diabetes, what would it be?” In this way, I am working with patients on their own terms and using a consultative decision-making process.

In summary, concordance happens when:

• Language is used that patients can understand and relate to
• Options are explored in lieu of simply giving advice
• Education is provided that is relevant to the patient’s immediate needs
• The right information is given at the right time
• Opportunities are given for clarification
• The patient demonstrates learned skills
• Point of care printed instructions are used to reinforce verbal information
• Learning is evaluated
• Constructive feedback is provided to the patient
• Constructive feedback is received from the patient

What is your experience with your patients? What educational techniques have you used to maximize concordance?

Barbara